D
Dance
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Dance refers to sequences of body movements
(and lack of them) that are purposeful, intention-
ally rhythmical, and culturally influenced expres-
sions that typically are accompanied by music and
sometimes by props and costumes. Dance plays
an important role in adolescence, with some
aspects of dance being studied considerably and
others essentially ignored. Somewhat surpris-
ingly, for example, researchers essentially have
ignored how the dance that may come to mind
when thinking of dancing, a sort of play and
spontaneous response to music, actually has not
received much attention. Instead, research has
focused on formal dance, dance as an after-school
group activity, dance as a form of therapy, and
dance as a social event that can bring hazards to
youth.
Dance can be formal, as in actions that are
purposeful presentations, such as a performing
art (e.g., ballet). This aspect of dance is one that,
for example, tells stories and emotionally moves
audiences. In this manner, dance is a mode of
communication that seeks to share knowledge
between dancers and audiences. As expected, an
individual’s culture influences their dance mak-
ing, performing, and viewing. Cultural beliefs and
attitudes help give meaning to dance. Given
# Springer International Publishing AG 2018
R.J.R. Levesque (ed.), Encyclopedia of Adolescence,
https://doi.org/10.1007/978-3-319-33228-4
cultural influences, dance can be conceived of
much more than a performing art, it can be a
liberal art, and it could also be an applied art.
Dance can be deemed as an important part of
education (see Hanna 2008).
During adolescence, dance can be an impor-
tant part of physical activity that is promoted
through extracurricular activities. As such,
dance can be added to the long list of extracur-
ricular activities that have been demonstrated to
result in positive benefits for students, both in the
way that it promotes healthy development by
encouraging positive behaviors and that it pro-
tects adolescents from negative outcomes by
deterring negative or risky behaviors (for
reviews, see Eccles et al. 2003). Dance activities
during adolescence provide a context for youth
to develop a sense of competence, build social
skills, and develop a healthy sense of self. Impor-
tantly, though, the process and effects of vying
for entry to extracurricular activities that are
competitive and selective can result in negative
outcomes. Although positive effects result for
those who are successful, those who are not can
suffer devastating and extended effects of not
being selected on their personal, social, and
school identity (Barnett 2006). Although dance
can relate to positive physical activity promo-
tion, it also continues to be linked to negative
outcomes, especially during adolescence. For
example, students who study ballet and some
other types of more professional dance are
regarded as being at a high risk for developing
854
eating disorders (for a review, see Toro et al.
2009). The risks relate to personality traits asso-
ciated with dancers, such as drive for thinness
and perfectionism (Thomas et al. 2005). Thus, it
may not be the activity itself that contributes to
positive or negative outcomes; the effects
depend on the individuals involved in the activ-
ities and the contexts in which dance activities
take place.
Dance therapy has been developed as a form of
art therapy for children, youth (as well as adults)
as it combines music, light exercise, and sensory
stimulation (see Chaiklin and Wengrower 2009).
Importantly, despite the focus on physical aspects,
there is a clear focus on relating it to emotional
issues in that dance therapy is viewed as the use of
movement as a process that furthers the emo-
tional, cognitive, and physical integration of
individuals. This form of treatment, although
sometimes criticized for lacking in empirical sup-
port, increasingly has been the subject of research
demonstrating effectiveness. For example, dance
movement therapy has been shown to be effective
in beneficially modulating concentrations of sero-
tonin and dopamine, and in improving psycholog-
ical distress in adolescents with mild depression
(Jeong et al. 2005).
Going to clubs and dancing, of course, can
have both positive and negative effects. Dance
events have long been associated with risk,
especially with drug and alcohol use (see Hunt
et al. 2007). For example, for some youth,
“house” is a combination of going to parties
and dancing all night while being high on
MDMA, a drug better known as XTC/Ecstasy.
Studies have shown that the drugs can be physi-
cally and cognitively harmful, but the “dancestasy”
experience may contribute positively to the
development of personal and social identity dur-
ing adolescence. The dancestasy experience can
have temporary negative effects on functioning
in school or at work, but the effects tend to be
short term (see Bogt et al. 2002). Although some
studies do put risks into this perspective, they
also do highlight the extent to which dance can
be of significance and how it can relate to other
aspects of adolescent development and develop-
mental outcomes.
Dangerousness
References
Barnett, L. A. (2006). Flying high or crashing down: Girls’
accounts of trying out for cheerleading and dance.
Journal of Adolescent Research, 21, 514–541.
Bogt, T. T., Engels, R., Hibbel, B., Van Wel, F., & Verhagen,
S. (2002). “Dancestasy”: Dance and MDMA use in
Dutch youth culture. Contemporary Drug Problems,
29, 157–181. An Interdisciplinary Quarterly.
Chaiklin, S., & Wengrower, H. (Eds.). (2009). The art and
science of dance/movement therapy: Life is dance.
New York: Routledge/Taylor & Francis Group.
Eccles, J. S., Barber, B. L., Stone, M., & Hunt, J. (2003).
Extracurricular activities and adolescent development.
Journal of Social Issues, 59, 865–889.
Hanna, J. L. (2008). A nonverbal language for imagining
and learning: Dance education in K-12 curriculum.
Educational Researcher, 37, 491–506.
Hunt, G., Evans, K., & Kares, F. (2007). Drug use and
meanings of risk and pleasure. Journal of Youth Stud-
ies, 10, 73–96.
Jeong, Y., Hong, S., Lee, M., & Park, M. (2005). Dance
movement therapy improves emotional responses and
modulates neurohormonesinadole scents with mild
depression. International Journal of Neuroscience,
115, 1711–1720.
Thomas, J. J., Keel, P. K., & Heatherton, T. F. (2005).
Disordered eating attitudes and behaviours in ballet
students: Examination of environmental and individual
risk factors. The International Journal of Eating Dis-
orders, 38, 263–268.
Toro, J., Guerrero, M., Sentis, J., Castro, J., & Puértolas,
C. (2009). Eating disorders in ballet dancing students:
Problems and risk factors. European Eating Disorders
Review, 17, 40–49.
Dangerousness
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Dangerousness is a state of being a peril or hazard;
it also is the ability to inflict harm or injury. The
concept of dangerousness has gained significance
in social responses to adolescents. For example, it
was perceptions that some youth were dangerous,
hard criminals that led to important reforms in the
juvenile justice system, such as the move toward
being more punitive. Illustrative of that move is
the transfer to adult courts of those deemed dan-
gerous. Dangerousness to the community is one of
Date Rape
the key factors that courts focus on when deter-
mining whether to transfer youth to adult courts
(the other factors are the adolescents’ level of
maturity and level of amenability to treatment)
(see Salekin et al. 2002). Dangerousness to one-
self (as well as the community) also figures prom-
inently in commitment proceedings to hospitals or
other institutions (see Weithorn 1988).
Despite being an important concept, what con-
stitutes dangerousness remains vague. One of the
most important studies in this regard was
conducted by Salekin and colleagues (see Salekin
et al. 2001, 2002). His research team examined
how clinical psychologists and, equally impor-
tantly, judges make decisions about dangerous-
ness. Most notably, they found that both juvenile
court judges and clinical child psychologists
believed that assessments of dangerousness
should include current and past violent offenses,
and the extent to which that violence might have
been unprovoked; that a focus should be placed on
the juvenile’s history of the juvenile; and they also
placed on whether juveniles exhibited psycho-
pathic personality traits. The main difference
was that juvenile court judges placed greater
importance on psychopathic traits when determin-
ing dangerousness while clinicians focused more
on indicated violence, aggression, and reckless
and sensation-seeking behavior, in conjunction
with psychopathic traits. Studies such as these
are of significance as they seek to guide more
effective ways to determine how to respond to
adolescents deemed troubling or troubled.
References
Salekin, R. T., Rogers, R., & Ustad, K. L. (2001). Juvenile
waiver to adult criminal courts: Prototypes for dangerous-
ness, sophistication-maturity, and amenability to treat-
ment. Psychology, Public Policy, and Law, 7, 381–408.
Salekin, R. T., Yff, R. M. A., Neumann, C. S., Leistico,
A. R., & Zalot, A. A. (2002). Juvenile transfer to adult
courts: A look at the prototypes for dangerousness,
sophistication-maturity, and amenability to treatment
through a legal lens. Psychology, Public Policy, and
Law, 8, 373–410.
Weithorn, L. (1988). Mental hospitalization of troublesome
youth: An analysis of skyrocketing admission rates.
Stanford Law Review, 40, 773–838.
855
Date Rape
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Date rape is the popular term used to describe the
nonconsensual sexual (vaginal, anal, oral) inter- D
course that is forced, either by physical force or
psychological coercion, on a person by an
acquaintance. Estimates reveal that sexual
assault is most prevalent among adolescents in
contrast to any other age group; 33% of all vic-
tims fall within the ages of 13–17 (see Young
et al. 2009). The majority of sexual assault cases
involve acquaintances (Rennison 2002). Regret-
tably, the statistics are not very precise, as com-
mentaries often conflate acquaintance sexual
assault with date rape. Sexual assault could
involve many different types of assaults than
would date rape, and that may explain why
there is so much variation in estimates reporting
the lifetime prevalence of date rape. Estimates
range from 13% to 27% among college-age
women and from 20% to 68% among adolescents
(Rickert and Wiemann 1998).
Researchers have identified many demo-
graphic characteristics that increase vulnerabil-
ity to date rape (which, again, often are studied
in the context of the more general term of sexual
assault) (see Rickert and Wiemann 1998; Vicary
et al. 1995). Those factors include younger age
at first date, early sexual activity, earlier age of
menarche, a past history of sexual abuse or prior
sexual victimization, and being more accepting
of rape myths and violence toward women.
Other risk factors include date-specific behav-
iors such as who initiated, who paid expenses,
who drove, date location and activity, as well as
the use of illicit alcohol. These types of findings
have contributed to a wide variety of efforts
aimed at preventing date rape and other assaults
(for a review see Weisz and Black 2009).
Legally, date rape involves a complex and
challenging area of criminal law (see Anderson
2005). Jurisdictions tend not to make legal dis-
tinctions between date rape and rape that is
856
committed by strangers. But, the reality is that
date rape is difficult to prosecute (Duncan 2007).
The difficulties emerge from the nature of the
relationship between the victim and the defendant
and those difficulties of proving a lack of consent.
Consent typically is viewed as positive coopera-
tion in an act freely and voluntarily, and with
knowledge of the nature of the act. In date rape
situations, consent may be a challenge to deter-
mine due to such factors as perceived consent,
poor communication, diminished capacity, and
intent. The complex legal issues relating to con-
sent mirror the same issues that are involved in the
perpetration of many date rape situations, namely,
when and how did someone consent to sexual
activity.
Cross-References
▶ Rape
▶ Statutory Rape
References
Anderson, M. J. (2005). Negotiating sex. Southern Cali-
fornia Law Review, 78, 1401–1438.
Duncan, M. J. (2007). Sex crimes and sexual miscues: The
need for a clearer line between forcible rape and non-
consensual sex. Wake Forest Law Review, 42,
1087–1139.
Rennison, C. M. (2002). Rape and sexual assault:
Reporting to police and medical attention, 1992–2000
(Bureau of justice report, NCJ 194530). Washington:
Bureau of Justice Statistics, Office of Justice Programs,
U.S. Department of Justice.
Rickert, V. I., & Wiemann, C. M. (1998). Date rape among
adolescents and young adults. Journal of Pediatric and
Adolescent Gynecology, 11, 167–175.
Vicary, J., Klingman, L., & Harkness, W. (1995). Risk
factors associated with date rape and sexual assault of
adolescent girls. Journal of Adolescence, 18,
289–306.
Weisz, A., & Black, B. (2009). Programs to reduce
teen dating violence and sexual assault: Perspec-
tives on what works. New York: Columbia Univer-
sity Press.
Young, A. M., Grey, M., & Boyd, C. J. (2009). Adoles-
cents’ experiences of sexual assault by peers: Preva-
lence and nature of victimization occurring within and
outside of school. Journal of Youth and Adolescence,
38, 1072–1083.
Dating Abuse: Prevalence, Consequences, and Predictors
Dating Abuse: Prevalence,
Consequences, and Predictors
May S. Chen1, Vangie A. Foshee2 and
Heathe H. Luz McNaughton Reyes2
1
Department of Health Behavior, University
of North Carolina at Chapel Hill, Chapel Hill,
NC, USA
2
Gillings School of Global Public Health,
University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA
Overview
Dating relationships can play a central part in
facilitating healthy adolescent development by
providing opportunities for youth to acquire skills
for interacting with others, establish autonomy,
and develop identity and intimacy. However, dat-
ing relationships that are violent and abusive can
have harmful effects on psychosocial develop-
ment and adjustment across the life-course
(Exner-Cortens et al. 2013). Recognizing this,
numerous organizations have declared preventing
adolescent dating abuse a public health and
human rights imperative (Graffunder et al. 2004;
Garcia-Moreno and Watts 2011), and research that
aims to understand the etiology of dating abuse
has soared over the past 25 years. As shown in
Fig. 1, the number of papers on adolescent dating
abuse published in peer-reviewed journals has
grown every year since 1990 to a peak of 77 arti-
cles published in 2014. The current entry synthe-
sizes results from this growing body of research.
First, we provide a brief overview of how dating
abuse is defined and measured. Then, we describe
the prevalence of dating abuse perpetration and
victimization in the USA and how the prevalence
varies over time and by demographic characteris-
tics. Next we summarize the results from longitu-
dinal studies that examined the consequences and
predictors of dating abuse perpetration and vic-
timization. Findings reported are from studies of
youth ages 12–21, excluding college and adult
samples. Longitudinal studies that control for
temporality of associations are emphasized since
Dating Abuse: Prevalence, Consequences, and Predictors
Published items in each year
90
80
70
60
50
40
30
20
10
0
Years
Dating Abuse: Prevalence, Consequences, and Predictors, Fig. 1 Number of articles published on adolescent
dating abuse from 1991 to 2015
that method allows the closest test of causation
available in the adolescent dating abuse literature.
The entry ends by highlighting future directions
for research.
What Is Adolescent Dating Abuse
and How Is It Measured?
Dating abuse refers to the use of violence against a
current or former dating partner and includes psy-
chological, physical, and sexual abuse (CDC
2016; Saltzman et al. 2002). Psychological abuse
can occur in person or electronically (i.e.,
technology-assisted or cyber dating abuse) and
includes nonphysical acts intended to produce
emotional harm or fear, such as those that humil-
iate, diminish, embarrass, and control the victim,
isolate the victim from friends and family, deny
the victim access to money or other basic
resources, produce anxiety or insecurity about
the relationship, and threaten the victim with
harm (Murphy and Hoover 2001; Saltzman
et al. 2002). Physical abuse includes actual use
of physical force, such as slapping, kicking, hit-
ting, punching, and attacking with a weapon, with
the intention or perceived intention of causing
physical harm or injury (Straus and Gelles
857
D
1986). Sexual abuse includes physically forcing
someone to engage in a sexual act against his or
her will, regardless of whether the act is com-
pleted or not, and attempting or completing sexual
acts against a person who is unable to consent to
the sexual act (Saltzman et al. 2002).
These different types of abuse have been found
to commonly co-occur (Hamby et al. 2012; Ozer
et al. 2004; Raiford et al. 2007; Thompson
et al. 2006; Sears et al. 2007), and psychological
abuse against partners has been found to predict
later use of physical abuse by adolescents (Cano
et al. 1998; O’Leary and Slep 2003). Further,
among adolescents, being a victim of dating
abuse is correlated with being a perpetrator of
abuse (Gray and Foshee 1997; Miller et al. 2013;
Orpinas et al. 2013), with the majority of adoles-
cents involved in dating abuse reporting both vic-
timization and perpetration (Gray and Foshee
1997; Haynie et al. 2013; O’Leary et al. 2008).
Adolescents who perpetrate violence against a
dating partner once are also likely to perpetrate
again (Cano et al. 1998; O’Leary and Slep 2003;
Williams et al. 2008; White and Smith 2009).
Almost all studies of adolescent dating abuse
measure abuse with act scales on which respon-
dents indicate whether and how often they have
used (or experienced) a specific abusive act
858
against (or from) a partner (Smith et al. 2015).
Respondents are categorized as perpetrators
and/or as victims based on whether they have
done or experienced any of the acts listed, or they
are given a numerical score based on the number
and/or frequency of acts committed (or experi-
enced). The Conflict Tactics Scale-2 (Straus et al.
1996), the Safe Dates Scale (Foshee 1996), and the
Conflict in Adolescent Dating Relationships Inven-
tory (CADRI; Wolfe et al. 1998, 2001) are the most
commonly used act scales, but there are others as
well (see Exner-Cortens et al. 2016 for a review).
Act scales have been criticized for being too sim-
plistic to capture the complexity of dating abuse
because they do not assess intent, motives, circum-
stances surrounding the abuse, acts perpetrated or
received in self-defense, or severity of acts (Foshee
and Matthew 2007). Even so, act scales continue to
be widely used because they are easy to administer
and code and they lend themselves well to creating
abuse variables that can be used in quantitative
analyses.
How Prevalent Is Adolescent Dating
Abuse?
Prevalence estimates of adolescent dating abuse
vary widely, making it difficult to determine the
true extent of the problem. The variability is due
to inconsistencies in the way prevalence estimates
are calculated (e.g., among daters only vs. among
daters and non-daters), the time frame (e.g., past
year vs. lifetime) and types of abuse (e.g., physi-
cal, psychological, sexual) assessed, the specific
behaviors of each type measured (e.g., mild,
moderate, and/or severe acts), ages studied,
mode of data collection (e.g., telephone vs. self-
administered), and characteristics of the sample
(e.g., national vs. local; Foshee and Matthew
2007). Here, prevalence data for dating abuse
perpetration and victimization are presented for
each type of dating abuse (psychological, physi-
cal, and sexual).
Victimization Prevalence Rates
Data on the prevalence of psychological and phys-
ical dating abuse victimization in the USA are
Dating Abuse: Prevalence, Consequences, and Predictors
drawn from five studies that used nationally rep-
resentative samples (see Table 1 for summary of
these studies; Halpern et al. 2001; Wolitzky-
Taylor et al. 2008; Hamby et al. 2012; Haynie
et al. 2013; Kann et al. 2014). In the National
Longitudinal Study of Adolescent Health (Add
Health), which assessed both psychological and
physical victimization among students in grades
7 through 12, 29% and 12% of youth who had
been in heterosexual relationships reported
experiencing psychological and physical dating
abuse, respectively, in the prior 18 months. For
those reporting same-sex relationships, the preva-
lences were 20% and 11% (Halpern et al. 2001,
2004). The NEXT Generation Health Study also
examined psychological and physical dating
abuse victimization but, in the past 12 months,
reported 24.2% and 10.7% of youth experiencing
psychological and physical dating abuse, respec-
tively. Neither of these studies made distinctions
as to whether psychological abuse was experi-
enced in person or through technology, and no
national studies to date have uniquely examined
the prevalence of technology-assisted psycholog-
ical dating abuse. However, local studies have
reported prevalences of technology-assisted
dating abuse victimization that range from 26%
(Zweig et al. 2013) to 56% (Cutbush et al. 2010).
The remaining three national studies measured
only physical dating abuse. The Youth Risk
Behavior Survey (YRBS), which assessed past
12-month physical victimization among 9th
through 12th graders, reported rates of physical
victimization that remained fairly stable from
1999 to 2013, ranging from 8.8% in 1999 to
10.3% in 2013 (Centers for Disease Control and
Prevention [CDC] 2000, 2002, 2004, 2006, 2008,
2010, 2012, 2014). The National Survey of Ado-
lescents (NSA; Wolitzky-Taylor et al. 2008) and
the National Survey of Children’s Exposure to
Violence (NatSCEV; Hamby et al. 2012) both
assessed lifetime physical dating abuse victimiza-
tion among 12–17-year-old adolescents. The for-
mer study found that 1.6% of adolescents
experienced serious physical and/or sexual abuse
during their lifetime, whereas the latter study
reported that 6.4% of adolescents experienced
physical abuse in their lifetime.
Dating Abuse: Prevalence, Consequences, and Predictors 859

Dating Abuse: Prevalence, Consequences, and Predictors, Table 1 Nationally representative estimates of the
prevalence of adolescent dating abuse victimization and perpetration
DV prevalence estimate
Year % Victimization % Perpetration
Study assessed Sample Type of abuse Overall Boys Girls Overall Boys Girls
National 1994–1995 7–12 grades Past 29.0 28.0 29.0 – – –
Longitudinal (N = 7,493) 18 months’
Study of psychological
Adolescent abuse
D
Health (Halpern Past 12.0 12.0 12.0 – – –
et al. 2001) 18 months’
physical abuse
National Survey 2005 12–17 years Lifetime 1.6 0.6 2.7 – – –
of Adolescents (N = 3,614) serious
(Wolitzy-Taylor, physical or
et al. 2008) sexual abuse
National Survey 2008 12–17 years Lifetime 6.4 8.3 4.5 – – –
of Children’s (N = 1,680) physical abuse
Exposure to
Violence
(Hamby
et al. 2012)
NEXT 2009–2010 Tenth grade Past 24.2 16.5 30.5 21.4 13.0 28.2
Generation (N = 2,203) 12 months’
Health Study psychological
(Haynie abuse
et al. 2013) Past 10.7 11.7 9.8 9.1 6.3 11.4
12 months’
physical abuse
Youth Risk 2013 Ninth–twelfth Past 10.3 7.4 13.0 – – –
Behavior Survey grade 12 months’
(Kann (N = 9,900) physical abuse
et al. 2014) Past 10.4 6.2 14.4 – – –
12 months’
sexual abuse

The YRBS is the only national study that has
assessed sexual dating abuse victimization, which
was defined as any sexual act that the adolescent
did not want to do including kissing, touching, or
being physically forced to have sexual inter-
course. YRBS assessment of past 12-month sex-
ual abuse victimization began in 2013 and the
reported prevalence for that year was 10.4%
(Centers for Disease Control and Prevention
2014). This estimate falls within the range of
local studies that reported prevalence rates for
date rape or attempted rape between 1% (Ackard
and Neumark-Sztainer 2002) and 14% (Poitras
and Lavoie 1995) and with local studies that
have found prevalence rates for other types of
forced sexual activity that range from 9%
(Foshee 1996) to 15% (Jezl et al. 1996).
Perpetration Prevalence Rates
Only one national study to date has examined the
prevalence of adolescent dating abuse perpetra-
tion (Haynie et al. 2013). In the NEXT Generation
Health Study, 21.4% and 11.4% of youth reported
past 12-month perpetration of psychological and
physical dating abuse, respectively. These preva-
lence rates are within the range reported by local
studies (Niolon et al. 2015; O’leary et al. 2008;
Foshee and Matthew 2007); however, prevalence
rates from local studies vary broadly, likely due to
the methodological issues noted above. For
860
example, a 2007 review of local studies found that
psychological abuse perpetration rates range
between 14% and 82% and physical abuse rates
range between 11% and 41% (Foshee and Mat-
thew 2007). When only severe forms of violence
likely to result in injury (such as hitting a partner
with an object, beating up a partner, and using a
knife or gun against a partner) are considered,
prevalence rates are generally lower ranging
between 8% (Coker et al. 2000; Foshee 1996)
and 14% (Gorman-Smith et al. 2001).
No national studies have examined the preva-
lence of sexual dating abuse perpetration. How-
ever, estimates from local studies suggest that
sexual dating abuse is generally less prevalent
than other types of perpetration, with between
3% (Foshee 1996) and 15% (Niolon et al. 2015)
of teens reporting having perpetrated some form
of sexual abuse against a date.
The Initiation and Development
of Dating Abuse Over Time
Teens generally begin to date during middle
school (Connolly and McIsaac 2009; Connolly
et al. 2004), and research suggests that dating
abuse occurs even in these early adolescent rela-
tionships (Miller et al. 2009; Simon et al. 2010;
Taylor et al. 2010). Longitudinal studies indicate
that the typical pattern of physical and sexual
dating abuse perpetration is curvilinear, with
levels of perpetration increasing up until around
age 16 or the end of the tenth grade and then
dropping as adolescents’ transition into young
adulthood (Foshee et al. 2009a; Giordano
et al. 2015; Reyes et al. 2011; Nocentini
et al. 2010; White and Smith 2009). This pattern
is similar to that for other types of antisocial
behavior (e.g., peer aggression, delinquency),
which also tend to peak during late adolescence
and decline during young adulthood (Farrell
et al. 2005; Windle 2000). These findings are
also consistent with theoretical perspectives
suggesting that the peak in antisocial behaviors
such as dating abuse during adolescence can be
attributed to a “maturation gap” during which
teens may not yet have developed the skills in
Dating Abuse: Prevalence, Consequences, and Predictors
interpersonal communication (Furman and
Shomaker 2008), conflict resolution (Furman
and Shomaker 2008; Larson et al. 1999), and
emotional control (Shulman 2003) needed to nav-
igate the complex challenges of initiating and
maintaining romantic relationships (Moffitt
1993). During late adolescence, these behaviors
may decline as teens gain social, intellectual, and
emotional maturity (Reyes 2009; Reyes Foshee
2013; White and Smith 2009). For a select group
of teens, however, patterns of aggressive behavior
toward others may begin in early childhood, gen-
eralize to romantic partners during adolescence,
and then persist into adulthood, reflecting a life-
course persistent versus an adolescent-limited tra-
jectory of interpersonal aggression (Reyes and
Foshee 2013; Moffitt 1993). Consistent with the
notion that there may be different types of trajec-
tories of aggression over time, some recent studies
suggest there may be subgroup heterogeneity in
the development of dating abuse during adoles-
cence, although the patterns identified in these
studies are not consistent (Brooks-Russell
et al. 2013; Orpinas et al. 2012, 2013). For exam-
ple, using data that spanned grades 6 through
12, Orpinas et al. (2012) identified two trajectory
classes for physical dating abuse victimization for
females: consistently low across all grades and
increasing linearly over time. In contrast, using
data that spanned grades 8 through 12, Brooks-
Russell et al. (2013) found three physical dating
abuse trajectory classes for females: a first class
characterized by consistently low levels of phys-
ical dating abuse victimization, a second class that
started with low levels of victimization that
increased to moderate levels until grade 10 and
decreased thereafter, and a third class that higher
initial levels of victimization that increased until
grade 10 and decreased thereafter. In a longitudi-
nal study focused on dating abuse (perpetration
and/or victimization) within relationships over
time, Johnson et al. (2015b) found that dating
abuse, although prevalent, displays a high degree
of variability across adolescence and young adult-
hood (ages 13–29); across five waves of data,
7.9% of respondents reported always having dat-
ing abuse (perpetration or victimization), 39%
reported never having dating abuse, and 53%
Dating Abuse: Prevalence, Consequences, and Predictors
experienced some discontinuity in dating abuse.
Extant literature parsing apart these developmen-
tal processes is limited, however, and more work
is needed to understand whether there are different
types of trajectories of dating aggression and, if
so, identify the factors that increase risk of chronic
involvement across the life-course.
Demographic Correlates
A large body of research suggests that adolescent
health risk behaviors are not equally distributed
across subgroups of adolescents defined by demo-
graphic characteristics such as sex, race/ethnicity,
and socioeconomic status (SES). These demo-
graphic characteristics may influence and/or be
markers for adolescent exposure to social contexts
(e.g., the family environment) and socialization
processes (e.g., gender role socialization, cultural
socialization) that can increase and/or decrease
risk of involvement in dating abuse (Foshee
et al. 2008). Below we summarize findings from
research that has examined whether and how ado-
lescent sex, race/ethnicity, and socioeconomic sta-
tus are associated with dating abuse victimization
and perpetration. Such research is critical to
informing our understanding of who is at risk for
dating abuse and thus should be targeted with
selective prevention interventions.
Sex Differences
Both the NSA and the YRBS suggest that girls are
more likely than boys to be victims of sexual
dating abuse (Hamby et al. 2012; Wolitzky-Taylor
et al. 2008; CDC 2014). In contrast, findings of
national studies with respect to sex differences in
risk for psychological and physical dating abuse
victimization are inconsistent (see Table 1). Rates
of psychological dating abuse victimization were
not found to differ by sex in the Add Health study,
but rates were higher for girls than for boys in the
NEXT Generation Study. In the NSA, which
assessed lifetime serious physical abuse victimi-
zation, rates of victimization were higher for girls
than for boys. In contrast, the Add Health and
NEXT Generation studies found no sex differ-
ences in rates of physical victimization, and the
861
NatSCEV study found that rates were signifi-
cantly higher for males than for females, although
rates of fear and injury due to dating abuse were
found to be higher for females than for males in
that study. Findings from the 1991 to 2011 YRBS
suggest that rates of physical victimization did not
differ for boys and girls; however, the 2013 YRBS
found higher rates among girls than boys (Vagi
et al. 2015). Vagi et al. (2015) speculate that this D
finding may be attributed to changes in the word-
ing of the 2013 YRBS physical dating abuse
victimization measure that aimed to minimize
reporting of unintentional violence (i.e., violence
perpetrated in play) and capture more severe
forms of physical abuse.
The only national study to examine sex differ-
ences in dating abuse perpetration rates found that
girls were more likely than boys to perpetrate both
psychological and physical dating abuse (Haynie
et al. 2013). This finding is consistent with local
studies that have generally found that female ado-
lescents are as or more likely than males to report
these types of dating abuse perpetration (O’Leary
et al. 2008; Niolon et al. 2015; for a review see
Foshee and Mathew 2007). In contrast, local stud-
ies have consistently found that sexual dating
abuse is more likely to be reported by males than
females (Niolon et al. 2015; Foshee 1996; Bennett
and Finneran; Poitras and Lavoie 1995).
We note that studies that have found that girls
are as or more likely than boys to engage in and/or
experience dating abuse have caused considerable
controversy, primarily because they have not
matched normative public perceptions, the expe-
riences of service providers interacting with those
involved in intimate partner violence, or the fact
that domestic violence homicides are overwhelm-
ingly male perpetrated. It has been suggested that
sex differences in physical dating abuse are more
likely to be detected when severe forms of dating
abuse are considered, with female adolescents
experiencing and male adolescents using more
severe forms of abuse. The findings of the NSA
study and the 2013 YRBS are consistent with this
assertion; both studies assessed severe forms of
dating abuse victimization and found higher rates
among females than among males. In addition,
some local studies with adolescents have found
862
that females are more likely than males to be
victims of severe physical dating abuse (Bennett
and Fineran 1998; Coker et al. 2000; Foshee
et al. 2009a). However, we note that other local
studies report no gender differences in victimiza-
tion from severe physical dating abuse (e.g., Jezl
et al. 1996; Lichter and McCloskey 2004;
O’Keefe and Treister 1998) or that boys are
more likely than girls to be victims of severe
dating abuse (Munoz-Rivas et al. 2007). The
NatSCEV study as well as some local studies
(e.g., Foshee 1996; Munoz-Rivas et al. 2007)
found that girls were more likely than boys to be
injured by a date, but O’Leary et al. (2008) found
no gender differences in injuries from dating
abuse. These inconsistencies point to the need
for more nuanced measurement and analytic tech-
niques to better understand sex differences and
similarities in adolescent dating abuse (Hamby
2015).
Socioeconomic Status Differences
Studies assessing the association between socio-
economic status (SES) and adolescent dating
abuse victimization have been inconsistent, with
no clear pattern emerging. For example, higher
SES has been associated with both reduced
(Foster et al. 2004; Raiford et al. 2007; Sanderson
et al. 2004; Spriggs et al. 2009) and increased
(Malik et al. 1997) risk of dating abuse victimiza-
tion among girls. Among boys, some studies have
found no association between SES and victimiza-
tion risk (Malik et al. 1997; Spriggs et al. 2009),
whereas others have found that SES is associated
with reduced risk (Halpern et al. 2001). These
inconsistencies may be explained by differences
in sample characteristics and in the variables
included in analyses. For example, Spriggs
et al. (2009) found that SES was negatively
related to dating abuse victimization among both
boys and girls, but when age and race/ethnicity
were included in the model, the association
became nonsignificant for boys. This study also
found that the effects of SES on victimization
were context dependent; SES was more strongly
related to girls’ victimization in more advantaged
schools, perhaps because their status differential is
Dating Abuse: Prevalence, Consequences, and Predictors
more evident in those contexts. This finding is
consistent with findings of research examining
intimate partner violence (IPV) among adult
women that has found that the association
between education (a marker of SES) and victim-
ization risk depends on macro-level factors (e.g.,
community-level tolerance of violence; Heise and
Kotsadam 2015).
Findings from studies assessing the link
between SES and dating abuse perpetration are
more consistent, with most studies reporting no
association (Chapple 2003; Foshee et al. 2001;
Lavoie et al. 2002; Malik et al. 1997; O’Keefe
1997; Simons et al. 1998). However, a study by
Foshee et al. (2009a) found that parent education,
a proxy for SES (Goodman 1999), was negatively
associated with levels of psychological and phys-
ical perpetration across ages 13–19 years.
Racial and Ethnic Differences
Overall, findings from studies assessing associa-
tions between race/ethnicity and dating abuse are
mixed and may vary depending on sex, type of
abuse assessed (i.e., psychological, physical, or
sexual; victimization or perpetration), and
whether the study controlled for potential con-
founders such as SES. Findings from the 2013
YRBS, which did not control for SES, found no
differences by race/ethnicity in risk of physical
dating abuse victimization for either boys or
girls, but there were racial/ethnic differences in
risk for sexual dating abuse, with different pat-
terns for girls as compared to boys (CDC 2014).
Specifically, sexual dating abuse victimization
was found to be higher among White and His-
panic girls than among Black girls, whereas,
among boys, sexual dating abuse victimization
was higher among Black than among White and
Hispanic boys. In studies using data from Add
Health, race/ethnicity was more strongly related
to physical dating abuse victimization for boys
than for girls, with minority boys, particularly
Black (Halpern et al. 2001; Spriggs et al. 2009)
and Hispanic (Halpern et al. 2009; Spriggs
et al. 2009) boys at greater risk than White boys.
However, other local studies have found that race/
ethnicity was not associated with physical
Dating Abuse: Prevalence, Consequences, and Predictors
victimization among boys either when controlling
(Foshee et al. 2004) or not controlling for SES
(O’Leary et al. 2008; Silverman et al. 2001).
The only nationally representative study that
examined dating abuse perpetration did not report
differences by race/ethnicity (Haynie et al. 2013).
However, some local studies suggest that Black
and Latino adolescents may be at increased risk
for physical dating abuse perpetration than White
adolescents even when controlling for SES
(Connolly et al. 2010; Foshee et al. 2009a,
2010). Findings from studies that stratify by gen-
der have been mixed, with some studies reporting
stronger associations between race/ethnicity and
dating abuse perpetration for boys than for girls
(Malik et al. 1997; O’Leary et al. 2008), and
others finding stronger associations for girls
(Foshee et al. 2010).
What Are the Consequences
of Adolescent Dating Abuse?
Understanding the consequences of adolescent
dating abuse is essential for accurately estimating
the extent of the public health problem. In addi-
tion, understanding the consequences can help
researchers and practitioners set priorities for the
field and develop appropriate primary and second-
ary prevention programs for youth. It is often
presumed that being a victim of dating abuse
during adolescence increases the risk of becoming
a victim of intimate partner violence (IPV) as an
adult, continuing the cycle of family violence.
Consistent with this perspective, a number of lon-
gitudinal studies suggest that being victimized by
romantic partners in adolescence increases risk for
IPV victimization in young adulthood (Halpern
et al. 2009; Exner-Cortens et al. 2013; Cui
et al. 2013; Gomez 2010). Using data from Add
Health, Halpern et al. (2009) found that, although
the most common pattern of IPV victimization
was young adult onset, a significant proportion
of the population showed persistent victimization
from adolescence to young adulthood (age
18–25). Expanding on these findings, Cui
et al. (2013) found that experiencing dating
863
abuse in adolescence significantly predicted IPV
victimization among young adults into their
mid-20s to mid-30s. In addition, existing retro-
spective studies indicate that approximately 51%
of the abused women in a shelter sample (Roscoe
and Benaske 1985) and 25% of abused women in
another sample indicated that they had been a
victim of violence while dating (Gayford 1975).
Several studies, primarily with girls, have D
examined health-related correlates of adolescent
dating abuse victimization. These studies report
that victimization is correlated with physical
injury, unhealthy weight-control methods, sub-
stance use, early sexual onset, multiple sexual
partners, nonuse of condoms, and pregnancy
(Howard and Wang 2003; Kreiter et al. 1999;
O’Leary et al. 2008; Roberts et al. 2005;
Silverman et al. 2001). Because of the cross-
sectional nature of these studies, it is not clear
whether these are causes or consequences of dat-
ing abuse victimization. However, the use of lon-
gitudinal designs to examine psychological and
behavioral consequences of adolescent dating
abuse victimization is becoming more common.
These studies suggest that consequences of dating
abuse victimization for boys include increased
suicidal ideation, antisocial behavior, cigarette
smoking, depressive symptoms, anxiety, and
alcohol and marijuana use (Ackard et al. 2007;
Brown et al. 2009; Ellis et al. 2009; Exner-Cortens
et al. 2013; Foshee et al. 2013a; Roberts
et al. 2003). The consequences for girls include
depression, anxiety, cigarette smoking, suicide
attempts, marijuana use, illicit substance abuse,
binge eating, and antisocial behavior. An impor-
tant limitation is that only two of these longitudi-
nal studies distinguished consequences of dating
abuse victimization separately by abuse type
(Exner-Cortens et al. 2013; Foshee et al. 2013a).
The remaining studies combined different types of
violence into a single composite score, making it
impossible to delineate consequences of different
types of dating abuse. Future studies should
examine consequences of each type of dating
abuse victimization separately.
To date, only four longitudinal studies have
examined the consequences of being a perpetrator
864
of dating abuse (Calvete et al. 2014; Foshee
et al. 2016; Johnson et al. 2014; Nahapetyan
et al. 2014). These studies indicate that being a
perpetrator of adolescent dating abuse predicts
negative changes in cognitive-emotional pro-
cessing of dating conflicts, lower college aspira-
tions, higher family conflict, greater likelihood of
marijuana use, higher depressive symptoms, and
greater suicide ideation (Calvete et al. 2014;
Foshee et al. 2016; Johnson et al. 2014;
Nahapetyan et al. 2014).
What Are the Predictors of Adolescent
Dating Abuse?
Knowing the “causes” of a behavior is a prereq-
uisite to developing approaches to prevent that
behavior (Gordon 1987). Below we provide a
narrative summary of predictors for dating abuse
perpetration and victimization. Longitudinal
designs provide better evidence of causation
than cross-sectional designs; therefore, only lon-
gitudinal studies of adolescent dating abuse are
presented below. In addition, only studies that
measure dating abuse perpetration and/or victim-
ization during adolescence were included. Our
description of the predictors identified in longitu-
dinal studies is organized by levels of the social-
ecological model, beginning with individual-level
factors (i.e., cognitions), interpersonal factors
(i.e., characteristics of the romantic relationship,
peers, or the family), and then attributes of the
school and neighborhood context. Figure 2 sum-
marizes the list of predictors discussed below and
whether they are associated with perpetration,
victimization, or both. All factors included in the
figure were found to be statistically significant
predictors of dating abuse at the 0.05 level in at
least one longitudinal study.
Predictors of Dating Abuse Perpetration
Individual-Level Predictors of Perpetration
Aggressive and antisocial behaviors. Aggressive
and antisocial behaviors (e.g., disobedience
toward parents, damaging of property, delinquent
behavior, conduct problems, aggression toward
Dating Abuse: Prevalence, Consequences, and Predictors
peers, direct bullying) have been shown to con-
sistently predict dating abuse perpetration among
both boys (Cleveland et al. 2003; Ferguson
et al. 2012; Lavoie et al. 2002; Foshee
et al. 2010, 2014; Morris et al. 2015; Reyes and
Foshee 2013) and girls (Brendgen et al. 2001;
Foshee et al. 2010, 2014; Morris et al. 2015).
For example, Foshee et al. (2014) found that direct
bullying (i.e., hitting, slapping, or picking on
another kid) in the sixth grade predicted the
onset of physical dating abuse perpetration by
the eighth grade among both boys and girls.
Importantly, the analyses were conducted in a
sample of adolescents who had not perpetrated
dating abuse at the sixth grade assessment,
strengthening the case for temporality of
associations.
Acceptance of dating abuse and traditional
gender norms. A small body of longitudinal
research has examined whether beliefs about the
acceptability of violence (Connolly et al. 2010;
Foshee et al. 2001; Mueller et al. 2013; Wolfe
et al. 2004; Reyes et al. 2016) and/or traditional
gender roles (Foshee et al. 2001; Reyes
et al. 2016) predict dating abuse, with inconsistent
findings. In particular, while some studies have
found a longitudinal association between beliefs
that are tolerant of dating abuse and abuse perpe-
tration (Connolly et al. 2010; Foshee et al. 2001;
Jouriles et al. 2013; Reyes et al. 2016), others have
found no such association (Wolfe et al. 2004;
Mueller et al. 2013). Mueller et al. (2013)
conducted the only study that has explicitly exam-
ined the potential for reciprocal relations between
attitudes toward violence and abusive behavior.
Using a sample of teens with a history of
delinquency-related behavior, that study found
evidence for a prospective relationship from dat-
ing aggression to beliefs among boys and girls,
but not vice versa (Mueller et al. 2013). Foshee
et al. (2001) similarly found no evidence that
traditional gender role beliefs predict dating
abuse among boys or girls. However, findings
from a study by Reyes et al. (2016) suggests that
this lack of association may have been due to a
failure to examine synergistic effects between
beliefs about traditional gender roles and beliefs
about the acceptability of violence. Using a
Dating Abuse: Prevalence, Consequences, and Predictors
Dating Abuse: Prevalence, Consequences, and Predictors, Fig. 2 Longitudinal predictors of dating abuse perpe-
tration (p) and victimization (v)
general sample of adolescent boys, that study
found that traditional gender role attitudes pre-
dicted dating abuse among boys who reported
high, but not low, levels of acceptance of dating
abuse (Reyes et al. 2016). Additional work is
needed to better understand whether and how
various norms, attitudes, and beliefs about gender
and acceptability of violence may work synergis-
tically to predict dating abuse.
Substance use. Several longitudinal studies
suggest that substance use behavior (alcohol, mar-
ijuana, and/or other drug uses) predicts dating
865
abuse perpetration (e.g., Epstein-Ngo et al. 2013;
Foshee et al. 2010; Rothman et al. 2011; Reyes
et al. 2014; Temple et al. 2013), although findings
are difficult to synthesize and compare due to dif-
ferences in the types of substance use behaviors
examined as well as differences in analytic
approach. Foshee et al. (2010) found that mari-
juana use predicted the onset of dating abuse
(DA) among girls, but neither cigarette nor alcohol
use predicted DA onset among either boys or girls.
Temple et al. (2013) found that both hard drug and
alcohol use uniquely predicted change in DA
866
(i.e., levels of DA at follow-up controlling for
baseline) among boys and girls, but marijuana use
did not. Longitudinal research that has examined
within-person associations between substance
use and DA across more than two time points has
also found evidence that alcohol (Epstein-Ngo
et al. 2013; Rothman et al. 2011; Reyes et al.
2014) and hard drug use (boys only; Reyes et al.
2014), but not marijuana (Epstein-Ngo et al. 2013;
Reyes et al. 2014) or cigarette use (Reyes
et al. 2014), predicted dating abuse perpetration.
In sum, these findings suggest a consistent within-
person link between alcohol use and dating abuse
perpetration, although more work is needed to
understand associations with other substance use
behaviors. Future longitudinal research should dis-
tinguish between- from within-person effects, elab-
orate on the potential biopsychosocial mechanisms
that explain effects, and determine whether and
how mechanisms differ for boys and girls.
Internalizing symptoms. Internalizing symp-
toms, including depression and anxiety, have
been found to predict dating abuse perpetration,
with some indication that the effect is stronger for
girls than for boys. For example, McCloskey and
Lichter (2003) found that depression was a stron-
ger predictor of dating abuse perpetration for girls
than for boys 1 year later. However, dating abuse
was not measured at baseline in this study so the
temporality of the association was not completely
controlled for. Foshee et al. (2010) also found that
depression predicted dating abuse perpetration
among girls but not boys, but in a different sam-
ple, Foshee et al. (2001) found that depression did
not predict dating abuse perpetration by girls or
boys. In addition, several studies suggest that
trauma symptoms (Wolfe et al. 2004), suicide
attempt (Kerr and Capaldi 2011), and anxiety
(Foshee et al. 2010; Ulloa et al. 2014) may also
be predictors of dating abuse perpetration. In sum,
these findings suggest that internalizing symp-
toms predict dating abuse perpetration, although
more work is needed to explain subgroup differ-
ences by demographic characteristics.
Interpersonal-Level Predictors of Perpetration
Romantic partners. The influence of romantic
relationship characteristics on adult intimate
Dating Abuse: Prevalence, Consequences, and Predictors
partner violence has been studied extensively,
but only a few longitudinal studies have examined
the influence of those characteristics on adoles-
cent dating abuse. In a longitudinal study span-
ning adolescence and young adulthood, Johnson
et al. (2015b) found that infidelity, disagreements,
and partner continuity were associated with an
increase in the proportion of relationships with
dating abuse (victimization and/or perpetration),
and increased trust and commitment were associ-
ated with a decrease in the proportion of relation-
ships with dating abuse. Connolly et al. (2010)
found that adolescent relationships characterized
by high levels of hostility predicted physical dat-
ing abuse 1 year later for both boys and girls,
although these findings again did not differentiate
between perpetration and victimization. Williams
et al. (2008) studied adolescent dating abuse per-
petrators to identify predictors of the recurrence of
dating abuse with other partners a year later. They
found that boys and girls who were perpetrators in
relationships that involved frequent quarrels, argu-
ments, and hostility at the first assessment were
more likely than perpetrators whose relationships
did not contain those characteristics to perpetrate
dating abuse a year later with a different partner;
contrary to their expectations, the association was
significant only among those who reported low
acceptance of aggression in dating relationships.
Engaging in sexual intercourse may increase the
emotional intensity of the romantic relationship,
which in turn might increase the risk for dating
abuse perpetration (Brooks-Russell et al. 2015).
Consistent with this hypothesis, having higher
number of sex partners (Cleveland et al. 2003)
and early sexual initiation (O’Donnell et al. 2006)
have been found to significantly predict dating
abuse perpetration by boys.
Peer context. A limited number of studies have
examined whether and how the peer context influ-
ences risk for dating abuse. This is an important
area for research given that social learning per-
spectives suggest that peers may play an impor-
tant role in modeling dating behaviors and
shaping normative beliefs about the acceptability
of dating abuse. Consistent with this perspective,
existing longitudinal studies have found that ado-
lescents with friends who engage in dating abuse
Dating Abuse: Prevalence, Consequences, and Predictors
are more likely to perpetrate dating abuse them-
selves (Arriaga and Foshee 2004; Foshee
et al. 2010, 2013b). Because these longitudinal
studies controlled for the temporality of associa-
tions, it can be concluded that the adolescents
perpetrated dating abuse after rather than before
their friend had been a perpetrator. Similarly,
peers may model and reinforce general antisocial
behaviors, which in turn may increase dating
abuse perpetration. Several longitudinal studies
have found positive associations between affilia-
tion with deviant peers and psychological and
physical dating abuse, with some studies finding
a stronger association for boys than for girls
(Morris et al. 2015), and others finding stronger
associations for girls than for boy (Schnurr and
Lohman 2008). In addition, having lower quality
and unreciprocated friendships have been found
to predict dating abuse perpetration among both
boys and girls (Foshee et al. 2010; Linder and
Collins 2005), and girls who are typically high
in social status are at increased risk for using
dating abuse throughout adolescence (Foshee
et al. 2010).
Family-related factors. Family characteristics
are among the most commonly studied predictors
of adolescent dating abuse. Low levels of parental
monitoring and supervision have consistently
been found to predict dating abuse perpetration
(Brendgen et al. 2001; Capaldi and Clark 1998;
Foshee et al. 2001; Lavoie et al. 2002; Simons
et al. 1998), and several studies suggest that the
association between parental lack of supervision
and dating abuse perpetration is mediated by
increased antisocial and delinquent behaviors
(Capaldi and Clark 1998; Lavoie et al. 2002;
Simons et al. 1998). Exposure to harsh parenting
practices (Jouriles et al. 2012; Lavoie et al. 2002;
Simons et al. 1998), inconsistent discipline (Bank
and Burraston 2001; Simons et al. 1998), and low
levels of parental warmth (Magdol et al. 1998;
Simons et al. 1998) have also been found to pre-
dict dating abuse perpetration. In a longitudinal
analysis of eighth and ninth grade adolescents,
Reyes et al. (2015) found that being hit by an
adult increased normative beliefs about dating
aggression and anger dysregulation, which in
turn increased dating abuse perpetration. Another
867
longitudinal study (O’Donnell et al. 2006) found
that experiencing abuse from parents predicted
perpetration of dating abuse by boys, but others
have found that corporal punishment and child
maltreatment predicted perpetration of dating
abuse only in subgroups of boys. For example,
Foshee et al. (2005) found that corporal punish-
ment predicted dating abuse perpetration for
Black boys whose mothers had not graduated D
from high school, but not for those whose mothers
had graduated from high school or for White
adolescents regardless of mother education.
Exposure to domestic violence in the home is
commonly thought to be a risk factor for adoles-
cent dating abuse, but empirical evidence for this
is mixed. O’Donnell et al. (2006) found that
witnessing violence between parents predicted
physical dating abuse perpetration by boys, and
Tschann et al. (2009) found longitudinal evidence
of an association for both genders. Likewise,
Latzman et al. (2015) found that exposure to
IPV was associated with higher levels of dating
abuse perpetration during a 5-month follow-up
assessment among a sample of adolescents
living in high-risk, urban communities. However,
several other longitudinal studies that examined
the effects of exposure to domestic violence on
adolescent dating abuse perpetration found
no association (Arriaga and Foshee 2004; Capaldi
and Clark 1998; Foshee et al. 2001; Lavoie
et al. 2002; Lichter and McCloskey 2004;
McCloskey and Lichter 2003; Simons
et al. 1998). This lack of association may be due
to unexamined moderated associations effects: for
example, Foshee et al. (2005) found that exposure
to domestic violence predicted adolescent dating
abuse perpetration by Black boys living in single-
parent households, but not by Black boys living in
two-parent households or White boys living in
either situation. Differences in when the exposure
occurred and the frequency or level of severity of
the exposure may also explain the lack of consis-
tent findings.
School and Neighborhood Predictors
of Perpetration
Factors at the upper levels of the social ecology
such as policy, media, neighborhoods, and
868
schools may influence dating abuse perpetration,
but only those at the school and neighborhood
levels have been examined with longitudinal stud-
ies, with some mixed findings. For example,
Foshee et al. (2011) found that school bonding
was associated with lower levels of dating abuse
perpetration among boys but not girls, but Cleve-
land et al. (2003) found that school attachment is
associated with lower dating abuse perpetration
for girls but not boys. Another recent study of
class norms (i.e., students in the same school and
grade level) found that, among both boys and
girls, class-level norms that are more supportive
of dating abuse predicted higher levels of physical
dating abuse perpetration (Taylor et al. 2015).
Only two studies to date examine longitudinal
associations between neighborhood-level factors
and adolescent dating abuse perpetration. Jain
et al. (2010) used longitudinal data to explore
the role of neighborhood collective efficacy
(defined as a community’s cohesiveness and will-
ingness to intervene for the common good) on
dating abuse perpetration, but found no significant
effects for either boys or girls. Chang et al. (2015)
examined the effect of structural (economic
disadvantage, residential instability, ethnic hetero-
geneity) and physical (physical disorder) charac-
teristics of the neighborhood on trajectories of
dating abuse perpetration, and found that girls
but not boys living in economically disadvan-
taged neighborhoods were at increased risk of
perpetrating dating abuse at all grades, even
when controlling for individual-level socioeco-
nomic status. The authors also found that neigh-
borhood collective efficacy was protective against
dating abuse in bivariate analyses, but the effect
was no longer significant after controlling for
individual- and neighborhood-level covariates.
More research examining neighborhood-level
predictors of dating abuse perpetration is currently
needed, especially studies that utilize longitudinal
designs and assess potential mediators of the
effect of these macro-level factors. In addition,
consistent measures of neighborhood-level fac-
tors are needed to facilitate comparison of find-
ings across studies (Johnson et al. 2015a). More
nuanced ways of conceptualizing and measuring
neighborhood-level factors are needed to obtain a
Dating Abuse: Prevalence, Consequences, and Predictors
better understanding of how these characteristics
might influence dating abuse.
Factors Not Predictive of Perpetration by
Boys or Girls
Several factors have not predicted dating abuse
perpetration for boys or girls. Although self-
esteem is considered an important factor in ado-
lescent behavior, the two longitudinal studies that
examine it as a predictor of dating abuse perpetra-
tion found no associations for boys or girls
(Foshee et al. 2001; Manning et al. 2014). Few
longitudinal studies have examined whether per-
sonal interaction skills such as skills for
responding to anger and settling disagreements,
ability to empathize with dating partners, and/or
self-efficacy in coping with relationship issues
predict dating abuse perpetration; the few studies
that have examined interaction skills as longitudi-
nal predictors of dating abuse perpetration did not
find significant associations (Foshee et al. 2001;
Wolfe et al. 2004), yet changing interpersonal
skills are primary foci for many dating abuse
prevention programs (De La Rue et al. 2016).
Predictors of Dating Abuse Victimization
Individual-Level Predictors of Victimization
Aggressive and antisocial behaviors. Many of the
same factors that predicted dating abuse perpetra-
tion also predict victimization. Early antisocial
behaviors, aggression against peers, and conduct
problems have all predicted the onset of dating
abuse victimization among boys (Magdol
et al. 1998; Miller et al. 2013; O’Donnell
et al. 2006) and girls (Foster et al. 2004; Magdol
et al. 1998; O’Donnell et al. 2006; Williams
et al. 2008). Morris et al. (2015) found that early
adolescent involvement in aggression predicted
subsequent psychological and physical dating
abuse victimization more strongly for females
than males, but the magnitude of the gender dif-
ference was small.
Acceptance of dating abuse and traditional
gender norms. With respect to attitudes and
norms, Foshee et al. (2004) found that holding
traditional gender stereotypes predicted chronic
victimization from sexual dating abuse for girls
Dating Abuse: Prevalence, Consequences, and Predictors
but not boys. Raiford et al. (2007) found that
among African American girls, knowledge and
attitudes about healthy and unhealthy relation-
ships, measured primarily through items tapping
unhealthy gender-based expectations of partners,
predicted female victimization. Together, these
findings suggest that girls who hold traditional
views of women may be at increased risk of dating
abuse victimization.
Substance use. Early alcohol use has been
associated with later dating abuse victimization
among both boys and girls (Cleveland
et al. 2003; East and Hokoda 2015; Millett
et al. 2013; Swahn et al. 2008), whereas cocaine
use and sedative/opiate use were associated with
severe dating victimization among girls only
(Epstein-Ngo et al. 2013).
Internalizing symptoms. Similar to perpetration,
depression has been found to predict both the onset
of dating abuse victimization of girls (Cleveland
et al. 2003; Foshee et al. 2004; Lehrer et al. 2006;
Tyler et al. 2011) and chronic victimization of girls
from sexual dating abuse (Foshee et al. 2004).
Using longitudinal data that spanned from grades
8 through 12, Brooks-Russell et al. (2013) found
that anxiety increased the odds of experiencing
physical dating violence victimization throughout
adolescence among girls but not boys.
Interpersonal-Level Predictors of Victimization
Romantic partners. Among both boys and girls,
being a victim in a relationship containing many
quarrels, arguments, and hostility predicted vic-
timization in a later relationship by a different
partner, but only among those who reported low
acceptance of aggression in dating relationships
(Williams et al. 2008). Likewise, Johnson
et al. (2015b) found that infidelity, disagreements,
and partner continuity were associated with an
increase in the proportion of relationships with
dating abuse (victimization and/or perpetration).
Increased trust and commitment were associated
with a decrease in the proportion of relationships
with dating abuse. Among boys only, early sexual
initiation has been associated with greater risk for
physical dating abuse victimization (O’Donnell
et al. 2006). Among both boys and girls, being
in a relationship that includes sexual intercourse
869
increased risk of dating abuse victimization
(Kaestle and Halpern 2005).
Peer context. With respect to peers, having
friends who were victims of dating abuse predicted
dating abuse victimization among both boys and
girls (Foshee et al. 2004). Having more deviant
friends has also been found to predict victimization
in longitudinal studies (East and Hokoda 2015).
Sexual harassment by peers may also be a risk D
factor for dating abuse victimization: Chiodo
et al. (2009) found that boys and girls who were
sexually harassed in the ninth grade were signifi-
cantly more likely to be a victim of dating abuse
2.5 years later than those who were not sexually
harassed. The forms of sexual harassment that pre-
dicted victimization were similar for boys and girls
except that girls received fewer homosexual slurs
and are more likely to experience comments about
or be rated on the sexual parts of their bodies.
Family-related factors. Experiencing violence
from parents (Foshee et al. 2004; O’Donnell
et al. 2006), family conflict (Magdol et al. 1998),
and lack of parental warmth (Magdol et al. 1998)
have been found to predict dating abuse victimi-
zation among both boys and girls. Witnessing
violence between parents has been found to pre-
dict male dating abuse victimization (O’Donnell
et al. 2006), but Lichter and McCloskey (2004)
found that exposure to marital violence did not
predict abuse among boys or girls. Finally, higher
levels of bonding with parents (Maas et al. 2010)
and mothers’ strictness, monitoring, and conser-
vative sexual attitudes (East and Hokoda 2015)
have been found to be protective against dating
abuse victimization although the latter study
found stronger associations for girls than boys.
A recent longitudinal study found that low paren-
tal closeness was associated with greater risk of
dating abuse victimization in residentially stable
neighborhoods but in not unstable neighbor-
hoods, pointing to the need for examining
potential synergistic effects of family and
neighborhood-level factors (Foshee et al. 2015).
School- and Neighborhood-Level Predictors
of Victimization
Like perpetration, factors at the upper level of the
social ecology likely predict dating abuse
870
victimization, but few studies have examined
these effects longitudinally. Two studies to date
examine neighborhood-level predictors of victim-
ization. Using data from Add Health, Spriggs
et al. (2009) found that witnessing a violent
crime (someone getting stabbed or shot) in the
past 12 months predicted dating abuse victimiza-
tion among adolescents. The other study to
explore neighborhood-level factors found that
higher levels of neighborhood collective efficacy
were protective against dating abuse victimization
among boys but not among girls (Jain et al. 2010).
One study found that watching X-rated movies in
the past 3 months predicted dating violence vic-
timization 1 year later among girls (Raiford
et al. 2007). Additional longitudinal work is
needed to examine whether and how policy,
media, neighborhood, and school-level factors
effect dating abuse victimization.
Conclusions and Future Directions
Dating abuse during adolescence is a prevalent
public health problem that has serious emotional,
developmental, and physical consequences and
can be predicted by a number of factors that
could be targeted for change in prevention pro-
grams. Despite the broad range of prevalence
estimates, it is clear that a substantial number of
adolescent boys and girls become involved in
dating abuse and that most are both victims and
perpetrators. Even the most conservative esti-
mates suggest that at least one in ten US teens
has experienced some form of physical dating
abuse and one-third have experienced psycholog-
ical abuse. Boys and girls who experience dating
abuse, either as a victim or as a perpetrator, face a
range of serious consequences, including physical
injury, depression, substance use, binge drinking,
antisocial behavior, and suicide ideation and
attempts. Factors predicting dating abuse perpe-
tration and victimization for both boys and girls
include early antisocial and delinquent behaviors
and aggression against peers; having friends who
are involved in dating abuse; relationships that
involve quarrels, arguments, and hostility; family
conflict; the experience of violence from parents,
Dating Abuse: Prevalence, Consequences, and Predictors
harsh parenting, and lack of parental warmth; and
witnessing of violence between parents. Some
school- and neighborhood-level factors have
been found to predict dating abuse perpetration
and victimization, though research examining
these associations is still nascent.
Despite the increased attention to adolescent
dating abuse in recent years, far less research has
been conducted in this area than on other adoles-
cent health risk behaviors. For example, com-
pared to the 77 studies of dating abuse published
in 2014, 1,276 peer-reviewed articles were
published on adolescent alcohol use and
492 were published on adolescent tobacco use.
In addition, as noted above, to date, only one
nationally representative study of adolescent dat-
ing abuse perpetration has been conducted. Future
research is needed to develop measures of dating
abuse that capture the complexity of the phenom-
enon while still lending themselves to quantitative
analysis. In addition, while longitudinal research
examining the etiology of dating abuse is grow-
ing, more work is needed to identify both individ-
ual and, in particular, social contextual risk and
protective factors that predict victimization and/or
perpetration. Such research should seek to deter-
mine whether and how associations between risk
and protective factors vary by sex, race, SES, age,
and sexual orientation so as to contribute to a
better understanding of who is at risk and when
intervening on these factors would be most effec-
tive. In particular, more research is needed to
assess the prevalence and predictors of dating
abuse perpetration by gay and lesbian adolescents
since all of the studies reviewed here assumed
heterosexual relationships. Finally, emerging
gene by environment studies suggest that genes
may play an important role in the etiology of
adolescent dating abuse (Foshee et al. 2015) and
should be explored further in future studies.
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Dating Abuse: Primary Prevention
Efforts
Heathe H. Luz McNaughton Reyes1,
Vangie A. Foshee1 and May S. Chen2
1
Gillings School of Global Public Health,
University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA
2
Department of Health Behavior, University of
North Carolina at Chapel Hill, Chapel Hill,
NC, USA
Introduction
Preventing dating abuse (DA) among adolescents
has been recognized as a public health problem
and human rights imperative (Spivak et al. 2014;
Lundgren and Amin 2015). Nationally represen-
tative studies of US high school students indicate
Dating Abuse: Primary Prevention Efforts
that approximately 20% of students who have
dated report having experienced psychological
DV in the past year and 10% have experienced
physical and/or sexual DV (Kann et al. 2014;
Haynie et al. 2013). DV victimization can have
serious negative health consequences for both
boys and girls, including physical injury;
unhealthy behaviors, such as drug and alcohol
use and binge eating; and depression and suicide
ideation and attempts (Ackard et al. 2007; Brown
et al. 2009; Exner-Cortens et al. 2013; Foshee
et al. 2013; O’Leary et al. 2008; Roberts
et al. 2003). Further, patterns of relationship con-
flict established during adolescence may carry
over into young adulthood, contributing to adult
intimate partner violence (Bouchey and Furman
2006; Magdol et al. 1998). Thus, prevention of
DV during adolescence is of particular importance
because doing so may contribute to reduce part-
ner violence across the life course. This chapter
provides a review of efforts to prevent DV
victimization and perpetration during adoles-
cence. While numerous programs have been
implemented that aim to prevent DV, relatively
few of these programs have used rigorous
methods to evaluate effects on DV outcomes,
which is critical to establishing a causal effect
of the intervention on DV victimization and/or
perpetration behavior (Lundgren and Amin
2015). This structured narrative review thus
focuses on describing DV prevention programs
that have been evaluated using randomized
controlled trials (RCTs) and that have assessed
effects on at least one DV outcome (psycholo-
gical, physical, and/or sexual victimization
and/or perpetration) during adolescence (ages
10–19 years). Findings from the evaluations of
these programs are described and synthesized,
and directions for future DV prevention and eval-
uation efforts are discussed.
Evaluations of Programs That Aim
to Prevent Adolescent Dating Abuse
To identify programs and studies eligible for the
review, electronic searches for published and
peer-reviewed literature were conducted using
877
PubMed, Google Scholar, and Web of Science.
Previous DV literature reviews were analyzed, as
were the reference lists for all reports and articles
identified. Search terms included “adolescents” or
“youth” and “dating abuse prevention” or “sexual
violence prevention” or “partner violence preven-
tion”. Studies that evaluated the effects of pro-
grams on DV using measures that did not
specifically assess violence perpetrated or experi- D
enced in the context of a dating (or intimate part-
ner) relationship were excluded (e.g., studies
using measures of sexual violence that did not
distinguish between non-partner- vs. partner-
perpetrated violence). In addition, programs
targeting university students were excluded
because they were considered to focus on emerg-
ing adulthood rather than adolescence.
We identified 17 randomized control trials
(RCTs) of 18 prevention programs that evaluated
effects on at least one type of DV victimization
and/or perpetration during adolescence. All
17 RCTs included a baseline and at least one
post-intervention assessment with time frames
for follow-up assessments ranging from 1–2
weeks to 4 years post-intervention. All DV out-
comes were assessed via self-report. Consistent
with literature that has found that both boys and
girls experience DV victimization and engage in
DV perpetration (Foshee and Reyes 2012), most
of the RCTs evaluated program effects on both
boys and girls (n = 16) and assessed effects on
both victimization and perpetration outcomes
(n = 13). Fifteen studies assessed program effects
on one or more types of DV victimization: eight
assessed psychological (including cyber) DV,
nine assessed physical DV, five assessed sexual
DV, and three assessed effects on a composite
victimization outcome (i.e., psychological and/or
physical and/or sexual DV). Fifteen studies
assessed program effects on one or more types
of DV perpetration: seven assessed psychological
(including cyber) DV, ten assessed physical DV,
five assessed sexual DV, and four assessed effects
on a composite DV perpetration outcome. All of
the programs were evaluated with adolescents in
the USA with the exception of the Stepping Stones
evaluation, which took place in South Africa
(Jewkes et al. 2008).
878
Organizations interested in selecting and
implementing DV prevention programs often
look for programs shown to be effective with the
particular population they wish to target. For this
reason, we have organized our description of the
programs using Gordon’s (1983) threefold classi-
fication system, which categorizes programs as
universal, selected, or indicated, according to the
population that is targeted. We classified half
(9) of the 18 programs as universal because they
were developed to be implemented with general
populations of adolescents. Six (33%) programs
were classified as selective, because they were
developed for populations determined to be at
risk for DV based primarily on demographic char-
acteristics. Three (17%) programs were classified
as indicated because they were developed for
populations with identifiable markers (e.g., his-
tory of child maltreatment) indicating high risk
for involvement in DV. In the following we pro-
vide a brief description of each program and find-
ings from research assessing the effects of the
program on DV outcomes. Several studies
assessed program effects on DV outcomes imme-
diately after the program had ended as well as at
follow-up assessments that occurred at later time
points. The description of findings focuses on
summarizing analyses of program effects on DV
outcomes assessed at later time points rather than
immediately post-intervention. We refer to the
relationship between treatment exposure and a
particular DV outcome as statistically significant
when the reported p-value associated with the
effect of treatment is less than 0.05; when the
reported p-value is less than 0.10, we refer to the
association as marginally significant.
Universal Programs
Of the nine universal programs that met our selec-
tion criteria, seven are school based. With two
exceptions, these school-based programs include
a classroom-based curriculum as the primary com-
ponent. The two exceptions are the School Health
Center Healthy Adolescent Relationships Program
(SHARP; Miller et al. 2015), which was designed
to be delivered by healthcare providers in school
health centers, and the building-only version of
the Shifting Boundaries (SB) program (Taylor
Dating Abuse: Primary Prevention Efforts
et al. 2013), which was designed to make changes
to the school contextual environment. The two
universal programs that are not school based are
Families for Safe Dates (FSD; Foshee et al. 2012),
which is a family-based program designed to be
completed by caregivers and their adolescents in
their homes, and Stepping Stones (Jewkes
et al. 2008), which is a community-based program.
A summary of program and study characteristics
and findings for each of the universal programs is
presented in Tables 1 and 2, respectively.
Safe Dates. The Safe Dates program targets
adolescents in the eighth and ninth grades and
includes a ten-session curriculum (45-min per
session), a theater production, and a poster contest
(Foshee et al. 1996, 1998). The program is
designed to prevent and reduce DV perpetration
and victimization. Activities to prevent the initia-
tion of DV are designed to decrease acceptance of
DV, increase perceived sanctions for DV, reduce
gender stereotyping, and improve conflict man-
agement skills and communication skills. Activi-
ties to promote cessation of DV target change in
these same constructs, along with cognitive fac-
tors found to influence decisions to take preven-
tive action, like leaving an abusive dating partner,
belief in the need for help, and awareness of
community resources for help. The RCT of Safe
Dates involved random allocation of 14 schools to
treatment and control conditions. Follow-up
assessments were conducted yearly up until
4 years post-intervention (Foshee et al. 1998,
2000, 2004, 2005). Adolescents exposed to SD
in the eighth or ninth grade reported less psycho-
logical, moderate physical, and sexual DV
perpetration and less moderate physical DV vic-
timization at all four follow-up periods, and there
were also marginal (p = 0.07) program effects on
sexual DV victimization across follow-up (Foshee
et al. 2005). Additionally, the program was effec-
tive in preventing severe physical DV perpetra-
tion across follow-up among those who reported
no or average involvement in severe physical DV
at baseline. The program did not have any effects
on psychological or severe physical DV victimi-
zation. The program was equally effective for
boys and girls and for white and minority
adolescents.
Dating Abuse: Primary Prevention Efforts 879

Dating Abuse: Primary Prevention Efforts, Table 1 Universal dating abuse (DA) prevention program characteristics
Target
Type; audience; Theoretical base; Components
Program name setting deliverer mediators (dose) Description
Safe Dates Universal; Audience: Theories: social Classroom-based Safe Dates promotes
school eighth and control, cognitive, curriculum (ten primary and
ninth graders and precaution 45-min sessions), secondary
Deliverer: adoption role-play, poster prevention of DV
teachers Mediators: norms, contest through activities
conflict designed to address D
management knowledge of DV,
skills, belief in DV norms, and
need for help, improvement of
awareness of prosocial skills (e.g.,
services conflict management
skills). Secondary
prevention of DV is
promoted through
encouragement of
help-seeking
Fourth R Universal; Audience: Theory: none Classroom-based Fourth R addresses
school ninth graders specified curriculum DV in the context of
Deliverer: Mediators: peer (21 75-min overlapping areas of
teachers resistance skills sessions), teacher risk behaviors (sexual
training, four activity, substance
parent newsletters, use, and peer
“safe school violence). Sessions
committees” divided into three
units addressing
safety and injury
prevention, healthy
growth and sexuality,
and substance use:
emphasis is on core
relationship issues
and pressures and
teaching skills to
promote safer
relationship decision-
making
Interaction- Universal; Audience: Theory: theory of Classroom-based IB curriculum
Based school sixth and reasoned action curriculum (five addresses
(IB) curriculum seventh Mediators: beliefs, 40-min sessions) boundaries in
graders attitudes relationships,
Deliverer: formation of
rape crisis deliberate
center relationships,
educator determination of
wanted/unwanted
behaviors, and the
role of the bystander
as intervener.
Lessons were
designed to make
students struggle
with “subjectivity
and ambiguity”
(continued)
880 Dating Abuse: Primary Prevention Efforts

Dating Abuse: Primary Prevention Efforts, Table 1 (continued)

Target
Type; audience; Theoretical base; Components
Program name setting deliverer mediators (dose) Description
Law and Universal; Audience: Theory: theory of Classroom-based LJ curriculum
Justice-Based school sixth and reasoned action curriculum (five focused on laws,
(LJ) curriculum seventh Mediator: 40-min sessions) definitions,
graders knowledge information, and
Deliverer: data about penalties
rape crisis for sexual assault/
center harassment and
educator research about
consequences for
perpetrators of
gender-based
violence/sexual
harassment
Shifting Universal; Audience: Theory: theory of Classroom-based Classroom sessions
Boundaries school sixth and reasoned action curriculum (six address DV
(SB) seventh Mediators: 40-min sessions), consequences, DV
graders knowledge, posters in school laws, relationship
Deliverer: attitudes, buildings, staff boundaries, and
school intentions surveillance of bystander
personnel unsafe areas, intervention.
“respecting Building-based
boundary intervention
agreements” includes hallway
posters, “respecting
boundary
agreements” that
students complete
when they want to
resolve a “boundary
dispute” with
another student, and
increased staff
surveillance of areas
of schools
(“hotspots”)
identified as unsafe
Respect in Universal; Audience: Theory: none Two 45-min RISE presentations
Schools school Seventh specified classroom-based focus on bullying
Everywhere and eighth Mediators: presentations by and gender-based
(RISE) graders knowledge, youth leaders aggression,
Deliverer: attitudes, including sexual
high school emotional school harassment and
age peers adjustment dating aggression.
Presentations are
manualized but were
allowed to be
personalized by
youth leaders
(continued)
Dating Abuse: Primary Prevention Efforts 881

Dating Abuse: Primary Prevention Efforts, Table 1 (continued)

Target
Type; audience; Theoretical base; Components
Program name setting deliverer mediators (dose) Description
School Health Universal; Audience: Theory: none Provider SHARP aims to
Center Healthy school High school specified discussion and facilitate clinic-based
Adolescent health students age Mediators: assessment of DV, assessment of DV
Relationships centers 14–19 years awareness, provision of a with the premise that
Program Deliverer: intentions to palm-sized discussion of DV
(SHARP) healthcare intervene to brochure, referral during a clinical D
providers prevent to victim service encounter may
relationship abuse, advocate (if DV enhance adolescents’
knowledge of was disclosed). ability to address DV.
resources, and Typical Providers reviewed a
self-efficacy to use discussions brochure that
harm reduction lasted <1 min discusses healthy
behaviors (longer if DV was relationships, how to
disclosed) help a friend, and DV
resources. During the
discussion, providers
screened for DV and
provided “warm”
referral (connecting
the patient to an
advocate via phone/in
person) to services if
DV was disclosed
Families for Universal; Audience: Theory: protection Six self- FSD aims to motivate
Safe Dates family Caregivers motivation administered and facilitate caregiver
(FSD) and their Mediators: booklets delivered engagement in dating
13–15-year- caregiver by mail to families. abuse prevention
old teens protection Each booklet is activities with their
Deliverer: motivation and designed to take teens that can lead to
families (self- date rule setting/ approximately 1 h decreases in risk
delivered) monitoring; teen to complete factors for DV
attitudes, norms, including attitudes,
and conflict norms,
resolution skills communication, and
conflict resolution
skills
Stepping Universal; Audience: Theory: adult 13 3-h sessions, Stepping Stones
Stones community 16–23-year- education theory three peer group aims to improve
old youth Mediators: not meetings, one sexual health
Deliverer: specified community through building
trained meeting gender-equitable
facilitators (approximately partnerships with
(sex matched) 50 h total). better
Delivered to communication
single-sex groups between partners.
Sessions address
sexual risk and
protective behaviors
and outcomes,
gender-based
violence, dealing
with grief and loss,
and communication
skills
882 Dating Abuse: Primary Prevention Efforts

Dating Abuse: Primary Prevention Efforts, Table 2 Universal dating abuse prevention programs: study character-
istics and findings
Study design; baseline sample Data collection mode;
Program size (n) assessment schedule Findings for DV outcomes
Safe Dates 14 schools randomized to Paper/pencil survey; Across follow-ups effects on
intervention and control immediate post and four psychological, moderate
groups; n = 1885 follow-ups 1.5, 2.5, 3.5, and physical, and sexual
4.5 years post-baseline (1, 2, DVP. Effects on moderate
3, and 4 years post- physical DVV, marginal
intervention) effects on sexual
DVV. Effects on severe
DVV among those
reporting no or average
baseline involvement.
No effects on
psychological or severe
physical DVV
Fourth R 20 schools randomized to Online survey; one follow-up At follow-up, effects on
intervention and control; 2.5 years post-baseline (2 years physical DVP at follow-up
n = 1722 post-intervention) for boys, but not girls
Interaction- 123 sixth- and seventh-grade Paper/pencil survey; At follow-up, no effects of
Based (IB) and classes (in seven schools) immediate post and one follow- the IB program (vs. control)
Law and Justice- randomized to IB, LJ, or up 6 m post-baseline (4–5 m on sexual or physical
Based control; n = 1639 post- intervention) DVP or sexual or physical
(LJ) programs DVV. No effects of the LJ
program (vs. control) on
sexual or physical DVV or
physical DVP. Iatrogenic
effects of LJ program
(vs. control) on frequency of
sexual DVP
Shifting 30 schools randomized to Paper/pencil survey; At follow-up, no effects of
Boundaries combined (building and immediate post and one follow- combined or classroom-only
classroom), building only, up 7–9 m post-baseline (6 m programs (vs. control) on
classroom only, or control; post-intervention) sexual DVP or sexual
n = 2655 DVV. Effects of building-
only (vs. control) program on
sexual DVV, but not sexual
DVP
Respect in 4 schools randomized to Paper/pencil survey; one At follow-up, no effects on
Schools intervention and control; follow-up approximately 7 m composite (psychological,
Everywhere n = 509 post-baseline (4–5 m post- physical, and sexual) DVV
intervention) outcome
School Health 11 school health centers Audio computer-assisted self- At follow-up, effects on
Center Healthy (SHCs) randomized to interview; one follow-up 3 m composite (physical and
Adolescent treatment and control; post-baseline (3 m post- sexual) DVV. Effects on
Relationships n = 1011 intervention) cyber DVV among those
Program reporting any DVV at the
baseline
Families for Families recruited nationwide Computer-assisted telephone At follow-up, effects on
Safe Dates and randomized to treatment interviews; one follow-up 6 m physical DVV. No effects on
and control; n = 464 post-baseline (3 m post- psychological DVV. No
intervention) effects on physical
DVP. Marginal
effects on psychological
DVP
(continued)
Dating Abuse: Primary Prevention Efforts 883

Dating Abuse: Primary Prevention Efforts, Table 2 (continued)

Study design; baseline sample
Program size (n)
Stepping Stones 64 villages and 6 townships
randomized to treatment and
control; n = 2776
Note: DAV dating abuse victimization, DAP dating abuse perpetration
Data collection mode;
assessment schedule
Individual face-to-face
interviews, two follow-ups
1 and 2 years post-baseline
(10 and 22 m post-intervention)
Findings for DV outcomes
At both follow-ups marginal
effects on composite
(physical and sexual) DVP
among boys (not assessed for
girls). No effects on DVV
among girls (not assessed for
boys) at either follow-up D

Fourth R: Skills for Youth Relationships
(Fourth R). The Fourth R program targets adoles-
cents in the ninth grade and includes 21 75-min
sessions that are designed to be integrated into
health education classes (Wolfe et al. 2009). Ses-
sions are divided into three seven-session units
focused on (1) personal safety and injury preven-
tion, (2) healthy growth and sexuality, and (3) sub-
stance use and abuse. A focus on developing
healthy relationship skills, including assertive
communication and conflict resolution skills, is
integrated throughout the units. Techniques used
to promote skills development include scenario
analysis and role-play opportunities to model
and practice skills. Unlike other school-based
DV prevention programs, this program was
implemented in sex-segregated classrooms, and
activities for boys and girls differed slightly to
maximize relevance and minimize defensiveness
on the part of participants. School-level compo-
nents included teacher training on DV and healthy
relationships, parent newsletters, and student-led
safe school committees. The RCT of Fourth R
involved random allocation of 20 schools to treat-
ment and control conditions with one follow-up
assessment conducted 2 years post-intervention.
Analyses suggest that exposure to the program
was significantly associated with reduced physi-
cal DV perpetration at follow-up for boys, but not
for girls (Wolfe et al. 2009). Effects on other types
of DV perpetration or victimization were not
assessed.
Interaction-Based and Law and Justice-Based
Programs. Taylor et al. (2010a) assessed the
effects of two universal programs on DV in a
sample of early adolescents (sixth and seventh
graders). The Interaction-Based (IB) program
focused on gender socialization and interaction
skills, and the Law and Justice-Based
(LJ) program focused on the laws and conse-
quences associated with gender violence and sex-
ual harassment. Each curriculum is comprised of
five 40-min sessions. The RCT of the IB and LJ
programs involved allocation of 123 classrooms
to one of the two programs or to a control group
(Taylor et al. 2010a). One follow-up assessment
was conducted approximately 6 months post-
intervention. At follow-up, neither the IB nor the
LJ program (vs. control) was effective in reducing
DV perpetration or victimization. In fact, contrary
to expectations, participants who received the LJ
program reported significantly more involvement
in sexual dating abuse perpetration than controls.
The authors suggested that this may have been
due to treatment group participants’ increased
recognition of certain behaviors as acts of
SV. Effects on DV outcomes were not moderated
by sex (Taylor et al. 2010b).
Shifting Boundaries (SB). Taylor et al. (2013)
built on the work they did assessing the IB and LJ
curriculum described above to assess the effects of
a modified combined version of the two programs
with the addition of a school building-wide inter-
vention component. Three versions of the inter-
vention, which was called Shifting Boundaries
(SB), were developed that target sixth- and
seventh-grade students. The first was a
classroom-only version (SB-classroom), which
synthesized lessons from the IB and LJ programs
and comprised six 40-min sessions designed to
help students to determine and set personal
boundaries. Sessions emphasize consequences
for perpetrators of DV and sexual harassment,
state and federal laws related to DV and sexual
884
harassment, the setting and communicating of
one’s boundaries in interpersonal relationships,
and the role of bystanders as interveners. The
second was a building-based intervention
(SB-building) which also aimed to increase
respect for personal boundaries and comprised
the following components: placement of posters
in school buildings to increase awareness and
reporting of DV and sexual harassment; hotspot
mapping in which students identified unsafe areas
of schools which were then targeted for greater
presence of school personnel in those areas; and
temporary school-based restraining orders
(respecting boundary agreements), which were
forms distributed to school personnel that students
could fill out to resolve a “boundary issue” with
another student. The third was a combined inter-
vention (SB-combined) that included both the
classroom- and building-based components.
The RCT of SB involved random assignment
of 30 schools to SB-classroom, SB-building,
SB-combined, and control conditions. A follow-
up assessment was conducted approximately
6 months post-intervention. At follow-up there
were no effects of the SB-combined or
SB-classroom interventions (vs. control) on
sexual DV (perpetration or victimization).
SB-building (vs. control) was associated with
reduced sexual DV victimization, but was not
associated with sexual DV perpetration. Effects
on these DV outcomes were not moderated by sex
or history of DV (Taylor et al. 2015). Effects on
other types of DV (i.e., psychological, physical)
were not assessed.
Respect in Schools Everywhere (RISE).
Connolly et al. (2015) developed and evaluated
RISE, which is a brief youth-led program for
preventing dating abuse as well as other youth
violence outcomes (bullying, sexual harassment)
among middle school youth. The youth leaders of
the program are selected from local high schools
and are required to participate in 16 after-school
sessions during which they are provided with
education in leadership skills and aggression pre-
vention. The youth leaders then prepare and pre-
sent two 45-min classroom workshops (the RISE
program) to seventh and eighth graders; one
workshop focuses on gender violence (DV and
Dating Abuse: Primary Prevention Efforts
SH) and the other focuses on bullying. The work-
shop presentations are manualized although youth
leaders have flexibility to adapt the presentation
format. The workshops are intended to increase
knowledge about aggressive behaviors, improve
attitudes toward aggression (i.e., decrease toler-
ance), and increase emotional school adjustment.
The authors proposed that a violence prevention
program led by youth, as compared to the usual
practice of having programs led by teachers or
adults, might be more engaging and influential in
terms of modifying participants’ attitudes and
school adjustment. The RCT of RISE involved
random assignment of four schools to intervention
and control conditions (Connolly et al. 2015). Stu-
dents attending schools in the control condition
received board-mandated “usual practice” anti-
violence programming led by teachers or other
adults. One follow-up assessment was conducted
approximately 4–5 months post-intervention.
RISE was not associated with DV victimization
(composite of psychological, physical, and sex-
ual) at follow-up; results were consistent for boys
and girls and across racial/ethnic subgroups. DV
perpetration was not assessed.
School Health Center Healthy Adolescent
Relationships Program (SHARP). SHARP is a
brief education and counseling intervention
designed to be delivered by healthcare providers
in school health centers (SHCs, comprehensive
clinics located in high schools) during routine
healthcare visits (Miller et al. 2015). Delivery of
the SHARP requires that healthcare providers
engage all patients, regardless of their reason for
seeking care, in a discussion about healthy and
unhealthy relationships guided by a palm-sized
brochure. During this discussion SHARP pro-
viders screen for DV and, if DV is disclosed,
conduct a warm referral (i.e., connecting a patient
to an advocate by phone or in person) to a victim
service advocate. SHARP providers reported that
this discussion typically lasted <1 min but could
last longer if DV was disclosed. In addition to the
provider-delivered intervention, SHARP SHCs
engage with youth advisory boards to organize
school-wide outreach events to raise awareness
about DV and encourage student use of SHCs.
The RCT of SHARP involved random assignment
Dating Abuse: Primary Prevention Efforts
of 11 SHCs to treatment and control conditions
(Miller et al. 2015). One follow-up assessment
was conducted approximately 3 months post-
intervention. Analyses of effects on DV at
follow-up were stratified by baseline DV status.
Among those who reported no past 3-month DV
victimization at baseline, exposure to SHARP was
associated with reduced onset of physical or sex-
ual (composite measure) DV victimization; no
association was found with onset of cyber DV
victimization. Among those who reported any
past 3-month victimization at baseline, SHARP
was associated with reduced risk of both physical
or sexual (composite measure) and cyber DV
victimization. Intervention effects were the same
for boys and girls. Effects on DV perpetration
were not assessed.
Families for Safe Dates (FSD). FSD is a
family-based program that is comprised of six
booklets mailed to caregivers of 13–15-year-old
adolescents (Foshee et al. 2012). Booklets include
interactive activities for caregivers and adoles-
cents to do together that are designed to increase
caregivers’ motivation for talking to their teens
about DV, improve their knowledge of DV, and
increase their date rule setting; alter adolescent
norms related to DV and improve their conflict
management skills; and improve communication
between adolescents and caregivers, so that there
would be less family conflict and easier discussion
of dating and DV issues. Two weeks after being
mailed a booklet, the caregiver was contacted via
telephone by a health educator who assessed
booklet completion, answered questions, encour-
aged participation, and mailed the family the next
booklet if indicated. The RCT of FSD involved
random assignment of 464 caregiver–teen dyads
to intervention and control conditions (Foshee
et al. 2012). Families were recruited across the
nation via targeted telephone lists; one follow-up
telephone interview was conducted with each
member of the dyad approximately 3 months
post-intervention. FSD was significantly associ-
ated with reduced physical DV victimization and
marginally (p = 0.09) associated with reduced
psychological DV perpetration. No effects were
found for psychological DV victimization or
physical DV perpetration, although the authors
885
note that the study was not powered to detect
effects on DV behaviors. Effects were consistent
for boys and girls.
Stepping Stones. Jewkes et al. (2008) evaluated
the effects of Stepping Stones, a community-based
program, on dating abuse behavior in a sample of
16- to 23-year-old South African youth. Stepping
Stones is a prevention program that aims to reduce
sexual risk behavior and partner violence through D
building gender-equitable relationships with bet-
ter communication between partners. The pro-
gram is delivered to single-sex groups, is run in
parallel, and includes 13 core 3-h-long sessions as
well as three meetings where the peer groups
come together that include activities designed to
promote dialogue about session topics. The ses-
sions are delivered by trained sex-matched facili-
tators and use participatory learning approaches
(role-play, drama, critical reflection) to engage
participants in critical reflection about motiva-
tions for behavior. Session topics include sexual
behavior and motivations, sex and love, concep-
tion and contraception, negative consequences of
sexual risk behavior, safer sex and condoms,
gender-based violence, dealing with grief and
loss, and communication skills. The RCT of
Stepping Stones involved randomization of 64 vil-
lages and 6 townships to intervention and control
conditions (Jewkes et al. 2008). Two follow-up
interviews were conducted approximately 10 and
22 months post-intervention (1 and 2 years post-
baseline). Analyses of program effects on DV
outcomes were stratified by sex. DV victimiza-
tion, but not DV perpetration, was assessed
among women. DV perpetration, but not DV vic-
timization, was assessed among men. The pro-
gram was marginally associated with reduced
physical or sexual (composite measure) DV per-
petration among men (at 1-year follow-up,
p = 0.09; at 2-year follow-up, p = 0.054); how-
ever, the program was not associated with physi-
cal or sexual (composite measure) DV
victimization among women at either follow-up.
Summary of Findings of Studies Evaluating
Universal Programs. Five of the nine universal
programs had at least one significant effect on a
DV outcome (Safe Dates, Fourth R, Shifting
Boundaries, SHARP, and Families for Safe
886
Dates), and one program (Stepping Stone) had a
marginally significant effect. Only one program,
Safe Dates, had effects on both victimization and
perpetration outcomes.
Selective Programs
The six selective programs selected for review
targeted the following subgroups: male athletes
(one program), low-income minority adolescents
(one program), Hispanic adolescents (two pro-
grams), pregnant adolescent girls (one program),
and pregnant adolescent girls and their partners
(one program). However, two of these programs,
Ending Violence: A Curriculum for Educating
Teens on Domestic Violence and the Law (EV;
Jaycox et al. 2006) and It’s Your Game: Keep It
Real (IYG; Peskin et al. 2014), while evaluated,
respectively, with populations comprised of
Latino teens and low-income minority teens, do
not appear to have been developed explicitly for
selective (i.e., exclusive) implementation with
those populations (i.e., these two interventions
could also potentially be classified as universal).
Four of the selective interventions were school-
based and three were community-based.
A summary of program and study characteristics
and findings for each of the selective programs is
presented in Tables 3 and 4, respectively.
Ending Violence: A Curriculum for Educating
Teens on Domestic Violence and the Law (EV).
The EV program is comprised of three 1-h ses-
sions focusing on legal aspects of dating abuse
that were taught by attorneys (Jaycox et al. 2006).
The program aims to increase knowledge of DV,
decrease acceptance of DV, promote help seeking,
and reduce perpetration and victimization. Topics
addressed in the session include ways to recognize
DV; barriers to help seeking; domestic violence
laws, including rights and responsibilities of per-
petrators and victims; ways to obtain protective
orders; and ways for DV victims to stay safe. The
RCT of EV was conducted with ninth graders in
11 high schools with greater than 80% Latino
students (Jaycox et al. 2006). Although this pro-
gram was not developed specifically to address
Latino culture, the approach of emphasizing legal
aspects of dating abuse delivered by lawyers was
justified based on a knowledge gap in the target
Dating Abuse: Primary Prevention Efforts
population. Tracks within schools were randomly
allocated to the treatment or control condition, and
one follow-up was conducted 6 months post-
intervention. At follow-up, no significant effects
were found on DV perpetration (composite of
psychological, physical, and sexual); these results
were consistent for boys and girls. Effects on DV
victimization were not assessed.
Coaching Boys into Men (CBIM). The CBIM
program was developed for male student ath-
letes based on research suggesting that male
athletes are more likely to engage in DV perpe-
tration and endorse attitudes accepting of vio-
lence against women than males who are not
athletes (Miller et al. 2012). The program aims
to engage athletic coaches as positive influential
role models to deliver violence prevention mes-
sages to their athletes. The program comprises
11 “training cards” that guide coaches to lead
10–15 min weekly discussions with their ath-
letes throughout the sports season. Through
these discussions the program aims to increase
awareness and recognition of DV, increase
gender-equitable attitudes, and increase inten-
tions to intervene as bystanders with peers.
Changes in these mediating factors were, in
turn, hypothesized to lead to decreased DV per-
petration and increased bystander intervention
in response to peer perpetration of abuse. The
RCT of CBIM involved randomization of
16 high schools to intervention and control con-
ditions (Miller et al. 2012, 2013). Athletic direc-
tors in each school approached all head coaches
of male and coeducational sports to participate.
One follow-up assessment was conducted
approximately 9 months post-intervention
(1 year post-baseline). Findings suggest that
CBIM was effective in reducing DV perpetra-
tion (composite of psychological, physical, and
sexual DV) at follow-up. Effects on DV victim-
ization were not assessed.
It’s Your Game: Keep It Real (IYG). The IYG
program is a sexually transmitted infection (STI)
and pregnancy prevention program, but effects of
the program on DV outcomes were also assessed
(Tortolero et al. 2010; Peskin et al. 2014). The
program, which was developed for implementa-
tion with ethnic-minority middle school youth,
Dating Abuse: Primary Prevention Efforts 887

Dating Abuse: Primary Prevention Efforts, Table 3 Selective dating abuse (DA) prevention program characteristics
Program Type; Target audience; Theoretical base;
name setting deliverer mediators Components (dose) Description
Ending Universal; Audience: ninth Theory: social Classroom-based Ending Violence
Violence school graders learning theory curriculum (three 1-h teaches youth
Deliverer: Mediators: sessions) about laws that
attorneys knowledge, norms, protect victims/
help seeking punish perpetrators
of DV. Emphasizes
legal dimensions D
of DV and
increasing comfort
seeking legal
services
Coaching Selective; Audience: male Theory: social 11 training cards CBIM aims to alter
Boys into school high school norms that guide coaches DV norms and
Men athletes Mediators: gender- to lead brief promote bystander
(CBIM) Deliverer: equitable attitudes, (10–15 min) weekly intervention
coaches awareness of group discussions among male
abusive behaviors, with athletes about athletes. The
intention to respect and DV program engages
intervene as prevention athletic coaches as
bystanders role models. Cards
guide coaches to
lead discussions to
raise awareness of
DV, promote
nonviolent
definitions of
masculinity, and
model bystander
intervention
It’s Your Selective; Audience: Theory: social 24 45-min lessons IYG aims to teach
Game: school low-income, cognitive, social (12 in seventh students to select
Keep It minority seventh influence grade, 12 in eighth personal limits,
Real (IYG) and eighth Mediators: grade), detect signs or
graders knowledge, refusal 12 parent–child situations that
Deliverer: and condom use homework challenge those
trained facilitator self-efficacy, activities. Includes limits, and use
normative beliefs group-based and refusal skills and
related to sexual individual other tactics to
behavior, risk computer-based protect those
exposure activities limits. Session
topics include
relationship
norms; setting
personal limits
and practicing
refusal skills;
information
about HIV, STIs,
and pregnancy;
and contraceptive
use skills
training
(continued)
888 Dating Abuse: Primary Prevention Efforts

Dating Abuse: Primary Prevention Efforts, Table 3 (continued)

Program Type; Target audience; Theoretical base;
name setting deliverer mediators Components (dose) Description
Juntos Selective: Audience: Theory: Six group sessions JOVEN was
Opuestos a community Hispanic ninth ecodevelopmental, for adolescents, two designed for
la Violencia graders social cognitive sessions for parents, Hispanic youth.
(JOVEN) Deliverer: Mediators: not two sessions for Session topics
research staff specified school personnel include relationship
(session length norms, Hispanic
unspecified) traditions, risky
substance use; safer
sexual; legal rights
and services;
conflict
management and
assertive
communication.
Parent sessions
addressed on DV
and effective
monitoring and
communication
practices
Young Selective; Audience: Theory: family Ten 75-min couple YPP was designed
Parenthood community 14–18-year-old systems and counseling sessions for pregnant
Program pregnant adolescent delivered during adolescent couples
(YPP) adolescents and developmental pregnancy and aims to promote
their partners theory. Mediators: (10 weeks +/ coparenting and
Deliverer: positive 2 weeks) paternal
master’s level relationship skills engagement. YPP
clinicians related to phases are
coparenting, designed to educate
positive paternal couples about
engagement coparenting, child
development, and
the parenting
transition; set
relationship goals
and identify skills
needed to reach
goals; and develop
communication and
self-regulation
skills
Building a Selective; Audience: Theory: social Four 90-min BALL was designed
Lasting community pregnant/ learning sessions for pregnant and
Love parenting Mediators: parenting African-
(BALL) adolescents communication American
Deliverer: skills, emotion adolescent girls.
research staff regulation Sessions address
strategies DV awareness,
safety planning,
healthy
relationships,
communication
skills, emotion
regulation, and
coping
Dating Abuse: Primary Prevention Efforts 889

Dating Abuse: Primary Prevention Efforts, Table 4 Selective dating abuse prevention programs: study character-
istics and findings
Study design; baseline sample Data collection mode;
Program size (n) assessment schedule Findings for DV outcomes
Ending 47 school tracks (in ten schools) Paper/pencil survey; immediate At follow-up, no effects on
Violence randomized to intervention and post and one follow-up 6 m composite (psychological,
control; n = 2540 post-baseline (6 m post- physical, and sexual) DVV
intervention) outcome
Coaching 16 schools randomized to Online survey; baseline, At follow-up, effects on
Boys into treatment and control; n = 2006 immediate post and one follow- composite (psychological, D
Men up 1 y post-baseline (9 m post- physical, and sexual) DVP
intervention) outcome
It’s Your 10 schools randomized to Audio computer-assisted self- At follow-up, effects on
Game: treatment and control; n = 981 interview; two follow-ups 18 m psychological (H only) and
Keep It (3 m post-intervention) and 2 y physical DVV (AA only) and
Real post-baseline (9 m post- psychological DVP (boys only,
intervention) H only). No effects on physical
DVP
Juntos Adolescents from within one Self-administered paper and Across follow-ups no effects on
Opuestos a school were randomized to pencil surveys; immediate post composite (physical and
la Violencia intervention and waitlist control (1 w post-intervention) and two sexual) DVV or DVP; no
Entre conditions; n = 82 follow-ups 3 and 12 m post- effects on psychological DVV
Novios intervention (how long after or psychological DVP
baseline not specified)
YPP Adolescents receiving teen Semi-structured face-to-face At 3-m follow-up, marginal
pregnancy services from clinics individual interviews with each effects (p = 0.06) on levels of
and schools and their partners member of their couple; physical DVP among couples
randomized to intervention and baseline (second trimester of (DVP score was computed as
usual care; n = 105 pregnancy) and two follow-ups average of both partners’
3 m post-birth (4–6 m post- reports). No effects on DVP at
intervention, 7–9 m post- 18-m follow-up
baseline) and 18 m post-birth
(19–21 m post-intervention,
22–24 m post-baseline)
BALL Adolescents receiving teen Self-administered paper and At post, marginal effects on
pregnancy services randomized pencil surveys; baseline and psychological DVP and severe
to intervention or waitlist immediate post 6 w post- physical DVV. No effects on
control; n = 72 baseline (1–2 w post- mild or severe physical DVP,
intervention) psychological DVV, or mild
physical DVV
Note: y year, m months, w weeks, DAV dating abuse victimization, DAP dating abuse perpetration

includes 24 45-min classroom sessions; half of the
sessions are delivered in the seventh grade and the
other half are delivered in the eighth grade. Class-
room sessions integrate group-based activities
with individual activities delivered on laptop
computers that include quizzes, animations, peer
video, fact sheets, “real-world” style teen serials,
and journaling. Session topics include healthy
relationships; setting personal limits; practicing
refusal skills in both general (e.g., regarding sub-
stance use) and sexual behavior-specific contexts;
information on puberty, reproduction, and STIs
and the importance of HIV, STI, and pregnancy
testing; and skills training on condom and contra-
ceptive use. The program also includes six
parent–child homework activities in each grade
that are designed to promote communication
about friendship, dating, and sexual behavior.
The RCT of IYG involved randomization of ten
schools to intervention and control conditions
(Tortolero et al. 2010; Peskin et al. 2014). Partic-
ipating schools had student populations that were
predominantly low income and ethnic minority
(39% African-American, 45% Hispanic). Trained
890
facilitators delivered the intervention. One follow-
up assessment was conducted 1 year post-
intervention. Analyses of effects on DV outcomes
assessed the main effects of the intervention on
DV behaviors as well as moderation by sex and
race/ethnicity (Peskin et al. 2014). Moderation
analyses suggest that the effects of IYG on phys-
ical and emotional DV victimization were consis-
tent for boys and girls but differed by
race–ethnicity. In particular, IYG was effective
in preventing physical victimization among
African-American, but not Hispanic youth. In
contrast, IYG was effective in preventing emo-
tional victimization among Hispanic, but not
African-American youth. Effects on emotional
DV perpetration varied by sex and by
race–ethnicity. IYG was effective in preventing
emotional abuse perpetration among boys, but
not girls, and among Hispanic but not African-
American youth (note three-way interactions
between intervention condition, sex, and race
were not examined). No main or moderated
effects of the program were found for physical
DV perpetration (Peskin et al. 2014).
Juntos Opuestos a la Violencia (JOVEN). The
JOVEN program was designed for implementa-
tion with Hispanic 13- to 16-year-old adolescents
(Gonzalez-Guarda et al. 2015). The program is
comprised of six group sessions for adolescents,
two group sessions for parents, and two sessions
for school personnel (session length unspecified).
Sessions include educational and skill-building
activities delivered using videos, music, group
discussion, and other modalities. Topics of the
sessions for adolescents include Hispanic tradi-
tions, pop culture, and dating; healthy and
unhealthy relationships; sex and drugs; legal
rights and accessing services; and bystander and
assertive communication skills. Sessions for par-
ents were designed to raise awareness about DV
and community resources and increase effective
parenting and communication practices. Sessions
for school personnel were designed to increase
effective mentoring of youth on relationships.
The RCT of JOVEN involved randomization of
82 ninth-grade Hispanic adolescents, all of whom
were recruited from one public school, and their
participating parent or legal guardian to an
Dating Abuse: Primary Prevention Efforts
intervention and a time-delayed control condition
(Gonzalez-Guarda et al. 2015). Research staff
delivered the intervention which was not
implemented during school hours (the specific
location(s) where the program was implemented
was not specified). Two follow-up assessments
were administered 3 and 12 months post-
intervention. Across follow-ups, no effects were
found on DV (composite of physical, sexual, and
psychological) victimization or perpetration.
Effects were consistent for boys and girls.
Young Parenthood Program (YPP). The YPP is
a 10-week counseling intervention designed for
pregnant adolescent couples that aims to support
the development of relationship skills needed for
positive coparenting and parenting (Florsheim
et al. 2011, 2012). The intervention is adminis-
tered by master’s level counselors who follow an
intervention manual. Intervention sessions lasted
an average of 75 min and are typically provided
once a week. The program is divided into five
phases focused on the following: (1) establishing
a therapeutic alliance and educating couples on
the link between coparenting and child develop-
ment; (2) setting relationship goals and determin-
ing what skills are needed to reach those goals;
(3) communication and self-regulation skills
development; (4) negotiating the transition to par-
enthood; and (5) other coparenting issues, includ-
ing family planning. The RCT of YPP involved
randomization of 105 pregnant 14–18-year-old
adolescents and their coparenting partner to inter-
vention and control conditions (Florsheim
et al. 2011). Two follow-up assessments were
conducted 4–6 months post-intervention
(3 months post-birth) and 19–21 months post-
intervention (12 months post-birth). For analyses
of intervention effects on DV outcomes, partners’
reports of physical DV perpetration and victimi-
zation were averaged at each assessment point.
That is, reciprocal, male-to-female, and female-
to-male violence were collapsed into a single IPV
score denoting whether any violence had been
experienced or perpetrated by either member of
the couple. Findings suggest the intervention was
marginally effective in preventing DV at the first
follow-up (3 months post-birth, p = 0.06), but
these marginal effects were not sustained at the
Dating Abuse: Primary Prevention Efforts
second follow-up (18 months post-birth,
p = 0.13).
Building a Lasting Love (BALL). The BALL
program was developed for African-American
girls receiving teen pregnancy services
(Langhinrichsen-Rohling and Turner 2012). The
program is comprised of four 90-min stand-alone
group sessions. Sessions were designed to
improve awareness of DV, communication skills,
emotion regulation, and coping skills. Session
topics included healthy relationships and safety
planning; coping with anger and disrespect; asser-
tive communication and conflict management;
and stress, coping, and time management skills.
Sessions, which were specified in a facilitator’s
manual and participant workbooks, included
material to be taught didactically as well as facil-
itated group discussions and other content-related
activities. The RCT of BALL involved randomi-
zation of 72 adolescent girls receiving teen preg-
nancy services to intervention and control
conditions (Langhinrichsen-Rohling and Turner
2012). One post-program assessment was
conducted immediately after the last program ses-
sion (6 weeks post-baseline); no other follow-up
assessments were conducted. BALL was margin-
ally associated with decreased psychological DV
perpetration (p = 0.08) and decreased severe
physical violence victimization (p = 0.09). No
effects were found for psychological DV victim-
ization, moderate physical DV victimization, or
moderate or severe physical DV violence
perpetration.
Summary of Findings for Selective Programs.
Two of the five selective programs had at least one
significant effect on a DV outcome (CBIM and
IYG) and two programs (YPP and BALL) had
marginally significant effects. Only one program,
IYG, had effects on both victimization and perpe-
tration outcomes.
Indicated Programs
The three indicated programs selected for review
targeted the following populations: adolescents
who had experienced child maltreatment (one
program), adolescents who screened positive for
youth violence and alcohol use (one program),
and adolescents who had been exposed to
891
domestic violence (one program). Two of the
interventions were community-based and one
was family-based. A summary of program and
study characteristics and findings for each of the
indicated programs is presented in Tables 5 and 6,
respectively.
Youth Relationship Project (YRP). The YRP
program targets 14–16-year-old adolescents with
a history of maltreatment and is comprised of D
18 2-h sessions taught by social workers and
other community professionals, with male and
female co-facilitators leading each session
(Wolfe et al. 1996). The program is designed to
increase knowledge about DV, alter attitudes
toward DV, increase understanding of power
dynamics in relationships, improve communica-
tion and problem-solving skills, increase aware-
ness of gender stereotypes that contribute to DV,
and increase participants’ help-seeking abilities.
Teaching techniques include role modeling and
behavioral rehearsal, value clarification and
problem-solving activities, and field trips to com-
munity agencies. The RCT of YRP was conducted
with 191 maltreated teens who were randomized
to intervention and control conditions (Wolfe
et al. 2003). Follow-up assessments were
conducted every 2 months for up to 20 months
post-intervention. Exposure to YRB was associ-
ated with reduced physical DV perpetration and
reduced physical and psychological DV victimi-
zation. There were no significant effects on psy-
chological DV perpetration. The effects on
physical abuse victimization were greater for
boys than for girls; all other effects did not differ
by sex.
SafERteens. The SafERteens program targets
14–18-year-old adolescents seeking care at an
emergency department who screened positive
for past-year violence and alcohol use
(Cunningham et al. 2009, 2013). The program
comprises a brief (30-min) counseling and edu-
cation intervention based on principles of moti-
vational interviewing (MI), which focuses on
“. . ..enhancing motivation to change in a respect-
ful, non-confrontational, and non-judgmental man-
ner” (Cunningham et al. 2009, p. 6). Activities are
designed to develop a discrepancy between current
behavior and future goals/values, reset norms,
892 Dating Abuse: Primary Prevention Efforts

Dating Abuse: Primary Prevention Efforts, Table 5 Indicated dating abuse (DA) prevention program characteristics
Target
Program Type; audience; Theoretical Components
name setting deliverer base; mediators (dose) Description
Youth Indicated; Audience: Theory: 18 sessions YRP was designed for youth
Relationships community 14–16-year- cognitive (15 2-h who had experienced
Project (YRP) old developmental; education maltreatment and aims to
maltreated feminist sessions, promote the development of
youth Mediators: 2 sessions adaptive nonviolent
Deliverer: healthy related to communication and problem-
trained relationship visiting solving skills. Sessions focus
facilitators skills, community on education and awareness,
emotional agencies, skills development, and social
distress 1 closing action activities to increase
session) help seeking
SafERteens Indicated; Audience: Theory: One 30-min SafERteens was designed for
community 14–18-year- cognitive session with high-risk inner-city youth and
old youth dissonance; two delivery uses adaptive motivational
reporting social learning modes: interviewing to enhance
past-year Mediators: computer- motivation and self-efficacy to
violence and norms, self- guided change, reset norms, and
alcohol use efficacy, intervention develop refusal, conflict
Deliverer: readiness to (CBI) and resolution, and emotion
self- change therapist- regulation skills
administered guided
(computer- intervention
guided (TBI)
mode)/
therapists
(therapist-
guided
mode)
Moms and Indicated; Audience: Theory: Six self- MTSD was designed for teens
Teens for Safe family Mothers who protection administered exposed to domestic violence
Dates have motivation booklets and was adapted from the
(MTSD) experienced Mediators: delivered by Families for Safe Dates (FSD)
domestic factors related mail to program (described above
violence and to mothers’ mothers who under universal programs).
their 12–16- program have MTSD aims to engage
year-old engagement; experienced mothers’ in DV prevention
teens mothers’ rule domestic and change teen risk factors
Deliverer: setting and violence and associated with
families monitoring; no longer live DV. Adaptations to the
(self- teen DV norms, with their program that were changes
delivered) gender abuser. from the original FSD
stereotyping, Booklets take program included increased
and conflict approximately emphasis on increasing
resolution skills 1 h to complete mothers’ self-efficacy to
address DV and beliefs that
their behaviors can influence
DV. In addition new content
addressed gender stereotyping

increase motivation and self-efficacy for change, organizational formal but differ in their mode of
and develop refusal skills. Two different versions delivery and presentation. The first version was
(or modes) of SafERteens were developed that designed to be delivered by research therapists
were designed to have the same content and trained in MI (therapist-based intervention, TBI)
Dating Abuse: Primary Prevention Efforts 893

Dating Abuse: Primary Prevention Efforts, Table 6 Indicated dating abuse (DA) prevention programs: study
characteristics and findings
Study design; baseline sample
Program size (n)
Youth Adolescents with a history of
Relationships maltreatment randomized to
Project intervention or control;
n = 191
SafERteens Adolescents seeking care at an
emergency department who
reported past-year violence and
alcohol use randomized to
computer-based intervention
(CBI), therapist-based
intervention (TBI), or control
conditions. DV analysis
restricted to those reporting any
past-year DVV or DVP;
n = 397
Moms and Mother–adolescent dyads
Teens for Safe randomized to treatment and
Dates control; n = 409
Note: DAV dating abuse victimization, DAP dating abuse perpetration
Data collection mode;
assessment schedule
Structured face-to-face
interviews; immediate post and
then follow-ups every 2 m until
final assessment at 24 m post-
baseline (20 m post-
intervention)
Self-administered
computerized assessments;
three follow-ups 3 m, 6 m, and
1 y post-baseline/-intervention
Telephone interviews; one
follow-up 9 m post-baseline
(6 m post-intervention)
Findings for DV outcomes
Across follow-ups effects on
physical DVP, psychological
DVV, and physical DVV;
stronger effects on physical
DVV for boys than for girls.
No effects on psychological D
DVP
CBI (vs. control) had effects on
moderate physical DVV at
3 and 6 m, but not at 12-m
follow-up; effects were
stronger for those reporting
higher levels of the outcome at
baseline. CBI was not
associated with severe physical
DVV any follow-up. TBI
(vs. control) had effects on
moderate physical DVVamong
those reporting higher baseline
levels at 6 m and 12 m. TBI
(vs. control) had effects on
severe physical DVV among
those reporting higher baseline
levels at 3 m, but not at 6- or
12-m follow-up. Neither CBI
nor TBI was associated with
moderate or severe physical
DVP at any follow-up
At follow-up, effects on
psychological and physical
DVV and psychological and
cyber DVP for adolescents
with high, but not average or
low exposure to domestic
violence. No effects on cyber
or sexual DVV or physical or
sexual DVP

who use tablet laptop computers to provide person-
alized feedback from screening and baseline sur-
veys. Therapists guide participants through “Safer
Choices” role-play scenarios selected by the com-
puter using preprogrammed algorithms. For exam-
ple, when participants reported they had been
involved in dating abuse, role-play scenarios were
presented on this topic. The second version was
designed as an interactive multimedia computer
program auto-administered via tablet laptops
(computer-based intervention, CBI). The CBI ver-
sion of SafERteens is narrated by a virtual “buddy”
who guides them through the intervention
elements.
The RCT of SafERteens involved randomiza-
tion of 533 eligible adolescents to computer-based
(CBI), therapist-based (TBI), or control condi-
tions (Cunningham et al. 2013). Follow-up assess-
ments were conducted 3, 6, and 12 months post-
intervention. Analysis of the effects of SafERteens
on DV outcomes was restricted to those reporting
any past-year DV at baseline because these partic-
ipants received tailored DV intervention messages
in addition to the peer violence and alcohol use
894
messages. Exposure to the CBI (vs. control) was
associated with reduced moderate physical DV
victimization at the 3- and 6-month follow-ups,
but not at 12-month follow-up. These short-term
effects were stronger for those reporting higher
levels of victimization at baseline. The CBI was
not associated with severe physical DV victimi-
zation across any of the follow-ups. Exposure to
the TBI (vs. control) was associated with reduc-
tions in moderate DV victimization at both the 6-
and 12-month follow-ups among those reporting
higher levels of victimization at baseline. The TBI
(vs. control) was also associated with reduced
severe physical DV victimization at the 3-month
but not at the 6- or 12-month follow-ups, among
those reporting higher levels of baseline victimi-
zation. Neither the CBI nor the TBI (vs. control)
was associated with moderate or severe physical
DV perpetration across any of the follow-ups.
Moms and Teens for Safe Dates (MTSD). The
MTSD program targets 12–16-year-old adoles-
cents who were exposed to domestic violence
against their mothers (Foshee et al. 2015c). The
program was adapted from the FSD program
(reviewed above under universal programs) and
is comprised of six self-administered booklets
which are delivered by mail and take approxi-
mately 1 h each to complete. Each booklet con-
tains interactive activities designed to engage
mothers in DV prevention; increase mother mon-
itoring of the adolescent; increase family close-
ness and cohesion; and change teen risk factors
associated with DV including conflict manage-
ment skills, DV norms, and gender stereotyping.
A systematic process was followed to adapt FSD
for the target population (mothers exposed to
domestic violence and their teens); example adap-
tations included increased emphasis on increasing
mothers’ self-efficacy to address DV and beliefs
that their behaviors can influence DV as well as
new content addressing gender stereotyping
(Foshee et al. 2015c). The RCT of MTSD
involved randomization of mother–teen dyads to
intervention and control conditions (Foshee
et al. 2015b). To be eligible for the study, mothers
had to have been in an abusive relationship but
currently living apart from the abusive partner.
One follow-up assessment was completed
Dating Abuse: Primary Prevention Efforts
6 months post-intervention. Analysis of interven-
tion effects first tested whether effects varied by
four a priori identified moderators (mother’s psy-
chological health, amount of adolescent exposure
to DV, adolescent sex, and race/ethnicity). Pro-
gram effects were found on psychological and
physical DV victimization and psychological
and cyber DV perpetration for adolescents with
high, but not average or low, exposure to domestic
violence. There were no main or moderated
effects of MTSD on cyber or sexual DV victimi-
zation or physical or sexual DV perpetration.
Summary of Findings for Indicated Programs.
All of indicated programs had at least one signif-
icant effect on a DVoutcome. Two programs, YRP
and MTSD, had effects on both victimization and
perpetration outcomes.
Global Summary of Study Findings
Main Program Effects
Just over half (n = 10, 56%) of the 18 programs
had at least one statistically significant (p < 0.05)
effect on a DV outcome in the expected direction
(i.e., preventing or reducing DV). Six programs
(Safe Dates, Fourth R, CBIM, IYG, YRP, and
SafERteens) were shown to have sustained effects
more than 6 months post-intervention; however
only three programs (Safe Dates, IYG, and YRP)
were found to have sustained effects on both
victimization and perpetration outcomes and on
multiple types of DV (i.e., psychological, physi-
cal, and/or sexual).
Programs varied widely in terms of their length
and intensity (i.e., dose) ranging from a
two-session workshop (RISE) to a curriculum
comprised of 21 75-min sessions (Fourth R).
Overall findings suggest that the more intensive
school-based programs (e.g., Safe Dates, Fourth
R, IYG) may have been more effective than shorter
(i.e.,  6 sessions) school-based programs (IB, LJ,
RISE, SB-classroom only, EV, JOVEN), all of
which were found to not have any favorable
effects on DV victimization or perpetration. How-
ever, it is possible that differences in program
content rather than duration account for differ-
ences in these effects. Further, findings suggest
Dating Abuse: Primary Prevention Efforts
that some of the “brief” programs that did not
involve implementation of a classroom-based cur-
riculum (e.g., SB-building only, SHARP, CBIM,
and SafERteens) may have promise for
preventing DV.
Overall, more programs had statistically sig-
nificant effects on psychological and physical DV
than on sexual DV. Specifically, in terms of vic-
timization outcomes, three programs were shown
to have significant effects on psychological DV
victimization (IYG, YRP, and MTSD), five pro-
grams were shown to have effects on physical
DV victimization (Safe Dates, FSD, IYG,
SafERteens, and MTSD), and only one program
was shown to have effects on sexual DV victim-
ization (Shifting Boundaries-building only). In
terms of perpetration outcomes, three programs
were shown to have significant effects on psycho-
logical DV perpetration (Safe Dates, IYG, and
MTSD), three programs were shown to have
effects on physical DV perpetration (Safe Dates,
Fourth R, and YRP), and only one program was
shown have effects on sexual DV perpetration
(Safe Dates). The effects of two programs
(SHARP and CBIM) on specific types of victimi-
zation and perpetration could not be determined
because composite measures were used.
Moderation of Program Effects
Most of the studies selected for review (n = 14,
82%) examined at least one potential moderator of
program effects. Such analyses are important for
determining the generalizability of program
effects across different subpopulations participat-
ing in the study. Commonly examined moderators
included baseline levels of the DV outcome
(4 studies), race/ethnicity (4 studies), and sex
(12 studies). Studies that examined baseline DV
as a moderator sought to determine whether pro-
gram effects varied depending on whether or the
extent to which an adolescent had engaged in
and/or experienced DV prior to program partici-
pation. Three of the four studies that examined
baseline DV history as a potential moderator
found differential program effects on at least one
DV outcome (Foshee et al. 2005; Miller
et al. 2015; Cunningham et al. 2013). Foshee
et al. (2005) found that the effects of Safe Dates
895
on severe physical DV victimization were stron-
ger for those whose baseline risk was lower. In
contrast the effects of SHARP (Miller et al. 2015)
and SafERteens (Cunningham et al. 2013) were
found to be stronger for those with higher baseline
risk. Baseline history of DV was not found to
moderate the effects of the Shifting Boundaries
program on DV outcomes (Taylor et al. 2013).
Only one of the four studies that examined D
race/ethnicity as a potential moderator found dif-
ferential program effects, and the direction of
these findings differed depending on the type of
DV being considered (Peskin et al. 2014). In
particular, IYG was found to reduce psychological
DV (victimization and perpetration) among His-
panic but not African-American youth. In con-
trast, the effects of IYG on physical DV
victimization were significant for African-
American but not Hispanic youth (Peskin
et al. 2014). All but two of the 12 studies that
examined sex differences found no sex differ-
ences in program effects on DV behaviors. The
two that found sex differences (Fourth R and IYG)
both found that the programs prevented DV per-
petration among boys but not girls (Wolfe
et al. 2009; Peskin et al. 2014).
Mediation of Program Effects
The assessment of the processes through which a
program works to prevent or reduce DV can
inform scientific understanding of why the inter-
vention worked. Although several of the studies
(n = 12, 70%) assessed the effects of the pro-
grams on risk factors for DV that were targeted
for change by program activities, only two studies
conducted formal mediation analysis to identify
the mechanisms explaining the effects of the pro-
gram on DV (Foshee et al. 2005, 2015b). Ana-
lyses of the Safe Dates program suggest that
effects on DV were mediated primarily by
changes in acceptance of DV, gender stereo-
typing, and awareness of community services,
not through improvements in conflict manage-
ment skills or belief in need for help (Foshee
et al. 2005). Analyses of MTSD found that ado-
lescent acceptance of DV, conflict management
skills, and feelings of family closeness and cohe-
sion mediated the effects of MTSD on DV
896
outcomes among teens with higher exposure to
domestic violence; there were no significant indi-
rect effects of the program on DV outcomes
through any of the targeted mediators for teens
with lower exposure to domestic violence
(Foshee et al. 2015b). We note, however, that
the analytic approaches used to assess mediation
in both the Safe Dates and MTSD studies did not
address temporality between the mediators and
the outcomes; as such it is unclear whether
changes in the mediators were, in fact, prospec-
tively associated with changes in DV. Despite
this limitation, these mediation analyses are use-
ful in that they suggest that program components
targeting these particular risk and protective fac-
tors are important for achieving effects on DV
behavior and thus should not be cut in program
adaptations.
Recommendations for Future Directions
Overall the number of programs that met the
selection criteria for this review was small (n =
18). Clearly more research is needed to expand the
number of programs being developed and tested
using rigorous designs. In the following, we pre-
sent recommendations for future directions for
this research based on this review.
Future studies should address methodological
limitations of previous program evaluations. All
of the studies reviewed were randomized trials
that controlled for most threats to internal validity.
However, nearly half (n = 8) of the studies
assessed only short-term program effects (final
follow-up conducted 6 months post-
intervention); as such, it is unclear whether these
programs had lasting effects on DV behavior.
Assessment of DV outcomes varied substantially
across studies; some studies conducted compre-
hensive assessments of multiple types of DV vic-
timization and perpetration outcomes (e.g., Safe
Dates), whereas others assessed only one type of
DV victimization and/or perpetration behavior
(e.g., Fourth R). The evaluations of several of
the programs (e.g., JOVEN, BALL, YPP,
SafERteens) had relatively small sample sizes
that may have limited the power of those studies
Dating Abuse: Primary Prevention Efforts
to detect any effects on DV outcomes, particularly
for less prevalent behaviors such as severe phys-
ical and sexual DV. Some studies appeared to
have been powered to detect program effects in
the full sample, but analyses of program effects
were conducted in samples that were stratified by
sex, race, or baseline DV status (e.g., SHARP,
IYG), and those analyses may thus have been
underpowered. None of the studies conducted a
cost-effectiveness analysis which can provide
information that is very useful for agencies when
making decisions about choosing which programs
to implement in their communities.
In addition to these limitations, as noted above,
almost no studies went beyond establishing a
main effect of the program to examine why the
program was or was not effective in producing
change in risk for DV. In some cases, we believe
this may be due to a lack of specification of the
program. For example, in several studies, the par-
ticular behavioral determinants (i.e., risk and pro-
tective factors for DV) being targeted by the
program and/or their theoretical or empirical link-
age to DV victimization and/or perpetration were
not described; only five of the 18 studies provided
a conceptual or logic model for the program being
evaluated that described the constructs targeted by
program content and/or their relationship with DV
outcomes. In other cases, research reports did
identify behavioral determinants targeted by pro-
gram activities, but evaluation was not conducted
to determine whether the program was, in fact,
effective in changing the targeted determinants
and/or whether change in these determinants led
to change in DV outcomes. We thus recommend
that designers of future programs to prevent DV
clearly describe the types of DV behaviors the
program is intended to prevent, the behavioral
determinants being targeted by the program and
their linkages to the DV outcomes and their theo-
retical or empirical base, and the behavior change
techniques (e.g., modeling, feedback on behavior;
providing information about health conse-
quences) being used to produce change in the
targeted determinants. Clear specification of the
program should, in turn, facilitate more nuanced
evaluation research that identifies the content and
mechanisms (through mediation analyses) that
Dating Abuse: Primary Prevention Efforts
produce change in DV thus informing scientific
understanding and future development of more
effective programs.
Also, although many of the studies examined
moderators of program effects, which is critical
for answering questions about for whom and/or in
what contexts the intervention is and is not effec-
tive, some potentially important moderators were
not examined. For example, an important poten-
tial effect modifier that should be considered in
evaluation research is the sexual orientation of the
adolescent. Heterosexuality is typically assumed
in current programs, and, because sexual orienta-
tion has not been examined as an effect modifier, it
is unclear whether the programs reviewed here
would or would not have had differential effects
depending on sexual orientation. It is also notable
that the types of moderators examined by studies
in the current review were limited to individual
personal or demographic characteristics (e.g., sex,
race, history of DV). Future studies should also
examine other types of social contextual variables
(e.g., school context, family context) that could
moderate program effectiveness on DVoutcomes.
Additionally, although many studies examined
potential moderators of program effects, none
empirically examined why there were differential
program effects for subgroups when subgroup
differences were found. For example, although
most studies found that program effects were con-
sistent for boys and girls, two found sex differ-
ences in program effects; three of four studies
found that program effects differed depending on
reports of DV at baseline; and two found race/
ethnicity differences. More research is needed to
explain why these programs were effective for
some groups but not others. Such research could
contribute to identify specific avenues for pro-
gram adaptation and development.
Most of the programs reviewed aimed to
change individual-level determinants of DV
(e.g., knowledge, attitudes). Yet social–ecological
models of partner violence (Fulu and Miedema
2015; Heise 1998) suggest that social contextual-
level risk factors for relationship violence (e.g.,
laws, social norms, neighborhood characteristics)
may be important targets for DV prevention pro-
grams. Interventions that target social contextual
897
factors hold particular promise because they have
the potential to influence large numbers of indi-
viduals and thus influence population-level
change. Bystander intervention programs repre-
sent one potential social contextual prevention
approach that may be particularly powerful when
used with adolescent populations given the
saliency of peer context during this developmen-
tal period. Programs that take a bystander D
approach aim to provide individuals with the
skills necessary to effectively intervene to change
social norms that are accepting of violence and
thus reduce the likelihood of future violence
(Banyard 2011). These types of interventions are
unique in that they engage individuals “. . ..as
potential witnesses to violence rather than as pos-
sible victims or perpetrators” (Coker et al. 2015,
p. 295). As such, they are posited to have a broad
social impact because increased positive
bystander behaviors among program participants
may diffuse through social networks, resulting in
community-level changes in violent behavior
(Coker et al. 2015). Bystander-focused interven-
tions have been found to be effective in reducing
interpersonal violence among university students
(e.g., the Green Dot program; Coker et al. 2015),
and two of the DV prevention programs we
reviewed (SHARP and CBIM) included
bystander components, though, due to the meth-
odological limitations described above, it is
unclear whether these programs worked to effect
change in DV through changes in bystander
intervention.
Also, more research is needed to develop,
implement, and evaluate programs that leverage
the use of technology to prevent or reduce DV
behavior. Technology access and use among ado-
lescents have increased tremendously over the
past decade, sparking the development of numer-
ous eHealth programs that target youth. However,
only two of the programs selected for this review
included a technology-based component, IYG and
SafERteens. Emerging research suggests that
behavior change programs for youth that can be
accessed through the Internet can be effective and
have the potential to provide easy non-school-
based access to program content that is engaging
to adolescents, minimizes cost, and circumvents
898
organizational barriers present in many settings
such as pressure on schools to devote class time
to academics (Shegog et al. 2014).
All of the programs selected for review were
implemented with adolescent populations, yet
longitudinal empirical research (for a review
see Vagi et al. 2013) has identified several child-
hood risk factors for intimate partner abuse (e.g.,
child maltreatment, negative family relations,
early problem behavior) that could be potent
targets for early life-course intervention efforts
(Magdol et al. 1998; Ehrensaft et al. 2003). More
research is needed to evaluate whether programs
targeting childhood risk factors may be effective
in preventing DV perpetration and/or victimiza-
tion during adolescence. There are a number of
extant evidence-based programs that target chil-
dren that have been shown to alter risk factors for
DV (e.g., Nurse–Family Partnership; Miller
2015); an important line of future research
could be to evaluate whether these programs influ-
ence DV victimization and/or perpetration during
adolescence.
Finally, in order to maximize public health
impact, future research is needed to determine
whether DV prevention programs can also be
effective at preventing other adolescent risk
behaviors. Both theory (Jessor et al. 1995) and
empirical research (e.g., Niolon et al. 2015;
Foshee et al. 2015a; Reyes et al. 2014) suggest
that DV is strongly connected to other forms of
peer violence (e.g., bullying, sexual harassment)
as well as to other risk behaviors (e.g., substance
use, sexual risk behavior). These findings suggest
that these behaviors and DV may share risk and
protective factors that could be targeted for
change in single programs to prevent multiple
risk behaviors (i.e., crosscutting prevention pro-
grams; Centers for Disease Control and Preven-
tion [CDC] 2016). Although the current review
focused on summarizing the effects of programs
on DV outcomes, it is noteworthy that ten of the
18 programs reviewed evaluated effects on risk
behaviors or outcomes other than DV. Findings
for program effects on these other risk behaviors
were mixed overall; however, five programs that
were found to have significant effects on DV were
also found to have significant effects on at least
Dating Abuse: Primary Prevention Efforts
one other type of risk behavior (Safe Dates,
Fourth R, Shifting Boundaries-building only,
IYG, and SafERteens). Specifically, Safe Dates,
Shifting Boundaries-building only, and
SafERteens were found to have effects on other
youth violence outcomes (Foshee et al. 2014; Tay-
lor et al. 2013; Peskin et al. 2014; Cunningham
et al. 2013), and the Fourth R and IYG were found
to reduce sexual risk behaviors (Peskin
et al. 2014; Wolfe et al. 2009). Taken together
these findings suggest adolescent DV prevention
programs can be effective in targeting multiple
behavioral outcomes. More research is needed to
understanding the optimal number and types of
behaviors to intervene on, the shared determinants
that should be targeted, and whether to intervene
on behaviors simultaneously or sequentially
(Spring et al. 2012). This is a critical line of
scientific inquiry given the potential for crosscut-
ting programs to be more efficient and have
broader benefits than programs that target a single
risk behavior.
Conclusion
In summary, studies have found evidence to sug-
gest that a number of different universal, selective,
and indicated prevention programs may be effec-
tive in preventing DV victimization and/or perpe-
tration during adolescence. Evidence of sustained
(>6 months post-intervention) effects on multiple
types of victimization and perpetration outcomes
was found for one universal (Safe Dates), one
indicated (IYG), and one selective (YRP)
program. We recommend that future evaluation
studies use designs that allow for long-term
assessment; evaluate multiple types of DV victim-
ization and perpetration outcomes; are well
powered to detect program effects; allow for
assessment of cost-effectiveness; and provide
nuanced information about what program compo-
nents do and do not work, how they work, and for
whom they work. Future areas of research should
seek to identify effective approaches that target
distal and social contextual risk factors, use infor-
mation technology to engage youth, and influence
multiple behavioral outcomes.
Dating Abuse: Primary Prevention Efforts
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Deafness
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Deafness involves partial or complete hearing
loss. Although the range of loss can be wide, and
quite specific terms could be used to describe a
variety of levels of hearing impairment, there
essentially are three broad categories of hearing
loss: profoundly deaf, moderately deaf, and hard
of hearing. The broad variation is of significance
in that it inevitably relates to adolescents’ experi-
ences. The various levels of hearing loss also are
important to consider in that they complicate
research examining its effects and the nature of
hearing loss. The different levels also challenge
efforts to understand the different interventions
that recently have emerged, as well as efforts to
understand their effectiveness. Despite these com-
plexities, research relating to deafness during ado-
lescence and other periods across the life span still
provides us with important findings and trends.
Estimates of the prevalence of deafness are
difficult to establish. Best estimates reveal that
permanent deafness affects roughly 1 in 750 chil-
dren (Davis et al. 1997; Davis and Wood 1992).
The prevalence of other forms of hearing
902
impairments during adolescence is not well
known given that they may be difficult to identify.
National studies reveal that approximately 14.9%
of children in the United States have low-
frequency or high-frequency hearing loss of at
least 16-dB hearing level in one or both ears
(Niskar et al. 1998). Importantly, those studies
also reveal that youth may not even be aware of
the significant hearing loss; of those with mea-
sured hearing loss, 10.8% were reported to have
current hearing loss during the interview (Niskar
et al. 1998). Using more narrow definitions of
hearing impaired leads to conclusions that as
many as 738,000 individuals in the United States
have severe to profound hearing loss; of these,
almost 8% are under the age of 18 (Blanchfield
et al. 2001). Thus, those affected by hearing loss
tend to be adults. Not surprisingly, research tends
to focus on adults (see Agrawal et al. 2008).
There is no doubt that hearing loss affects
health and quality of life, but the extent to which
it does remains debatable to the extent that there
are no simple direct links between hearing loss
and health outcomes. Research does indicate that
deafness associates with cognitive, communica-
tion, and socio-emotional development problems
(Fellinger et al. 2008). Indeed, research has long
reported increased rates of psychosocial problems
in deaf children (Hindley et al. 1994), with the
prevalence of psychopathology reported over the
last three decades varying from 0% to 77% (van
Gent et al. 2007). Although some researchers have
reported a link between psychopathology and
degree of hearing loss, other more recent reports
actually do not (Hindley et al. 1994). It is believed
that, at least in the United States and several other
countries, conditions for hearing-impaired and
deaf youth have significantly changed over the
last decade. The change tends to be viewed as
improvement and greater integration with those
who are not hearing impaired. The difference is
due to technology, mainstreaming in schools, and
earlier detection, as well as cochlear implants, that
have altered and significantly improved the qual-
ity of life for hearing-impaired youth. Some note,
for example, that mainstreaming in schools may
account for fewer differences in levels of psycho-
pathology in deaf children attending mainstream
Deafness
schools versus special schools (Aplin 1987;
Arnold and Atkins 1991; Van Eldik 2005).
Despite the above encouraging findings,
researchers still report differences between hear-
ing and non-hearing-impaired adolescents. For
example, a recent study using children as infor-
mants, in addition to parents and teachers, found
that deaf children have higher rates of emotional
and behavioral problems; the most significant dif-
ferences in deaf children were in conduct prob-
lems, emotional problems, and peer problems;
yet, no significant differences in overall mental
health were observed (Fellinger et al. 2008). Prev-
alence rates of emotional problems have been
reported to be more than twice as high as in the
general population of hearing adolescents but
behavioral problems are found only to be slightly
higher than for hearing groups (van Gent et al.
2007). Despite these findings, other research does
indicate that it may not be hearing impairment per
se that causes emotional and behavioral problems
in deaf children (Hindley and Van Gent 2002; van
Gent et al. 2007). A recent study found that three
factors associated with psychopathology in deaf
youth: lower IQ, signing as mode of communica-
tion, and multiple physical disorders; and that
study concluded that “the only variable signifi-
cantly associated with a dossier diagnosis of a
primary emotional disorder appeared to be a his-
tory of three or more physical disorders” (van
Gent et al. 2007, p. 955). Importantly, physical
health factors also are risk factors for hearing
children (Friedman and Chase-Lansdale 2002) as
is low IQ (Friedman and Chase-Lansdale 2002).
These factors make it difficult to pinpoint the
sources of difficulties. Recent research has found
that the overall quality of life for deaf children was
largely similar to that of the control group, but that
children reported dissatisfaction with interests and
recreational activities (isolation) and their physi-
cal health (Fellinger et al. 2008). Current research
clearly suggests, then, that actors such as commu-
nication problems, physical health issues, and liv-
ing conditions may account for the increase in the
risk of psychiatric disorders in the deaf youth
population and that more research is needed.
Although the above studies offer complex
results, they represent a new wave of research in
Deception
that they actually focus on the adolescents them-
selves. Studies that have deaf children as infor-
mants are lacking and most studies use
questionnaires directed at the adults observing
deaf children’s lives (i.e., parents and teachers).
These studies are important to consider in that
differences in reports pertaining to the same child
have been found (Fellinger et al. 2008) and the
level of agreement between informants (child,
teacher, parent) is generally low (van Gent et al.
2007). With the exception of cochlear implant
studies, quality of life studies do not focus on the
deaf child as the informant. The choice of infor-
mants may explain much of the variation in reports
of psychopathology in deaf youth and more
research is needed using deaf youth as informants.
Despite progress in understanding the experi-
ence of hearing loss during adolescence, much
remains to be investigated and learned. For exam-
ple, the prevalence of hearing loss in the United
States differs across racial/ethnic groups, and risk
factors are not well known (Agrawal et al. 2008).
Similarly, given that hearing loss becomes more
pronounced in later life, hearing loss prevention
(through modifiable risk factor reduction) and
screening should begin much earlier. These and
other conclusions are likely to emerge as the study
of adolescence focuses increasingly on the factors
that contribute to adolescents’ adjustment and the
types of environments that society should aim to
provide youth to ensure their most healthy
adjustment.
References
Agrawal, Y., Platz, E. A., & Niparko, J. K. (2008). Preva-
lence of hearing loss and differences by demographic
characteristics among US adults: Data from the
National Health and nutrition examination survey,
1999–2004. Archives of Internal Medicine, 168,
1522–1530.
Aplin, D. (1987). Social and emotional adjustment of
hearing-impaired children in ordinary and special
schools. Educational Research, 29, 56–64.
Arnold, P., & Atkins, J. (1991). The social and emotional
adjustment of hearing-impaired children integrated in
primary schools. Educational Research, 33, 223–228.
Blanchfield, B. B., Feldman, J. J., Dunbar, J. L., & Gard-
ner, E. N. (2001). The severely to profoundly hearing-
impaired population in the United States: Prevalence
903
estimates and demographics. Journal of the American
Academy of Audiology, 12, 183–189.
Davis, A., & Wood, S. (1992). The epidemiology of child-
hood hearing impairment: Factors relevant to planning
of services. British Journal of Audiology, 26, 77–90.
Davis, A., Bamford, J., Wilson, I., Ramkalawan, T.,
Forshaw, M., & Wright, S. (1997). A critical review
of the role of neonatal hearing screening in the detec-
tion of congenital hearing impairment. Health Technol-
ogy Assessment, 1, 1–176.
Fellinger, J., Holzinger, D., Sattel, H., & Laucht, M. (2008). D
Mental health and quality of life in deaf pupils.
European Child & Adolescent Psychiatry, 17, 414–423.
Friedman, R. J., & Chase-Lansdale, P. L. (2002). Chronic
adversities. In E. T. M. Rutter (Ed.), Child and adoles-
cent psychiatry (4th ed., pp. 261–276). London:
Blackwell.
Hindley, P., & Van Gent, T. (2002). Psychiatric aspects of
specific sensory impairment. In M. Rutter & E. Taylor
(Eds.), Child and adolescent psychiatry (4th ed.,
pp. 842–857). London: Blackwell.
Hindley, P., Hill, P. D., McGuigan, S., & Kitson, N. (1994).
Psychiatric disorder in deaf and hearing impaired chil-
dren and young people: A prevalence study. Journal of
Child Psychology and Psychiatry, 35, 917–934.
Niskar, A. S., Kieszak, S. M., Holmes, A., Esteban, E.,
Rubin, C., & Brody, D. J. (1998). Prevalence of hearing
loss among children 6 to 19 years of age: The third
National Health and nutrition examination survey.
Journal of the American Medical Association, 279,
1071–1075.
Van Eldik, T. (2005). Mental health problems of Dutch
youth with hearing loss as shown on the youth self
report. American Annals of the Deaf, 150(1), 11–16.
van Gent, T., Goedhart, A., Hindley, P., & Treffers,
P. (2007). Prevalence and correlates of psychopathol-
ogy in a sample of deaf adolescents. Journal of Child
Psychology and Psychiatry, 48(9), 950–958.
Deception
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Overview
Deception, the variety of ways that individuals
can be dishonest to get what they want, appears
commonplace. There are deceptions to others as
well as to ourselves. These deceptions serve
important functions as they help maintain rela-
tionships. But, they can also be problematic,
904
such as when they relate to deviant behavior but
more commonly in the harm it can cause relation-
ships as well as people’s healthy development.
This essay examines trends in this area of research
as it relates to adolescents, including highlighting
areas in need of more research.
Deception
Deception, typically defined as deceiving and dis-
honesty, comes in many forms. Deception can
involve pretense, trickery, concealment, feigning,
obfuscation, diversion, lying, misleading, and a
variety of other ways that individuals actively
provide misinformation. Whether misinformation
is provided in specific instances rests on how
individuals create boundaries that determine the
amount of information that they will share with
others as well as, importantly, with themselves
(in the form of self-deception). Research relating
to adolescence has tended not to address decep-
tion directly, but much research relating to the
adolescent period sheds light on the significance
of deception as it relates to adolescence. That
research, however, tends to focus on adolescents’
own deceptions rather than others’ deceptions of
adolescents. Overall, research does reveal that
deceiving may be a necessary part of healthy
development but that relatively greater deception
likely reflects problematic circumstances and con-
tributes to negative outcomes.
Among other areas of research relating to
deception by adolescents, one of the most
illustrative areas involves deception in their
relationships with their parents. The adolescent
period involves developmental milestones in
parent–child relationships that contribute to
changes in the management of information that
reflect, and shape, changing parenting relation-
ship boundaries. Part of those boundary changes
involves adolescents’ expanding their views of
what they deem personal and their resisting par-
ents’ monitoring in efforts to change boundaries.
That resistance has important implications for the
parent–child relationship, parental socialization
efforts, and the transfer of information. The vast
majority of adolescents report withholding some
Deception
information from parents, especially information
that relates to personal or deep moral issues, and
that withholding is what adolescents use to create
boundaries between themselves and others (see
Darling et al. 2006; Smetana et al. 2006).
The reasons for creating boundaries and for
withholding information are numerous, but they
typically include a desire to foster privacy, con-
cern that parents would not be understanding, and
effort to avoid sanctions (Darling et al. 2006; Yau
et al. 2009). These motivations mean that the
nature of parent–child relationships has a power-
ful effect on the extent to which adolescents
deceive. Perceptions of parents’ roles and legiti-
macy have been deemed key factors that influence
adolescents’ deceptions. Adolescents are more
likely to disclose information accurately when
they believe that they were obliged to obey par-
ents with regards to a particular issue (Darling
et al. 2006) and when adolescents believe that
their parents have a legitimate claim to informa-
tion (Cumsille et al. 2010). Deception, then, may
be part of healthy individuation, but low levels of
disclosure and high levels of concealment reflect
poor quality relationships and problem behaviors
(Finkenauer et al. 2002, 2005). Not surprisingly,
youth involved in problem behavior are more
likely to be manipulative and more likely to tell
self-serving lies as well as more lies (Kashy and
DePaulo 1996). Adolescents who have strong
relationships with parents, and who view parents
as more trustworthy, are less likely to keep infor-
mation from them (Yau et al. 2009; Kerr
et al. 1999), a finding that may explain why par-
ents’ more aggressive efforts to pursue greater
disclosure runs the risk of fortifying boundaries
and increasing distress (Mazur and Hubbard
2004; Masche 2010).
Importantly, little research has examined the
extent to which, and if so why, parents deceive
their children. A handful of studies have exam-
ined the phenomenon of “parenting by lying.”
That phenomenon involves parents’ telling their
children lies to influence their emotional states
and behaviors. Late adolescents report that their
parents lied to them while maintaining a concur-
rent emphasis on the importance of being honest,
and parents report lying to their children to
Deception
promote behavioral compliance or positive feel-
ings (Heyman et al. 2009). It also appears that
parents who promote honesty do not necessarily
lie less to their children. This aspect of parenting
appears across cultures, although there appear to
be variations, such as parents in China using
deception to control behavior more often (or, at
least admitting to it more) than do parents in the
United States (Heyman et al. 2013). Although
these findings are intriguing, it is important
to note that there continues to be scant literature
on parents’ deceptions; what does exist lacks
the depth and nuances of other areas of research
relating to either deception or parent–child
relationships.
The place of deception in parent–child rela-
tionships finds parallels in research on peer rela-
tionships. For example, researchers who study
deception in romantic relationships (as well as
other forms of everyday relationships) suggest
that people communicate their love and support
of others, in part, by lying to them, such as
complimenting them, pretending to agree with
them, and claiming to understand them (see
Ennis et al. 2008). As with parent child–rela-
tionships, deception in romantic relationships
has been linked to three factors (see Cole 2001).
First, deception relates to the relative need for a
reciprocal exchange of information, such as the
perception that another acts dishonestly leads one
to be dishonest toward them as may happen when
relationships lack of emotional closeness and
decline in commitment. Second, deception can
also occur to avoid punishment, in such instances
in which telling the truth is not in one’s best
interests when the confidant may act in a judg-
mental manner and disapproval. Relatedly, decep-
tion may be important to nurturing positive
images of partners and may help avoid negative
thoughts, including conflict. Third, deception fills
individuals’ attachment beliefs, such as if they are
uncomfortable with intimacy, they may use
deception to keep partners at a safe distance. In
this sense, deception in romantic relationships can
mirror those of parent–child relationships in that
they serve as a mechanism to preserve or elimi-
nate boundaries, such as their partners’ closeness,
interest, and intrusiveness. As with parent–child
905
relationships, relatively high deception can con-
tribute to negative outcomes, as evidenced by
research on self-silencing in adolescent relation-
ships, which indicates that self-silencing relates to
poor relationship satisfaction overall as well as
frustration and depressive symptoms (Harper
and Welsh 2007).
Although research on deception tends to focus
on relationships, it is important to consider the D
nature of self-deception. Self-deception figures
prominently in the study of mental health. For
example, drug and alcohol addiction constitutes
a disorder characterized by denial, dishonesty, and
self-delusion, and substance abusing individuals
demonstrate more denial and self-deception than
nondrug-using peers (Strom and Barone 1993;
DiClemente et al. 2004). This denial is made
quite obvious in approaches that aim to assist
youth who have addictions. Treatments necessar-
ily involve confronting an addict’s denial and
resistance to treatment, and recovery involves a
switch in focus from denial to readiness for
change or from a restructuring of one’s self-
perception based more on realism and honesty
than deception. It is no mistake that leading pro-
grams, such as 12-step programs, focus on having
participants examine their personal weaknesses,
admit their mistakes, and make amends to these
individuals; these activities aim to confront more
extreme forms of denial and self-delusion (see
Ferrari et al. 2008).
Although self-deception plays a key role in
addictions, it also plays a key role in other pathol-
ogies and deviant behavior. Indeed, deception is a
necessary prerequisite to criminal conduct and
behavioral expressions of pscychopathy and a
wide variety of complex mental health disorders.
The denial of illness in anorexia nervosa illus-
trates well the significance of self-deceptions (for
a review, Vandereycken 2006). The current under-
standing of anorexia nervosa reveals that it can
consist of least two forms of deception. The first
form of deception is unintentional and can include
a variety of distorted information processing that
may be signs of neurobiologically impaired self-
awareness (anosognosia), distortions of reality
that are psychotic-like, dissociation, or efforts to
cope with illness (such as would be expected
906
through wishful thinking or the normal filtering
out of ideas that do not fit our preconceived
notions of circumstances). The second form is
more marked by intention and deliberate, such as
refusing to self-disclose and avoiding disclosure
due to fears of consequences, and not necessarily
engaging fully in efforts to get better (e.g., malin-
gering). Deception, then, may be a negativistic
refusal to communicate or an expression of dis-
turbed perceptions and interpretations of
experiences.
Efforts to understand the roots of deception
continue to grow dramatically and focus on rea-
sons for deceiving, the ability to resist it, and
developmental considerations. As we have seen,
individuals are dishonest for multiple reasons,
such as because they wish to avoid painful reali-
ties or they succumb to social influences (social
norms, expectations, pressures) (see, e.g.,
DePaulo and Kashy 1998). Resisting these influ-
ences and facing difficult realities require individ-
uals to behave authentically (by remaining true to
themselves) or honestly (by refusing to deceive),
and such resistance requires personal strength,
psychological stability, and an awareness of
one’s own mental processes. Attachment theory
has been the leading theory used to examine how
personal strength and accurate self-perceptions
develop, and that research suggests that those
strengths develop from supportive relationships
(see Gillath et al. 2010). Youth who engaged in
greater “true-self” behaviors report higher self-
esteem, positive affect, and unconditional support
from close others (Harter et al. 1996). In a real
sense, these findings are unsurprising in that
healthy relationships are central to mental health,
but they are surprising to the extent that healthy
relationships tend to be conceived as devoid of
deception.
Conclusion
Deception figures prominently in adolescents’
lives. Although it tends to be viewed as problem-
atic, it turns out that deception plays important
roles in healthy development as well as healthy
relationships. Yet, it also is clear that deception
Deception
can become problematic. Researchers have
started to take deception seriously and have
made important steps to understand its place in
adolescent development. But, it is clear that
research remains in its infancy and focused on
adolescents’ own deception rather than decep-
tions aimed to adolescents.
Cross-References
▶ Confabulation
▶ Lying
▶ Malingering
References
Cole, T. (2001). Lying to the one you love: The use of
deception in romantic relationships. Journal of Social
and Personal Relationships, 18, 107–129.
Cumsille, P., Darling, N., & Martínez, M. L. (2010). Shad-
ing the truth: The patterning of adolescents’ decisions
to avoid issues, disclose, or lie to parents. Journal of
Adolescence, 33, 285–296.
Darling, N., Cumsille, P., Caldwell, L. L., & Dowdy,
B. (2006). Predictors of adolescents’ disclosure strate-
gies and perceptions of parental knowledge. Journal of
Youth and Adolescence, 35, 667–678.
DePaulo, B. M., & Kashy, D. A. (1998). Everyday lies in
close and casual relationships. Journal of Personality
and Social Psychology, 74, 63–79.
DiClemente, C. C., Schlundt, D., & Gemmell, L. (2004).
Readiness and stages of change in addiction treat-
ment. The American Journal on Addictions, 13,
103–119.
Ennis, E., Vrij, A., & Chance, C. (2008). Individual differ-
ences and lying in everyday life. Journal of Social and
Personal Relationships, 25, 105–118.
Ferrari, J. R., Groh, D. R., Rulka, G., Jason, L. A., & Davis,
M. I. (2008). Coming to terms with reality: Predictors
of self-deception within substance abuse recovery.
Addictive Disorders and Their Treatment, 7, 210–218.
Finkenauer, C., Engels, R. C. M. E., & Meeus, W. (2002).
Keeping secrets from parents: Advantages and disad-
vantages of secrecy in adolescence. Journal of Youth
and Adolescence, 31, 123–136.
Finkenauer, C., Frijns, T., Engels, R. C. M. E., & Kerkhof, P.
(2005). Perceiving concealment in relationships
between parents and adolescents: Links with parental
behavior. Personal Relationships, 12, 387–406.
Gillath, O., Sesko, A. K., Shaver, P. R., & Chun, D. S.
(2010). Attachment, authenticity, and honesty: Dispo-
sitional and experimentally induced security can reduce
self- and other-deception. Journal of Personality and
Social Psychology, 98, 841–855.
Decriminalization
Harper, M. S., & Welsh, D. P. (2007). Keeping quiet: Self-
silencing and its association with relational and indi-
vidual functioning among adolescent romantic couples.
Journal of Social and Personal Relationships, 24,
99–116.
Harter, S., Marold, D. B., Whitesell, N. R., & Cobbs,
G. (1996). A model of the effects of perceived parent
and peer support on adolescent false self-behavior.
Child Development, 67, 360–374.
Heyman, G. D., Luu, D. H., & Lee, K. (2009). Parenting by
lying. Journal of Moral Education, 38, 353–369.
Heyman, G. D., Hsu, A. S., Fu, G., & Lee, K. (2013).
Instrumental lying by parents in the US and China.
International Journal of Psychology, 48(6),
1176–1184.
Kashy, D. A., & DePaulo, B. M. (1996). Who lies. Journal
of Personality and Social Psychology, 70, 1037–1051.
Kerr, M., Stattin, H., & Trost, K. (1999). To know you is to
trust you: Parents’ trust is rooted in child disclosure of
information. Journal of Adolescence, 22, 737–752.
Masche, J. G. (2010). Explanation of normative declines in
parents’ knowledge about their adolescent children.
Journal of Adolescence, 33, 271–284.
Mazur, M. A., & Hubbard, A. S. E. (2004). “Is there
something I should Know?”: Topic avoidant responses
in parent-adolescent communication. Communication
Reports, 17(1), 27–37.
Smetana, J. G., Metzger, A., Gettman, D. C., & Campione-
Barr, N. (2006). Disclosure and secrecy in adolescent-
parent relationships. Child Development, 77, 201–217.
Strom, J., & Barone, D. F. (1993). Self-deception, self-esteem,
and control over drinking at different stages of alcohol
involvement. Journal of Drug Issues, 23, 705–714.
Vandereycken, W. (2006). Denial of illness in anorexia
nervosa – A conceptual review: Part 2 – Different
forms and meanings. European Eating Disorder
Review, 14, 352–368.
Yau, J. P., Tasopoulos-Chan, M., & Smetana, J. G. (2009).
Disclosure to parents about everyday activities among
American adolescents from Mexican, Chinese, and Euro-
pean backgrounds. Child Development, 80, 1481–1498.
Decriminalization
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Decriminalization describes the process by which
acts or deeds are removed from legal categories of
criminal behavior. In popular culture, it most
likely refers to the legalization of drugs or certain
behaviors (such as sexual behaviors) that were
previously subject to criminal penalties. For
907
adolescents, the term most likely connotes the
removal of certain types of juvenile offenders
from the juvenile court system and handling
them, instead, in the child welfare system or out-
side of courts altogether. In the USA, this process
occurred largely in the late 1960s and 1970s,
although its reversal quickly occurred in the
1980s and has been largely ignored.
The decriminalization of status offenses in the D
USA was hastened by an enormously influential
federal legislation known as the Juvenile Justice
and Delinquency Prevention Act of 1974 (see, e.g.,
Blitzman 2007). Among other provisions, the act
established a federal Office of Juvenile Justice and
Delinquency Prevention to assist the states in bet-
ter accomplishing juvenile justice system objec-
tives and made grants to states contingent on
averting placement of status offenders in detention
and correctional facilities. The legislation is also
known for its focus on deinstitutionalizing status
offenses, which was an effort to not institutional-
ize youth who had committed status offenses. The
federal mandates helped support significant
reforms, including state statutes that were then
tailored to federal requirements.
A major result of legislative changes was the
removal of status offenses from the category of
delinquency and the creation of new a status-
offense category or the use preexisting depen-
dency/neglect category. It was this separation
that became known as decriminalization. Differ-
ent states recategorized status offenses into differ-
ent labels, such as person in need of supervision
(PINS), minor otherwise in need of supervision
(MINS), juvenile in need of supervision (JINS),
child in need of supervision (CHINS), youth in
need of supervision (YINS), and a child of a
family in need of services (FINS).
Although decriminalization has long been seen
as the default rule, the legislation was amended in
1980, in response to family and juvenile court
judges’ frustration with their inability to enforce
orders by placing juveniles in secure facilities.
Under the “valid court order exception,” status
offenders may be incarcerated, without a state’s
jeopardizing federal funding, for violations of
court orders entered in dependency or children in
need of supervision proceedings that prohibit the
908
child from engaging in specified status offense
behaviors, such as running away from home or
foster care. The valid court order exception
substantially has undermined the Act’s original
goal of reducing the use of secure detention to
punish status offenders. The use of valid court
orders has been viewed as disproportionately
used against certain groups of status offenders,
especially girls (Humphrey 2004). This process
has become known as the recriminalizing sta-
tus offenses in that offenders could now be
reclassified as delinquents and placed in secure
confinement.
Cross-References
▶ Juvenile Court Rationales and Models
References
Blitzman, J. D. (2007). Gault’s promise. Barry Law
Review, 9, 67–98.
Humphrey, A. (2004). The criminalization of survival
attempts: Locking up female runaways and other status
offenders. Hastings Women’s Law Journal, 15, 165–184.
Defense Mechanisms
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Defense mechanisms are forms of thinking
meant to preserve an individual’s self-esteem or
to protect them psychologically from feelings of
anxiety that may arise from particular situations.
These mechanisms are often unconscious pro-
cesses, rendering the individual unaware that
they are employing them as coping mechanisms.
Early theorists, such as Freud (1937, 1966), often
equated defense mechanisms with psychopathol-
ogy since they involved a distortion of reality.
Today, however, psychologists and others are
discovering that defense mechanisms also inevi-
tably play a role in normal, everyday functioning
Defense Mechanisms
(see Vaillant 1993). Defense mechanisms can
be adaptive and support normal functioning;
indeed, it is difficult to argue that they are
uncommon ways of approaching life. It is when
individuals excessively rely on these mecha-
nisms that their use can reflect severe psycholog-
ical problems.
Theorists and researchers have identified
many types of defense mechanisms. Among the
most well-recognized defenses are those that
involve denial (refusal to admit something), pro-
jection (ascribing one’s own unacceptable quali-
ties to others), rationalization (explaining away
unacceptable matters to make them acceptable),
intellectualization (reducing anxiety by thinking
about matters in a cold, calculated, and unemo-
tional manner), repression (keeping information
out of conscious awareness), sublimation
(converting unacceptable impulses to acceptable
ones), reaction formation (reducing anxiety by
acting in the opposite manner of true feelings),
and regression (reverting to prior patterns of cop-
ing). Although these are the most recognized
types of defense mechanisms, it is important to
recognize that there are many other forms that
often are not even construed as such, perhaps
because they are positive. Those forms of coping
include, for example, altruism (satisfying needs
by helping others), affiliation (turning to others
for support), and humor (coping by making
light of situations or showing their ironic
components). Together, these types of defense
mechanisms certainly support the claim that
defense mechanisms are common and serve
important ends.
Vaillant (1993) arguably offered the best mod-
ern analysis of defense mechanisms. Vaillant,
who drew from psychoanalytic theory, argued
that defenses could be categorized along four
levels. Level I involves pathological defenses,
which include extreme projection, denial, and
delusional projection. Level II refers to immature
defenses, which include fantasy, idealization,
passive aggression, and acting out. Level III
involves neurotic defenses, which include
intellectualization, regression, and repression.
The last level, Level IV, refers to mature
defenses, and these would include the use
Delay of Gratification 909

of humor, sublimation, and altruism. Although References

not adopting a full developmental approach,
Vaillant’s categorization clearly does highlight Freud, A. (1937/1966). The ego and the mechanisms of
defense. New York: International Universities Press.
how some defense mechanisms reveal a sense
Porcerelli, J. H., Thomas, S., Hibbard, S., & Cogan,
of maturity and emotional health as they help R. (1998). Defense mechanisms development in chil-
optimize development. dren, adolescents, and late adolescents. Journal of Per-
Other researchers have attempted to take more sonality Assessment, 71, 411–420.
Vaillant, G. E. (1993). The wisdom of the ego. Cambridge:
explicitly developmental approaches to the study
of defense mechanisms. Some, for example, have
Harvard University Press. D
placed different types of defense mechanisms in
a hierarchy (most notably, see Porcerelli et al.
1998). Researchers have done so based on the Degradation
age at which they emerge or on their relative
level of maturity or immaturity. For example, ▶ Humiliation
some defense mechanisms require less cogni-
tion, such as denial, whereas others require
more complex cognitive activity, such as intel-
lectualization, or simply more abilities, such as Delay of Gratification
sublimation. As a result of the need for different
cognitive or other abilities, denial tends to be Roger J. R. Levesque
seen more frequently in children aged 5–7, and Indiana University, Bloomington, IN, USA
is infrequent in adolescents and adults. Con-
versely, projection is almost never seen among
the youngest children, a little more so in older
Overview
children, and frequently seen in adolescents
The ability to control oneself, often referred to as
and adults. When observed in adults, denial
self-regulation, is a developmental process that
and projection are considered immature, and
sublimation and altruism are considered mature has broad implications for individuals as well as
society at large. Yet, precisely how adolescents
defenses. Few doubt that the ability to use differ-
learn to be able to control their actions that they
ent mechanisms varies with a variety of individ-
ual differences. wish to commit but should resist for a better
outcome, referred to as delay of gratification, has
The above developments in the understanding
not been the subject of much empirical research.
of defense mechanisms are important. Still, a
more empirical understanding of them likely will This entry examines the concept and highlights
key findings as well as challenges that emerge
remain unsatisfactory given that the area is marred
from efforts to study the phenomenon. It also
by limitations in efforts to investigate them. Lim-
itations are not surprising. The use of defense concludes by highlighting findings relating to the
effects of the ability to delay gratification.
mechanisms is difficult to assess given that indi-
viduals need to be, by definition, unaware of their
use. Even despite these challenges, considerable Defining Delay of Gratification
progress has been made toward better understand-
ing how people address anxieties and potential The concept of delayed gratification refers to
stresses to their psychological health. This pro- the psychological orientation that individuals
gress confirms the need to factor developmental adopt when they decide to forego immediate grat-
considerations, not the least of which would be ification for the sake of reaching a more valuable
how the period of adolescence shapes the devel- but delayed outcome. In research, delayed gratifi-
opment of defense mechanisms, and how adoles- cation also refers to the ability to exercise self-
cents make use of them. control that one exhibits during the waiting
910
process used to assess the ability to delay gratifi-
cation. Delayed gratification has been studied pri-
marily in children, and it has been studied for a
considerably long time (see Mischel and Ayduk
2004). Although it is believed that the delay of
gratification paradigm applies to adolescents,
researchers who study the delay of gratification
during adolescence tend to refer to it or view it as a
part of the constructs of impulse control, self-
control, or self-regulation. Regardless of the
term used, researchers tend to view the delay of
gratification as the key component of children’s
ability to exercise self-control, as a disposition
that is quite stable over time, and a basic and
positive aspect of personality.
Delay of Gratification During
Adolescence
Given that the above constructs typically studied
during adolescence relate to the phenomenon of
delayed gratification, there is value to examining
important research in this area in order to under-
stand the roots of what appears during adoles-
cence. The ability to self-regulate or otherwise
control one’s impulses is important for a variety
of reasons. It is important for understanding ado-
lescents’ own behaviors, especially their risk tak-
ing. It is also important for greater society given
that the difficulties in exerting self-control link to
numerous problem behaviors such as substance
abuse, risky sexual activity, and violence (Carroll
et al. 2009). Indeed, the ability to control oneself
and act in ways that consider the future certainly
constitutes a key aspect of human development.
Individual differences in self-control are read-
ily apparent early in life and tend to be fairly stable
across the life span. Children with self-regulatory
deficits show more psychopathology, are more
readily frustrated and aggressive, pay less atten-
tion in school, and have lower academic success
than children who exercise self-control. As ado-
lescents, such children have deficits in their aca-
demic, cognitive, and social competencies, and
these deficits persist into adulthood (Ayduk
et al. 2000). In their study of delay of gratification,
for example, Mischel et al. (1988) assessed
Delay of Gratification
participants during preschool and a decade later
when the children were in adolescence. They
found persistent correlations between self-imposed
delay time during childhood and later ratings on a
variety of healthy characteristics. They noted that
delaying behavior in childhood predicted a set of
cognitive and social competencies and stress toler-
ance consistent with experimental analyses of the
process underlying effective delay when the chil-
dren were in preschool. Children who are able to
wait longer during childhood, for example, were
rated, by parents, as more rational, planful, atten-
tive, tolerant of stress and frustration, as well as
academically and socially competent. The ability to
delay gratification apparently stabilizes early and
its benefits continue.
Research demonstrating continuity in terms of
related outcomes is important, but it remains a
challenge to study delay of gratification during
adolescence. The study of self-regulation during
childhood typically uses Mischel’s (1974) delay
of gratification assessment procedure. This
method involves leaving young children alone
with two attractive reward objects, such as one
versus two marshmallows. The children’s ability
to delay gratification is determined by evaluating
what they do after they have been instructed that
they will receive the larger reward if they wait for
the experimenter to return. If they cannot wait and
call the experimenter to return, they receive the
smaller reward. The ability to delay gratification is
measured by the time that the child delays ringing
the bell. Studies of adolescents have tried to tap
into the same process as Mischel’s delay of grat-
ification paradigm. Although those studies have
used approaches that are subject to criticism, they
nevertheless identify trends similar to those found
in research conducted with younger participants.
Given how rewards work, it is understandably
difficult to design appropriate experiments that
would meaningfully tap into mechanisms relating
to Mischel’s delay procedure. Incentives are diffi-
cult to find for adolescents, and it is difficult to
determine what a meaningful delay would be for
them. Still, some have used analogue measures such
as choices between hypothetical money rewards
and financial incentives (Funder and Block 1989;
Krueger et al. 1994; Wulfert et al. 2002). These
Delay of Gratification
studies, as well as some that use other methods,
generally report consistent findings that support
the positive view of the ability to delay gratification.
A few studies provide strong examples of this
area of research. For example, Funder and Block
(1989) present their findings from experiments
that assessed 14-year-old subjects who chose
between immediate monetary payment and
larger, delayed payments on five occasions.
They found that, compared to those who delayed,
adolescents who were unable to contain their
impulse for immediate gratification were rated
as less intelligent and more rebellious, self-
indulgent, irritable, restless, aggressive, and gen-
erally not self-controlled and hostile. In another
study (Funder et al. 1983), the same research
team reports that boys who delayed gratification
tended to be described as deliberative, attentive,
reasonable, reserved, cooperative, and able to
modulate motivational and emotional impulses.
Girls who delayed gratification were consistently
described in such positive terms as intelligent,
resourceful, and competent. Girls who did not
delay were viewed as tending to fall apart under
stress and characterized as easily offended,
sulky, and whiny. Girls who were less able to
delay gratification were also more likely to be
victimized by other children. Wulfert
et al. (2002) found that adolescents who were
deemed more impulsive had low self-esteem,
underperformed in school, and engaged in a vari-
ety of behaviors deemed problematic, such as
cigarette smoking, drinking, marijuana use, and
fighting. Together, these studies indicate that
adolescents who are unwilling to delay gratifica-
tion show a broad range of personality attributes,
attitudes, and behaviors that might be described
as signs of being undercontrolled.
The mechanisms that account for the ability to
delay gratification have been studied most exten-
sively in children, although the mechanisms
appear to transfer to adolescents. The leading
researchers in this area, Mischel and his colleagues
(see, e.g., Mischel and Ayduk 2002, 2004), frame
the ability to delay in terms of “willpower”
dynamics. They use a framework that casts
mechanisms in terms of the interaction between
“hot” and “cold” cognitive decision-making
911
systems. Hot systems are those that are impul-
sive (the “go” systems) and the cold ones are
those that are more cool and deliberate (the
“know” systems). The ability to delay gratifica-
tion comes when an individual is able to exert
the willpower needed to “cool” or self-distance
oneself from negative arousal in frustrating or
otherwise difficult situations. These controls
prevent the use of “hot” impulsive responses D
that would inhibit the ability to achieve longer-
term goals. This observation has led researchers
to try to identify ways to help individuals cool
their systems, such as by using purposeful self-
distraction and cognitive reframing (Mischel
and Ayduk 2004). The ability to work though
these systems is seen as not only leading to
positive life outcomes, as noted above, but also
to protecting individuals from long-term conse-
quences of dispositional vulnerabilities.
Conclusion
Studies have had difficulty studying the process
of delaying gratification during adolescence.
Those that do exist tend to reveal patterns similar
to those found during early childhood. The stud-
ies also find that a disposition conducive to
delaying gratification tends to be quite stable
over time, even though it may manifest itself
differently. Although researchers who study the
adolescent period adopt different terminologies
and focus on different aspects of the ability to
delay gratification, it is clear that the capacity to
delay gratification is important during adoles-
cence and that this actually is the very time
when real-life difficulties arise from youth’s
inability to control their impulses.
Cross-References
▶ Self-Regulation
References
Ayduk, O., Mendoza-Denton, R., Mischel, W., Downey, G.,
Peake, P. K., & Rodriguez, M. (2000). Regulating the
interpersonal self: Strategic self-regulation for coping
912
with rejection sensitivity. Journal of Personality and
Social Psychology, 79, 776–792.
Carroll, A., Houghton, S., Durkin, K., & Hattie, J. (2009).
Adolescent reputations and risk: Developmental trajec-
tories to delinquency. New York: Springer.
Funder, D. C., & Block, J. (1989). The role of ego-control,
ego-resiliency, and IQ in delay of gratification in ado-
lescence. Journal of Personality and Social Psychol-
ogy, 57, 1041–1050.
Funder, D. C., Block, J. H., & Block, J. (1983). Delay of
gratification: Some longitudinal personality correlates.
Journal of Personality and Social Psychology, 44,
1198–1213.
Krueger, R. F., Caspi, A., Moffit, T. W., White, J., &
Stouthamer-Loeber, M. (1994). Delay of gratification,
psychopathy, and personality: Is low self-control spe-
cific to externalizing problems? Journal of Personality,
64, 107–129.
Mischel, W. (1974). Processes in delay of gratification. In
L. Berkowitz (Ed.), Advances in experimental social
psychology (Vol. 7, pp. 249–292). San Diego: Academic.
Mischel, W., & Ayduk, O. (2002). Self-regulation in a
cognitive-affective personality system: Attentional con-
trol in the service of the self. Self and Identity, 1, 113–120.
Mischel, W., & Ayduk, O. (2004). Willpower in a
cognitive-affective processing system: The dynamics
of delay of gratification. In R. F. Baumeister &
K. D. Vohs (Eds.), Handbook of self-regulation:
Research, theory, and applications (pp. 99–129). New
York: Guilford.
Mischel, W., Shoda, Y., & Peak, P. (1988). The nature of
adolescent competencies predicted by preschool delay
of gratification. Journal of Personality and Social Psy-
chology, 54, 4–10.
Wulfert, E., Block, J. A., Ana, E. S., Rodriguez, M. L., &
Colsman, M. (2002). Delay of gratification: impulsive
choices and problem behaviors in early and late ado-
lescence. Journal of Personality, 70, 533–552.
Delinquency
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Delinquency is a behavior that refers to the viola-
tion of law that, if occurring in an adult, would be
considered a crime. That general definition, how-
ever, is fraught with so many exceptions that it is
now a challenge to view it as a general rule. In the
United States, the age at which an offense is
defined as crime rather than a delinquent act varies
by characteristics of crimes, victims, and
Delinquency
offenders; it may be lower than 14 years of age
to as high as 21 years (Levesque 2000). In recent
years, there has been a tendency to include viola-
tions of regulations that would not ordinarily be
considered crimes, such as, truancy and running
away from home. Equally making it difficult to
maintain a general rule is the variety of ways that
offenses that were once deemed delinquent acts
could now be charged as crimes by transferring
juveniles to adult court and by having many
offenses that confer dual jurisdiction with juvenile
and adult courts (Polachek 2009).
Cross-References
▶ Deviancy
▶ Deviancy Training
▶ Gangs
References
Levesque, R. J. R. (2000). Adolescents, sex and the law:
Preparing adolescents for responsible citizenship.
Washington: American Psychological Association.
Polachek, E. A. (2009). Juvenile transfer: From “Get Bet-
ter” to “Get Tough” to where we go from here. William
Mitchell Law Review, 35, 1162–1193.
Delinquency Trajectories
Frances P. Abderhalden1 and Sara Z. Evans2
1
Department of Criminology and Criminal
Justice, University of West Florida, Pensacola,
FL, USA
2
Department of Criminology and Criminal
Justice, University of West Florida, Pensacola,
FL, USA
Developmental Trajectories
Overview/Introduction
During adolescence, delinquency is closer to
being normative than at any other point in the
life course. It is also the case, however, that
adolescents demonstrate dramatically different
Delinquency Trajectories
patterns or trajectories of deviant behavior during
this period. These trajectories vary with regard to
onset, seriousness, and desistance of delinquent
behavior. Explaining these differing patterns of
externalizing behavior problems is important
because there is strong evidence that some por-
tend negative consequences during adulthood.
The likelihood of criminal behavior persisting
from childhood and teenaged years into adulthood
can be predicted in part by an individual’s trajec-
tory of delinquent behavior.
Theoretical Perspectives on Delinquency
Trajectories
Life course theory is useful in examining patterns
of offending from a developmental perspective.
This approach emphasizes factors such as social
ties to others, how the past shapes the future, and
the importance of timing (Elder 1998). With
regard to antisocial behavior, the theory posits
that childhood behavioral characteristics and
experiences determine whether an individual will
act out in deviant ways just as a teenager and then
desist, as most do, or will become a persistent
offender throughout their life. Laub and Sampson
(2003) integrated life course principals with their
social control framework and note that various
sources of influence can affect an individual’s
pattern of behavior in both positive and negative
ways. They conceptualize these events as “times
of decision or opportunity when life trajectories
may be directed on to more adaptive or maladap-
tive paths” (Rutter and Rutter 1993, p. 244). They
extend the life course perspective by adding an
emphasis on an age-graded theory of informal
social control and argue that throughout an indi-
vidual’s life social institutions are influential to
differing degrees (Laub and Sampson 2003). For
example, children and preteens are influenced
more heavily by their parents than older adoles-
cents, but as youth reach adolescence, the influ-
ence of parental behaviors and attitudes begins to
fade in favor of peers (Steinberg and Monahan
2007; Hoffmann and Cerbone 1999). Unlike other
theories of antisocial behavior, Sampson and
Laub (2003) attempt to explain both continuity
913
and discontinuity in behavior. Their theory of
age-graded informal social control tries to explain
trajectories of offending by identifying changing
social influences over time. Their intent is to
include both childhood as well as experiences
later in life to understand developmental
outcomes.
Moffitt (1993, 1997) developed a dual-
taxonomy model in which she identified two tra- D
jectories of delinquent behavior: adolescent-
limited and life-course-persistent trajectories.
She argues that these two trajectories vary in
timing and length of antisocial behavior. For
most individuals the highest rate of delinquency
is found during adolescence. Much past research
has shown that offending drops dramatically by
age 16–17 for most persons and remains very low
thereafter. For a small subset of offenders, how-
ever, offending continues to increase or remains
stable throughout life. These two offending pat-
terns overlap in adolescence, which makes it dif-
ficult to identify differences during this time
period; a prediction has been supported in recent
research (Young 2014). Life-course-persistent
offenders engage in antisocial behavior at earlier
ages and at every stage of life. Factors such as
inept parenting, cognitive deficits, and psycholog-
ical traits such as low self-control lead to early
interactions with teachers, law enforcement, and
other authority figures. Most of these interactions
will lead to negative consequences, which in turn
limit options for a change in lifestyle, a process
whereby “life course persistents” become
ensnared by the consequences of their antisocial
behavior (Moffitt et al. 2002; Woodward
et al. 2002). This process, known as “cumulative
continuity,” is a gradual buildup of consequences
associated with delinquent or antisocial behavior,
wherein each individual act snowballs upon the
results of previous acts, making it more and more
difficult for one to change the trajectory of their
own life (Moffitt 1997).
Adolescent-limited delinquency refers to anti-
social behavior during adolescence, whether in
the form of status offenses (e.g., truancy, drinking
underage) or other minor delinquent acts such as
shoplifting. These individuals have more norma-
tive childhoods and do not begin to display
914
antisocial or delinquent behaviors until a later age.
By middle adolescence these behaviors are nor-
mative and expected but decline with age (Moffitt
1997). For adolescent-limited offenders, respon-
sibilities of work and/or school begin to take
precedence over delinquent activities and most
begin to realize that these activities may threaten
their future success. In addition, some of the acts
that were delinquent or taboo (i.e., drinking, sex-
ual activity) become more acceptable as they
grow older (Moffitt 1997). There is some support
in the literature for the effect of this “maturity
gap” on adolescent-limited offending (Young
2014; Barnes and Beaver 2010). Finally, these
adolescent-limited offenders also do not have the
same psychological and familial deficits as most
life-course-persistent offenders and are not bat-
tling against a history of antisocial behavior that
has accumulated for years. This results in better
opportunities for success in postsecondary educa-
tion and the work force. There have been numer-
ous studies that investigated the presence of these
two patterns through adolescence (for a review
see Moffitt 2003).
Factors Influencing Trajectory Group
Membership
Past research indicates that there are many factors
that distinguish between offenders who desist
early in life and those that who do not, including
contact with delinquent peers (Miller et al. 2009);
cognitive abilities (Piquero and White 2003); and
victimization (Cullen et al. 2008). Further, some
events that are somewhat normative to adults,
such as a residential move or the death of a friend,
may have a more lasting negative impact on chil-
dren or adolescents (Hoffmann and Cerbone
1999). Finally, family of origin factors are found
to play an important role in adolescent problem
behaviors. For example, parenting practices con-
sistent with authoritative parenting such as
warmth (Simons and Conger 2007) and harsh
discipline (Simons et al. 2013) are negatively
associated with delinquency for adolescents,
regardless of SES or ethnicity (Simons
et al. 2013, 2014). Scholars have also investigated
the influence of family structure on childhood
behavioral outcomes. Studies investigating this
Delinquency Trajectories
issue show that with the exception of stepparents,
youth in households with two parents or care-
givers have the most positive outcomes while
those in households with only one parent or care-
giver tend to have more behavior problems in
comparison (Simons et al. 2006a).
Family Factors
One of the best known predictors of antisocial
behavior stems from parenting practices (Simons
et al. 2004). Some have found that maltreatment
during adolescence is more predictive of
increased offending, as compared to during youn-
ger years (Stewart et al. 2008). Similarly, Pires
and Jenkins (2007) found that effects of parental
warmth and rejection on drug use differed based
on the age of the respondent. Rejection was more
influential for young adolescents (age 10) than
warmth, while the opposite was true later in ado-
lescence. They suggest that positive attributes of
parent–child relationships such as warmth may
inadvertently be interpreted by the child as
approval for their behaviors, even if those behav-
iors are antisocial in nature.
Besemer and Farrington (2012) investigated
the delinquency trajectories of children who
have sporadic and chronic offending fathers.
They look at how intergenerational criminal
behavior is related to offspring criminality.
Using data from the Cambridge Study in Delin-
quent Development with 411 males from London,
as well as some with female siblings who were
factored into the study as offspring, they found
that the sons’ conviction trajectories resulted in
five groups: nonoffenders, low desisters, low
chronic offenders, and high desisters, and chronic
offenders (Besemer and Farrington 2012). The
daughters’ conviction trajectories were similar
but only resulted in three groups: nonoffenders,
low desisting offenders, and chronic offenders.
Overall, chronic offending fathers did not predict
chronic offending children significantly different
than low desisting fathers. This means that con-
viction of any kind was the biggest predictor of
delinquent behavior, regardless if the father
desisted or persisted (Besemer and Farrington
2012). Yonai et al. (2015) also examined how
parental convictions influenced the trajectories of
Delinquency Trajectories
delinquency. They found similar results that con-
viction, or incarceration, was a bigger predictor of
later chronic offending for the juveniles as com-
pared to chronic relative offending. Parental
imprisonment matters more in the chronic trajec-
tory of children, than persistent offending by par-
ents (Besemer and Farrington 2012; Yonai
et al. 2015).
The relationship between harsh discipline and
behavioral outcomes is studied substantially in
prior literature (For reviews see (Gershoff 2002;
Hicks-Pass 2009; Larzelere and Kuhn 2005;
Paolucci and Violato 2004). The relationship
studied most prominently in this type of research
is that between corporal punishment and antiso-
cial behavior. There is a significant amount of
empirical support that adolescents who are phys-
ically punished by their parents display increased
levels of antisocial behavior, when using scaled
measures of antisocial behavior indicators
(Grogan-Kaylor 2004, 2005; McKee et al. 2007;
Simons et al. 2000; Straus and Mouradian 1998;
Straus et al. 1997).
While disciplinary techniques are critical in
understanding the effects of parenting on child-
hood outcomes, additional components of the
parent–child relationship are consequential as
well. Multiple scholars argue that “authoritative”
parents foster the most prosocial children; author-
itative parenting is illustrated as support and nur-
turance but also a reasonable amount of control
which includes setting rules and enforcing conse-
quences for breaking those rules (Meteyer and
Perry-Jenkins 2009; Simons et al. 2005). Author-
itative parenting is associated with numerous
positive outcomes for children, including psycho-
logical adjustment and school achievement
(Simons et al. 2004, 2007). Researchers point
out, however, that it is not simply control in iso-
lation that promotes these positive outcomes but
the control coupled with support and warmth
(Simons et al. 2000).
Hoeve and colleagues (2008) examined how
delinquent trajectories and parenting styles are
related. Using the Pittsburgh Youth Study, they
wanted to see the extent that parenting styles
predicted the different trajectory paths of adoles-
cence between 10 and 19. The five trajectory
915
categories are similar to prior literature, with non-
delinquent, minor persisting, moderate desisting,
serious persisting, and serious desisting trajecto-
ries found. They identified three parenting tech-
niques, authoritative, authoritarian, and
neglectful, to compare against the development
of delinquency in the youth. They found that
parenting style does matter, but is not the sole
factor, in regards to non- or minor delinquents D
versus more serious offenders. Serious persisters
were significantly more likely to stem from fam-
ilies using authoritarian parenting as compared to
nondelinquents. The researchers do point out that
parenting is not the only factor that should be
considered, as all of the sample prior offending
was the most predictive of continual offending.
Keijsers and colleagues (2012) investigated the
transformation of parent–child relationships in
later childhood and adolescence to see if trajecto-
ries change. They used the Pittsburgh Youth Study
and a male only sample to look at the quality of the
parent–child relationship, joint activities between
the parent and child, and the general delinquency
of the children. Five offending trajectories were
uncovered: nonoffenders, moderate childhood
offenders, adolescent-limited offenders, serious
childhood offenders, and serious persistent
offenders (Keijsers et al. 2012). The differences
in parent–child relationship differ between the
trajectory groups and provide support for the
developmental changes mattering in delinquent
behavior. Nonoffenders reported high and stable
quality of relationship between their parents,
while serious persistent offenders reported poorer
quality of relationships across their childhood and
adolescence. These results indicate that parenting
factors matter when following offending trajecto-
ries of youth.
Baglivio et al. (2015) investigated how adverse
childhood experiences impact delinquency trajec-
tories of youth over time from 7 to 17. Using data
from 64,000 adjudicated juveniles in Florida, they
identified five trajectory groups and how the expo-
sure to adverse childhood experiences impacted
early onset and chronic offending risk factors.
Similarly, Murphy and colleagues (2012) exam-
ined how protective factors changed the trajectory
of delinquent offending versus the vulnerability
916
factors (read adverse childhood experiences)
impacted risk factors for youth. Murphy
et al. (2012) used the National Longitudinal Sur-
vey of Youth with a sample size of 8,984 (49%
female) to see how these protective factors at
home were predictive factors for delinquency tra-
jectories. In both samples (Baglivio et al. 2015;
Murphy et al. 2012), exposure to adverse child-
hood experiences, or low protective factors, was
predictive of high delinquency trajectory groups.
The adverse nature of parenting and environmen-
tal support resulted in trajectory groups of high
delinquency rates and more persistence in crimi-
nal behavior than other trajectory groups com-
pared to higher protective factors.
Effectively monitoring and supervising chil-
dren is a key element in authoritative parenting.
Antisocial behavior in children and adolescents is
shown to be related to parental monitoring/super-
vision (Simons et al. 2004). Parents who are more
aware of where their children are and how they are
spending their time have less opportunity to
engage in delinquent behaviors. Multiple studies
have supported this connection, either in the form
of authoritative/supportive parenting or a unique
effect of limit setting or supervision (Juon
et al. 2006; Kirk 2009; Meteyer and Perry-Jenkins
2009; Middleton et al. 2009). Additionally, the
components of the guardians own antisocial
behavior or mental health may also impact the
offending trajectories of adolescents.
Family structure is also investigated for having
an influence on the childhood behavioral out-
comes. It is quickly becoming the societal norm
to come from households without both biological
parents (Amato 2005). This decrease in being
raised with a family form that includes both bio-
logical parents leads to support research that chil-
dren are more at risk for developing behavioral,
emotional, and cognitive difficulties (Amato
2005; Simons et al. 2004). In general, results
show that children raised in families with both
biological parents have the most positive out-
comes. Households with only one biological par-
ent, or with a stepparent, are more inclined to have
behavior problems in comparison (Apel and
Kaukinen 2008; Cavanagh and Huston 2006;
Simons et al. 2006a). Recently there has been an
Delinquency Trajectories
increased interest in investigating the relative out-
comes of cohabitating families, as this form of
family is increasing in popularity (Amato 2005).
In general, cohabitating couples have a negative
impact on behavior, with results consistently the
effect, although not as significantly as in single-
parent households (Amato 2005; Apel and
Kaukinen 2008; Cavanagh and Huston 2006).
Family transitions into new forms often are dis-
ruptive and upsetting to an adolescent, so it is not
surprising that these transitions are linked to
increased behavior problems and outbursts
(Magnuson and Berger 2009; Petts 2009).
Recently, two studies found that a shift into a
single-mother family structure was associated
more significantly with antisocial behavior
than a transition into a two-parent household
(Langenkamp and Frisco 2008; Magnuson and
Berger 2009).
Effects of transitions may also differ based on
the type of family structure that occurs. For exam-
ple, Juby and Farrington (2001) found that paren-
tal divorce was more important in predicting
delinquency than parental death. While separation
of the family unit negatively impacted an adoles-
cents’ behavior, regardless of the reason for sepa-
ration, the degree of negative behavior was
dependent on the reason. Murray and Farrington
(2005) investigated how incarceration of parents
effected boys’ antisocial behavior. They argue
that imprisonment of a parent may be a particu-
larly important risk factor for delinquency
because of the example it may set for appropriate
behavior. In line with this thinking, they found
parental imprisonment is a strong predictor of
delinquency through the life course for boys
and that separation was the most important
factor in predicting the antisocial behavior and
delinquency.
Krohn et al. (2009), in contrast, found that the
effect of family transitions differed by gender.
Family transitions impact on delinquency and
drug use through direct and indirect effects on
the peer relationships, and school performance
of the youth was the primary investigation of the
authors. They found that there were no direct or
indirect effects of family transitions for females.
Nevertheless, number of family transitions
Delinquency Trajectories
directly influenced delinquency and indirectly
through peer interactions for males.
Race/Ethnicity
Although there are a few notable exceptions (Park
et al. 2008, 2010), most of the research on trajec-
tories of offending has focused on Caucasian sam-
ples. Piquero and White (2003) investigated the
effect of cognitive abilities on possessing charac-
teristics identified by Moffitt (1993) as more prev-
alent among life-course-persistent offenders using
an African American sample. They found that
increased cognitive abilities negatively affected
one’s likelihood of being a life-course-persistent
offender. The identification of an individual as a
life-course-persistent offender in this study was
based upon criteria specified by Moffitt (1993)
as hallmarks of this type of offender. Racial
discrimination is linked to a variety of negative
outcomes in regards to African American adoles-
cents, including cognitive abilities like depression
(Dubois et al. 2002; Simons et al. 2002), physical
health problems (Williams and Mohammed
2009), anger (Simons et al. 2003, 2006b), as
well as other forms of externalizing behaviors
such as delinquency (Burt 2009; Simons
et al. 2006b).
Park and colleagues (Park et al. 2008, 2010)
have conducted two studies identifying trajectory
groups with growth mixture modeling (Muthen
and Muthen 1997–2008) and using the Mobile
Youth Survey, an inner-city African American
population. Their research uncovered three trajec-
tory groups, including a “steady” (but low level)
group displaying little delinquency, an “incremen-
tal” group showing a stable increase in delin-
quency over time, and a “high starter” group that
begin with a high level of delinquency but
declined over time. Further analysis on these tra-
jectory groupings indicated that the high starter
and incremental group fared worse in terms of
variables such as substance use, self-esteem, and
parental monitoring (Park et al. 2008). In a follow-
up study with the same sample, the same authors
predicted membership in trajectory group with
multivariate analyses. They found that similar
factors of parental control, school suspension,
and substance use predicted membership in the
917
steady (low level) group in relation to the incre-
mental and high starter group (Park et al. 2010).
Bradshaw and colleagues (Bradshaw
et al. 2010) identified trajectories of antisocial
behavior using the same methodology as above
with the intent to predict experiences of later
negative life outcomes. Using a sample of Balti-
more African Americans, they hypothesized that
individuals within two different types of “early D
starter” trajectories would be at a greater risk for
these negative life events (such as substance use,
dropping out of school, teen pregnancy, etc.).
Their results supported this hypothesis for both
boys and girls; membership in an early starter
trajectory predicted the experience of a larger
number of negative outcomes, as compared to
later starter groups.
Higgins et al. (2012) examined the trajectories
of delinquency and victims of bullying with an
African American sample. Using the National
Longitudinal Survey of the Youth they included
a sample of Hispanic and African American youth
to determine if there is an intersection of victimi-
zation from bullying and delinquency trajectories.
They found three delinquency trajectory groups: a
low stable group, a desisting group, and a high
and changing group (Higgins et al. 2012). They
also found that bullying was found between the
two highest groups of delinquency trajectories,
the desisting group and the high and changing
group, with bullying victimization trajectories
being the lowest for the low and stable delin-
quency trajectory group (Higgins et al. 2012).
These findings support that bullying may be con-
sidered a “street credibility” influence on African
American youth, as well as considered a sociali-
zation process to gain acceptance into delinquent
peer groups.
Evans et al. (2016) looked specifically at the
trajectories of an African American sample,
examining trajectories of offending from age
10 to 19 using longitudinal data from a sample
of nearly 400 African American males. The
results indicated there were four groups of
offenders displaying distinct patterns of behavior:
a low-level group, an early starter/declining
group, a late starter group, and an early starter/
chronic group. Consistent with prior research
918
(Park et al. 2008, 2010), there were multiple tra-
jectory groups, including the presence of a late
starter group. The results from this study indicated
that individuals who were exposed to early and
increasing levels of racial discrimination were
more likely to be in the early starter groups as
compared to negligible delinquents. Those that
had more delinquent friends were also more likely
to be in the early onset and persistent delinquent
groups when compared to the lower level delin-
quents. Recent research (Burt et al. 2012) high-
lights the importance of racial discrimination as a
correlate of crime and delinquency, and Evans
et al. (2016) add to this growing body of empirical
support. Increases in racial discrimination also
significantly predicted group membership in the
expected direction. This study, unlike most of the
others using an African American population,
does not rely upon data from urban inner-city
populations.
Deviant Peers
Deviant peers are considered one of the strongest
correlates for delinquent behavior. Deviant peer
networks which foster negative behaviors are fre-
quently studied in criminology (Warr 2002), with
most researchers taking one of two viewpoints.
The first, endorsed by Gottfredson and Hirschi
(1990), suggests that deviant peers seek out
those who are similar to themselves, so they
“self-select” into deviant peer groups. In contrast,
the other argues that deviance is learned through
peer networking, meaning that association with
antisocial peers exacerbates or teaches deviance
to youth that would otherwise be prosocial (Akers
and Sellers 2009; Dong and Krohn 2016).
Regardless of the mechanism, peers influence
each other to engage in both deviant and conven-
tional behaviors. A multitude of research has
focused on how involvement with delinquent
peers contributes to an individual’s continued
and increased delinquent behavior, even after con-
trolling for background characteristics including
self-control (Button et al. 2007; Matsueda and
Anderson 1998; Miller et al. 2009). Dong and
Krohn (2016) expand on this deviant peer and
trajectory relationship by looking at gang affilia-
tion, as well as the delinquent peer association, to
Delinquency Trajectories
look at long-term trajectories. They found that
gang affiliation does predict future offending as
an adult and that delinquent peer association
results in less serious long-term offending. These
findings show that deviant peers can vary from
gang affiliation, which Dong and Krohn (2016)
argue also impacts family variables, to traditional
misbehavior of delinquent peer groups, both
resulting in trajectory paths of crime.
Similarly, Brook and colleagues (2013) inves-
tigated whether membership in a delinquent tra-
jectory group can predict long-term offending.
Membership in trajectory groups between the
ages of 14 and 24 were used to determine if a
relationship was found to higher violence, deviant
peers, substance abuse, and other risk factors later
in life. The sample consisted of African American
and Puerto Rican individuals from New York
City. They found that those in desisting trajectory
groups during adolescence did not persist to
engage in deviant behavior or with deviant peers
in adulthood. They also found that membership in
high persistence trajectory groups in adolescence
was a predictor of future violence and criminal
behavior in adulthood, compared to moderate
delinquent trajectories. Overall, Brook
et al. (2013) found that membership in trajectory
groups as an adolescent did help predict future
trajectories in adulthood.
Age of Onset
Moffitt (1993, 1997) argues that an especially
important predictor of childhood- versus
adolescent-onset delinquency is age of onset. This
was investigated by Dandreaux and Frick (2009)
using two samples of pre-adjudicated boys, one
identified as childhood onset and the other as ado-
lescent onset. They uncovered that more severe
aggression was found primarily in children from
the childhood-onset group. This group also dem-
onstrated higher levels of family disorder and
showed higher rates of callous-unemotional traits.
Furthermore, the adolescent-onset group displayed
lower levels of traditionalism or support for tradi-
tional values. A recent study also found links
between age of onset and violence, although the
effects only lasted through adolescence
(Tzoumakis et al. 2012). Results from this study
Delinquency Trajectories
indicated that although early onset was linked to
violent behavior in adolescence, there were not
significant impacts on violence in adulthood.
Employment
Employment often has no effect on delinquency
after controlling for differences between workers
and nonworkers (Apel et al. 2007); yet, these
authors did find one positive effect for employ-
ment for group of adolescents who are at risk for
antisocial behavior at an early age. Skardhamar
and Savolainen (2012) examined if employment
could change the trajectory of an individual.
They investigate if the trajectory of antisocial
behavior is changed at the point of job entry and
if this transition is the point of desistence for
offenders. Using a sample of 1,063 males
between 2001 and 2006, from the administrative
registers data in Norway, they were able to merge
this data with governmental databases to deter-
mine the intersection of job entry and desistence
(or persistence) in criminal activity. They found
that the majority of the sample had desisted from
criminal behavior prior to gainful employment
and that the employment did not reduce any fur-
ther criminal behavior. This study serves to pro-
vide a limitation in the employment literature on
trajectories, as the turning point was looked at as
the gain of employment and not the search for
employment. Skardhamar and Savolainen (2012)
suggest the turning point and desistence from
criminal trajectories actually occurs when one
begins seeking employment and not when the
employment is actually obtained.
Education is often thought of as a turning point
in life course literature, and human capital is often
described as utilizing learned occupational skills
(Piquero et al. 2014). Piquero and colleagues
(2014) studied the trajectories of longitudinal
offending from adolescence through early adult-
hood to determine if social or human capital was
more predictive of antisocial behavior. Using data
from the Pathways to Desistance, Piquero
et al. (2014) examined males and females of pri-
marily nonwhite demography, from 14 to 17 at the
beginning of the study and through 7 year’s initial
collection. They found three trajectory groups to
be present: very low-rate chronic offenders,
919
low-rate chronic offenders, and high-rate chronic
offenders. Human capital indicators were found to
be most prevalent in the very low-rate chronic
offenders, as compared to the other two trajectory
groups. This result indicates some evidence of
education and occupational skills having an
impact on criminal trajectory paths.
Cognitive Abilities D
One characteristic identified by Moffitt (1993,
1997) as a feature that can distinguish between
life-course-persistent and adolescent-limited
offenders are cognitive abilities. Results are some-
what mixed, with some indicating a link between
cognitive deficits and delinquency, including low
IQ (Wolfgang et al. 1972) as well as other neuro-
psychological measures (Donnellan et al. 2000;
Moffitt and Silva 1988; Piquero 2001; Piquero
and White 2003). Excelling in school can be one
manifestation of greater cognitive abilities that can
serve to buffer adolescents from pursuing criminal
activity past common teenage delinquency.
McCuish et al. (2014) examined how cognitive
abilities in regards to psychopathic traits are
related to offending and the trajectories of adoles-
cences on a life-course-persistent offender. Using
the Incarcerated Serious and Violent Young
Offender Study, McCuish et al. (2014) investi-
gated 243 males and 64 females on their violent
offending trajectories. Additionally, they used the
Psychopathy Checklist: Youth Version to rate the
symptoms and severity of the psychopathic traits
for the youth. They found that antisocial behavior
in regards to psychopathy was the only indicator
of membership in a high-risk trajectory, as com-
pared to a moderate-risk trajectory of offending.
The presence of psychopathic traits is cumula-
tively related to the chronic offending trajectories
of youth, but at the individual level, only antiso-
cial traits are significantly supported (McCuish
et al. 2014). Reiterated in Corrado et al. (2015),
the individual nature of psychopathic traits makes
determining how trajectories are influenced by
psychosis alone difficult, but rather the break-
down of individual traits such as antisocial behav-
ior, high impulsivity, and aggressive behavior are
the true indicators of chronic offending trajecto-
ries in youth.
920
Victimization
Victimization and offending clearly linked
(Lauritsen and Laub 2007), but the theoretical
reasons behind this link and the causal direction
is less clear (Ousey et al. 2011). A number of
studies have found that experiencing victimiza-
tion exacerbates future offending behaviors
(Cullen et al. 2008; Daigle et al. 2007; Hay and
Evans 2006). Kim and Lo (2015) found that not
only does experiencing victimization increases
delinquency trajectories, but who the victimiza-
tion was delivered by also increases the delin-
quency. They found that youth who were
victimized by parents belonged to a trajectory
group with a much sharper decline in delinquency
during adolescence but projected long-term
offending following the decline. While non-
parental victimization resulted in membership in
a stable nonchronic offending trajectory.
Gender
There is substantial support that the processes
leading to offending may be different for males
versus females (Giordano et al. 2002; Heimer and
De Coster 1999). Moffitt (2003) posits that this is
not necessarily true and that even though the
proportion of males and females in each type of
group may be different, the predictors of group
membership are the same. Silverthorn and Frick
(1999) argue that this may be true but needs revi-
sion. They hypothesized that females will display
a delayed-onset pattern that is developmentally
similar to early onset boys. This viewpoint was
tested by White and Piquero (2004), who found
mixed results. Females in their sample who
displayed a late onset of delinquent behavior
were very similar to males who showed early
onset. However, they also found the presence of
an early onset group in both gender samples, and
these comparisons showed that females fared
worse on about half of the risk factors considered.
Zheng and Cleveland (2013) recently investi-
gated gender differences in trajectories of devel-
opment in antisocial behavior. Using the National
Longitudinal Study of Adolescent Health and a
sample size of 6244, they found four different
trajectory groups: low, desister, decliner, and
chronic. Females were consistently less violent
Delinquency Trajectories
than males throughout; however, both genders
desisted in similar fashion from all trajectory
groups. Only males were found in the chronic
trajectory group, with self-reported mild to mod-
erate antisocial behaviors. All groups had some
trace of antisocial tendencies, but females were
less violent and desisted from criminal behavior
sooner than males. Walters (2012), using the
National Longitudinal Survey of Youth, also
found that males had slightly more serious trajec-
tories than females but found that females did
exist in the high trajectory group.
Immigration
Jennings et al. (2013) investigated how immigra-
tion status relates to offending. A trajectory anal-
ysis found four trajectories of Hispanic
immigrants: very low-rate offenders, high-rate
late-onset escalators, initially high-rate desisters,
and high-rate chronic offenders. Results indicated
that Hispanic immigrants were more likely to be
desisters or low-rate offenders than native-born
Hispanics in the United States. Interestingly,
they also found that Hispanic immigrants who
were not married were the most likely to be
high-rate late-onset escalators, with offending
beginning in late adulthood. These findings only
examined a singular state and immigrant group,
nevertheless, the insight into the links between
immigration and trajectories provides insight
into a specific group and intersection.
Number of Trajectory Groups
While a taxonomic approach may be appropriate,
dividing offenders into only two groups is
problematic. While studies have consistently
shown the presence of the two groups, other dis-
tinct trajectory groups have appeared as well.
Most recent research investigating trajectory
groups has identified between three and five dis-
tinct groups, depending upon the sample (Piquero
and White 2003), including a group characterized
by antisocial behavior in childhood but not later in
adolescence (Park et al. 2008) and a group
displaying little antisocial behavior at any point
during childhood or adolescence (Roisman
et al. 2010). Piquero and colleagues (2010) used
the Cambridge Study in Delinquent Development
Delinquency Trajectories
data to identify trajectories of offending. They
were interested to see if, while controlling for
early environmental and individual risk factors,
an individuals’ membership in these trajectory
groups affected their likelihood of “life failure”
at later ages. They identified five trajectory groups
and found support for their hypothesis, the pat-
terns of offending predicted life failure at later
ages net of the effect of early risk factors.
Offenders in the chronic trajectory group were
more likely to be heavy drug users and have
more convictions than lower rate, nonoffenders,
and adolescent-peak offender trajectory groups.
Using the same data set described above,
Farrington et al. (2009) also investigated multiple
categories of offenders, resulting in four groups:
nonoffenders, adolescence-limited offenders,
late-onset offenders, and persistent offenders.
Farrington et al. (2009) were interested in a wide
variety of family, school, socioeconomic, individ-
ual, and behavioral factors. Overall, results
supported the view that chronic offenders fared
the worst in terms of most risk factors compared to
all other groups.
Bersani et al. (2009) also investigated trajecto-
ries of offending over the life course using a
sample of convicted criminal offenders in the
Netherlands. They found some significant differ-
ences in individual characteristics across trajec-
tory group, yet they found no consistent pattern of
risk factors to differentiate individual offending
patterns. Overall they had weak predictive power
for grouping individuals into trajectory groups;
however, their data for offending was based on
official conviction records, and the number of
adolescent risk factors was narrow.
Tzoumakis and colleagues (2012) investigated
the link between age of onset and violent offenses
from adolescence through adulthood. They used
the Montreal Longitudinal Study using a sample
of adjudicated youth, with 210 individuals used
for the final sample. The data for the final sample
has collection taken from different points in time,
early to mid-adolescence, mid- to late adoles-
cence, and early 30s. They found that while age
of onset may be predictive of committing a violent
offense in adolescence, the age of onset is not
predictive of adult violence (Tzoumakis
921
et al. 2012). They found that early onset did not
predict violent behavior continuing into adult-
hood and that adult offenders specializing in vio-
lent crimes were not always adolescent offenders.
These results help in developmental life course
with the suggestion to look into the subcategories
of versatility and specializations as the stages of
criminal behavior patterns (Tzoumakis
et al. 2012). Young (2014) used Add Health data D
to look at the trajectories of popularity (perceived
and sociometric) to identify predictors of life-
course-persistent individuals and adolescence-
limited individuals in early childhood. They
uncovered that children who seek popularity
through marijuana use and property crime ended
being classified as adolescent-limited, with the
antisocial behavior ending at the end of their
childhood. However, the children who seek pop-
ularity through violent and aggressive means are
more likely to continue to offend past their ado-
lescence, resulting in the life-course-persistent
classification (Young 2014).
Methodological Limitations
While the methodologies that produce trajectories
have provided insight into adolescent delin-
quency, the assignment of individuals to a group,
especially when the behavior of interest is an
undesirable one, has risks that need to be
acknowledged as well. Nagin says, “Because the
groups are intended as an approximation of a more
complex reality, the objective is not to identify the
‘true’ number of groups. Instead, the aim is to
identify as simple a model as possible that dis-
plays the distinctive features of the population
distribution of trajectories (2005, p. 173).” There
are two particular risks associated with this anal-
ysis (Nagin 2005). First, both the number of
groups and the pattern each follows should not
be interpreted as permanently fixed. The stability
of the groups identified and their patterns are
highly sensitive to the length of time being
assessed (Nagin 2005; Sampson et al. 2004).
Researchers should be cognizant of this and
acknowledge it as a limitation. Secondly, while
identifying risk factors for increased delinquency
922
is an important task, one must remain mindful that
just because an event or characteristic is a risk
factor does not imply that everyone who experi-
ences that event or possesses that characteristic will
actually display increased delinquency (Nagin
2005). Trajectory models provide an avenue to
summarize complex patterns in a parsimonious
way. They “improve a researcher’s ability to iden-
tify, summarize, and communicate complex pat-
terns in longitudinal data (Nagin 2005, p. 184).”
Conclusion
It is important that we continue to investigate
factors affecting patterns of offending through
adolescence and into early adulthood. Sampson
and Laub (2003, 1993) theorize that both early
indicators such as parental relationships, as well
as experiences throughout adolescence, are
important in determining patterns of antisocial
behavior over the life course. Jennings and
Reingle (2012) conducted a meta-analysis on
delinquency trajectories and found that trajectory
research is broken into 2–7 groups, separated by
severity of offending, as well as persisters and
desisters. They also found that there is consider-
able variation between trajectory groupings,
based on what is being studied and who the data
comes from. No surprise, the majority of the tra-
jectory research is based out of Moffitt’s taxon-
omy and shaped with adolescence limited and life
course persisters. Finally, Jennings and Reingle
(2012) suggest that research moves beyond the
categorizing of groups of trajectories and severity,
but back to theoretical implication and answering
research questions using the trajectories, as well
as looking to unpack the influences and preven-
tion of the trajectory groups as compared to each
other. Assink and colleagues (2015) also agree
with this continued research being more focused
not on the grouping itself but on the implication
from the trajectories and the comparisons between
adolescence-limited and life-course-persistent
tracks. Assink et al. (2015) suggests looking
more into the family unit and trajectory paths of
mother, sibling, father, and grandparent related
risk factors, as well as the mental and physical
Delinquency Trajectories
health backgrounds. They suggest that only
through the comparison of adolescence-limited
and life-course-persistent offenders can the risk
assessment and prevention and treatment be
discussed (Jennings and Reingle 2012; Assink
et al. 2015). Future work should continue to inves-
tigate these processes to further understand how
they affect offending patterns through young
adulthood and beyond, as well as for their impli-
cations for prevention of delinquency during
adolescence.
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Delinquent Youth with Disabilities
Christopher A. Mallett
School of Social Work, Cleveland State
University, Cleveland, OH, USA
Overview
Most youth in the United States do not have a
disability. In fact, a vast majority will not ever
suffer from a mental health disorder, substance
abuse problem, special education disability, nor
be traumatized by maltreatment. However, the
children and youth who do have one of these
disabilities or experiences are much more often
found in the juvenile justice system – in other
words, under juvenile court supervision – when
compared to the general youth population. Evi-
dence to date has identified that a majority of
youth who have been placed under juvenile
court supervision (adjudicated delinquent) have
at least one of these troubles, and oftentimes
more than one. And in what is an interrelated
Delinquent Youth with Disabilities
concern, a disproportionate number of these
youth are minorities. With a burgeoning juvenile
court system, both in cost and number of youth
involved, today’s more punitive approach to
working with these delinquent youth is shifting
toward a rehabilitative approach. This shift
toward rehabilitation is the preferred method to
decrease the unfavorable impacts that these dis-
abilities have on juvenile court outcomes, espe-
cially for minority youth.
Youth (Juvenile) Delinquency
Youth (juvenile) delinquency, commonly referred
to as youth being in trouble with the law, is both a
growing area of concern and an ignored problem.
The good news, though, is most youth are never
involved with illegal activities nor arrested; and
for those youth who are arrested once, a majority
of them are never arrested a second time. In other
words, most youth grow out of illegal, illicit, or
truant behaviors. However, not every youth (and
family) is so fortunate.
The number of youth involved with the United
States’ juvenile justice system has been steadily
growing over the past 30 years (around two mil-
lion annually), though the number of youth actu-
ally under juvenile court supervision has been
declining slightly over the past decade
(Sickmund 2009). This decrease may be a reflec-
tion of the cost of involving so many youth in the
juvenile courts, or may reflect the more recent
movement away from harsh punishments, that
typically lead to longer juvenile court supervision,
toward more rehabilitative approaches. In fact, the
history of the juvenile courts, first established in
the late 1800s, is analogous to a pendulum that has
been shifting back and forth from what has been
called the “the tough on crime,” or punishment
approach, to the “parens patriae” approach, or one
in which the courts take on a benevolent and
helpful “parent” role. In today’s juvenile courts,
one problem is clear – a majority of the youth who
do come under juvenile court supervision suffer
from at least one moderate to severe disability – a
situation that is only recently being recognized
and addressed.
Delinquent Youth with Disabilities
Juvenile delinquency itself is a legal term. It
means that the juvenile court judge has made the
decision that the youth is in need of court super-
vision or oversight. This necessitates a juvenile
court hearing and a finding by a judge that the
youth (a majority of whom found delinquent are
between the ages of 14 and 17) requires some
level of additional supervision. This supervision
may be minimal or substantial, may last for a few
months or a few years, and may include more
punitive approaches (for example, electronic
monitoring or placement into a detention center)
or more rehabilitative approaches (for example,
family counseling or psychological evaluations).
Youth take a number of different paths to being
adjudicated (meaning “court determined”) delin-
quent. To better understand this, a review of one
state’s definition of “delinquency” is helpful for
most states use this or similar language. The State
of Ohio defines a delinquent youth as one: (a) who
violates any law of this state, the United States, or
any ordinance or regulation of a political subdivi-
sion of the state, which would be a crime if com-
mitted by an adult; and, (b) who violates any
lawful order of the court. Normally this means
that a youth commits a crime, thus breaking a
state law. This crime may be against other people
(for example, assault or domestic violence),
against property (for example, burglary or vandal-
ism), or involve illicit drugs (for example, posses-
sion or sale of marijuana). However, there are
other circumstances that are not considered
crimes, or against the law, if committed by an
adult, but because the youth is a minor (under
the age of 18) the actions/circumstances are illegal
and called status offenses. Some of these status
offenses include truancy (not attending school),
running away from home, staying out past com-
munity curfews, and underage possession or con-
sumption of alcohol.
Whichever path the youth takes to delinquent
acts and eventual delinquency adjudication, one
thing is clear: these supervised youth have a much
greater chance of having a disability or past trau-
matic experience when compared to non-
delinquent youth populations. These disabilities
include mental health disorders, substance use and
abuse problems, special education disabilities,
927
and histories of maltreatment – children who
have been abused and/or neglected. While these
maltreatment histories are frequently not catego-
rized as a distinct disability, they are harmful to
many of the youth and also so common in the
delinquent populations, that it is important to do
so here.
D
Youth Disability Definitions/Systems
To further understand what these disabilities
include or entail, there are some common defini-
tions used nationwide in working with at-risk
children and youth. First, in special education
(public schools) there are four federally recog-
nized categories: severely behaviorally
handicapped (SBH), learning disabled (LD),
severely emotionally disturbed (SED), and devel-
opmentally handicapped (DH). Further identified
specific disabilities include mental retardation,
hearing impairments, visual impairments
(including blindness), orthopedic impairments,
autism, traumatic brain injury, or other health
impairments (Individuals with Disabilities Educa-
tion Act 2004). Second, the mental health and
substance abuse disorders are identified through
psychiatric diagnosis utilizing the American Psy-
chiatric Association’s Diagnostic and Statistical
Manual of Mental Disorders-IV (APA 2000). Dis-
orders commonly found in delinquent populations
include behavior disorders (conduct, oppositional
defiant), affective disorders (depression, mood),
attention-deficit hyperactivity disorder, substance
(alcohol and drug) disorders, and phobias. Third,
child and youth maltreatment is defined by state
law, but each state categorizes these acts as phys-
ical abuse, sexual abuse, and neglect. Neglect may
include medical care neglect, home care neglect,
school neglect (not attending), emotional with-
drawal by parent, and/or a combination of these
types.
The laws, regulations, and professional stan-
dards that have established what these disabilities
are today have also produced separate service
delivery systems to address these distinct disabil-
ity and maltreatment concerns. These systems,
run at the state and local (county) level, include
928
the public school systems administering special
education disability services, local mental health
and substance abuse agencies, child welfare and
protective service agencies, and, as is the frame-
work for this essay, the juvenile justice system.
What is wholly problematic today is that a child or
youth who is at risk and in need of disability
services can and does access these systems for
very different reasons, many times leading to the
youth (and family) being involved with more than
one system over time, or more than one system at
the same time, often without collaborative efforts
between the systems.
For example, a youth having suicidal thoughts
will most likely come to the attention of mental
health professionals, unless, however, that youth
is masking these feelings with significant sub-
stance use, in which case substance abuse pro-
fessionals will probably become involved. If this
youth instead cannot control these harmful feel-
ings, he or she may release them through aggres-
sive or assaultive behavior, oftentimes leading to
police and potential juvenile court involvement.
If, by chance, this same youth has a parent or
guardian harming them through abuse, this may
be reported to the county children’s services
agency, opening up an investigation and further
need for supervision or removal of the youth from
the home. As can be seen in this example, these
are separate disability service delivery systems,
but for the at-risk youth and families they may
be very interconnected. This connectivity is found
when examining the disability prevalence rates of
these youth within the juvenile justice system.
Disability Prevalence Rates/Delinquency
Links
As noted earlier, the juvenile courts handle
approximately two million cases annually, of
which the most common court outcome is delin-
quency adjudication (for 1.6 million of these
youth annually). For many supervised youth in
the courts, this means being placed on probation;
in other words, having a probation officer respon-
sible for following up and making sure the youth
(and family) adhere to the judge’s orders. This
Delinquent Youth with Disabilities
population of juvenile court-involved youth is
disproportionately represented by youth with
disabilities – and in an interrelated problem, a
disproportionate number of these youth are Afri-
can American and Hispanic. One significant lim-
itation to note with these juvenile justice system
prevalence rates is that a majority of the research
studies are with youth being held in juvenile
detention centers and incarceration facilities. It is
necessary to expand this research to the full juve-
nile court populations, a majority of whom are not
held in these facilities. However, while acknowl-
edging this limitation, the current disability rates
are troubling. Youth involved with the juvenile
courts, oftentimes referred to as juvenile
offenders, have a significantly larger number of
disabilities and disorders when compared to the
general youth population (Mallett 2009) (Table 1).
Mental Health Disorders
These delinquent youth populations have high
prevalence rates of mental health disorders,
40–70%, which is significantly higher than the
general youth population of between 9 and 16%.
These disorders range from mild to severe diag-
nostic levels of impairment and include depression
or dysthymia (a less severe form of depression)
(15–20%), anxiety disorders (24–29%), mood
disorders (10–25%), attention-deficit hyperactiv-
ity disorder (13–30%), behavioral disorders
(52–80%), and (more rarely) psychotic or bipolar
disorders (3–7%).
Delinquent Youth with Disabilities, Table 1 Offender
and general youth disabilities and maltreatment histories
Juvenile offender General youth
Disability type populations population
Mental health 40–70% 9–16%
disorders
Substance abuse 25–67% 5–6%
disorders
Special 33–41% 4–10%
education
disabilities
Maltreatment 40–60% 1.4%
histories
Delinquent Youth with Disabilities
But of particular concern within this group of
juvenile court-involved youth is the estimated
15–20% who have been diagnosed with a severe
mental health illness – major depression, bipolar
disorder, and other mood disorders. While this
group of youth is small in number, they account
for a large percentage of the resources utilized
within the youth mental health system. Mood
and affective disorders (including some depres-
sion) often are seen as anger or irritability which
may lead to trouble with other juvenile offenders,
or the youth may turn these harsh feelings upon
themselves with self-harmful or suicidal behav-
iors. Additionally, youth with anxiety disorders
tend to be more withdrawn, though not youth
with posttraumatic stress disorder – many times
a result of abuse or witnessing violence. Though
common in the delinquent populations, conduct
disorder is not merely an “acting out” problem,
but includes much more significant and long-
lasting problematic behavior (Grisso 2008; Teplin
et al. 2006).
Today, there is a limited debate as to which
occurs first for these youth – mental health prob-
lems or involvement with the juvenile justice
system – though there is significantly more evi-
dence of the link from earlier mental health prob-
lems to later youth delinquency. Aggressive
behaviors before age 13, hyperactivity and atten-
tion problems, and depression have been found
predictive of delinquency, in particular physical
aggression and stealing behaviors. It should be
noted that delinquency is almost certainly the
result of the accumulation and interaction of
youth experiences, called risk factors, which
include the disabilities discussed here, in addition
to deficits in the family (poverty, single parent-
ing), school, peers (friends who are delinquent),
and neighborhood (poorer, higher crime areas)
(Hawkins et al. 2000).
Substance Abuse Disorders
These delinquent youth populations also have
high prevalence rates of substance abuse disor-
ders, 25–67%, which is significantly higher than
the general youth population of around 5%.
929
Higher rates of substance abuse and disorders
are found for youth in detention and incarceration
facilities, when compared to earlier juvenile jus-
tice system stages (for example, at referral or
juvenile court intake). Some studies have found
race and gender differences: non-Hispanic Whites
(Caucasians) higher rates, African American low-
est rates; and females more likely than males to
have a co-occurring mental health disorder. One D
of the ongoing measurement concerns is that stan-
dard criteria for substance abuse and disorders are
not consistently utilized across studies, limiting
the broader discussion of the findings. Though
many juvenile courts use some screening, or stan-
dardized assessments that include substance use
or abuse measures, it is difficult for the court
personnel to identify the youth most in need of
treatment (Chassin 2008). It is also impractical for
the juvenile courts to be expected to offer appro-
priate treatment for the number of youth showing
signs or significant signs of addiction. However,
there is substantial knowledge on what programs
or interventions may work to treat youth sub-
stance abuse.
There is no one program or intervention found
to be the most effective in addressing youth sub-
stance abuse. However, there are a number of
general principles that have been developed
across programs and treatments and found to be
effective. These include the use of more than one
treatment type or modality; having treatment be
readily available during multiple treatment epi-
sodes; meeting multiple client needs including
mental health and physical health; continuous
monitoring of the treatment provided, and possi-
ble drug use; adequate treatment duration; recog-
nition of co-occurring disorders; recognition of
the long-term recovery process; use of counseling,
medications, and medical detoxification; and sup-
port for involuntary treatment (National Institute
on Drug Abuse 2006).
Special Education Disabilities
These delinquent youth populations have high
prevalence rates of special education disabilities,
33–41%, primarily learning disabilities, which is
930
significantly higher than the general student pop-
ulation of between four and ten percent. Learning
disabilities are language difficulties that impair the
youth’s thinking, speaking, writing, listening,
reading, spelling, or mathematical abilities. Chil-
dren with low academic achievement and aca-
demic failure in elementary school, and in
particular those with unidentified special educa-
tion needs or disabilities, are at increased risk for
later violent behaviors. Specifically, youth with
unidentified special education disabilities may be
disproportionately represented in those youth who
are suspended, expelled, and/or drop out of high
school – youth outcomes that are all risk factors for
later delinquent activities (Mears and Aron 2003).
Research knowledge to date, though, is limited in
further explaining this link between these special
education disabilities and delinquent activities.
There exists some evidence that youth with these
disabilities are at higher risk of re-offending,
called recidivism; and other evidence that the
increased risk for these youth is minimal.
Child Maltreatment
These delinquent populations also have high prev-
alence rates of youth who have a history of mal-
treatment (being abused or neglect), 40–60%, an
experience that is very uncommon, a little over
1% of all children or youth. However, identifying
which maltreated children and youth are at risk for
later delinquency is difficult because the connec-
tion is complicated and unclear.
Research findings explaining this link between
maltreatment and delinquency have been contra-
dictory, resulting from methodological and
research design differences (Tuell 2002). There
is some evidence that this group of youth have a
greater chance of being arrested as adolescents,
though the pattern varies by gender, race, and
maltreatment type (physical abuse, sexual abuse,
and neglect). There do seem to be some outcome
differences based on gender and the type of
maltreatment – for example, girls who have been
physically abused are more at risk to be physically
violent – but further research is needed. Some
studies have identified victims of physical abuse
Delinquent Youth with Disabilities
and neglect to have an elevated risk for delin-
quency, but not victims of sexual abuse; while
others have found sexual abuse to be the explana-
tion. There is more agreement that children or
youth who suffer more severe abuse or neglect,
and those with repeated exposure, do have a
greater risk of moderate to severe delinquency.
Contradictory evidence also exists on the impact
that out-of-home placement due to this maltreat-
ment may have on youth. Though delinquency is a
result of the combination of risk factors (youth,
family, school, peers, and neighborhood), and
these factors tend to be cumulative and interactive
making prediction difficult, being a victim of mal-
treatment continues to be found even in the pres-
ence of these other risk factors.
Comorbidity (Co-occurring) of
Disabilities
Comorbidity is often the term used to discuss the
presence of more than one mental health disorder
or the combination of a mental health disorder and
a substance abuse disorder. It seems that this phe-
nomenon of multiple disabilities may be very
common among the delinquent youth population,
though research is very limited. When this area is
studied, between 30% and 67% of juvenile court-
involved youth have been identified with one of
the following comorbidities: two or three mental
health disorders; a mental health disorder and an
active substance abuse disorder; a mental health
disorder with past maltreatment histories; or a
mental health disorder, a substance abuse disor-
der, and a special education disability (Garland
et al. 2001; Mallett 2009; Teplin et al. 2006).
It is important in future research that juvenile
court and delinquency outcomes be investigated
to identify what impact these disabilities, or com-
binations of disabilities, have on referrals, proba-
tion, length of juvenile court supervision,
recidivism (re-offending), secure facility place-
ment, and other important juvenile justice con-
cerns. One of these outcomes, being placed into
a secure detention or incarceration facility, is a top
concern for the juvenile justice system for three
reasons: (1) a disproportionate number of
Delinquent Youth with Disabilities
minority youth are locked, and on average held
longer, in these facilities with little explanation
as to the reasons or causes – African American
youth are six times more likely than whites;
Hispanic youth three times more likely
(Puzzanchera and Adams 2008); (2) the high
costs of holding youth in these facilities; and,
(3) the negative and harmful outcomes for the
youth held in these facilities.
On an average day, 54,500 youth are incarcer-
ated in this country’s 591 detention centers and
2,964 correctional facilities (Sickmund et al.
2008), and, as discussed, many of these youth
have at least one significant disability. Incarcerat-
ing these youth is ineffective public policy that
compromises public safety because most of the
youth do not improve after their release from these
facilities. They are less likely to find employment
and less likely to complete high school. In fact, the
experience of detention makes it more likely that
detained youths will continue to engage in delin-
quent behavior, and may increase the odds that
youth will recidivate (re-offend) – costing the
courts and communities additional resources –
and in no way improving the youth’s chances for
success, or at least a smoother transition into
young adulthood.
Next Steps
The juvenile courts are today moving away from
the “tough on crime” approach that has been com-
monly used over for the last few decades, an
approach focused on increased punishments,
increased incarcerations, and less tolerance for
youthful offenders and re-offenders. Because
this approach has not significantly decreased the
number of youth in the juvenile justice system,
has not decreased youth recidivism, nor shown
very many positive outcomes, juvenile courts
have been moving toward a rehabilitative
approach. This movement is fully supported by
the fact that a large number of these youthful
offenders suffer from at least one significant dis-
ability, disabilities that may be interrelated to their
delinquency behaviors. It is increasingly recog-
nized by the juvenile justice system that early
931
disability identification and coordination efforts
with other youth-caring systems – mental health,
substance abuse, special education, and child
welfare – leads to cost-effective interventions
and delinquency prevention.
These coordination efforts across the different
youth and family systems, though, are very chal-
lenging, for each system has its own policies,
regulations, and priorities. It is increasingly appar- D
ent that these youth and families have problems
that cross these systems and involve the youth in
more than one of the systems. For the past two
decades, the lack of coordination among these
youth-caring systems has been identified as a
major barrier to more effective and positive out-
comes. Often titled “systems of care,” these
efforts, undertaken at the state and local levels,
try to share the resources (programmatic and
funding) across the systems and reallocate these
resources to more efficiently work with the multi-
system involved youth and families (Pires 2002).
These coordinated efforts are effective when pol-
icy makers actively work together and share
resources; they fail when preservation of one sys-
tem over another is the priority. However, these
coordination efforts across the juvenile courts,
mental health and substance abuse systems, child
welfare agencies, and public schools are very
important because of the number of youth are
increasingly identified as multiply-disabled and
because their outcomes are not encouraging. One
system alone cannot be expected to handle the
multiple-problem situations that many of these
delinquent youth present.
While this topic of delinquent youth with
disabilities is garnering increased attention,
there remain a number of important knowledge
gaps that should be addressed in conjunction
with ongoing systems coordination efforts.
Future research should include national and
regional studies of these cross-system youth
and families to identify prevalence, trends, and
coordination effort outcomes; juvenile court
outcomes for youth with these differing disabil-
ities; improved predictive pathways from these
disabilities to juvenile court involvement; gen-
der and race disability differences and court out-
comes; and additional proven interventions to
932
use at various and, it is hoped, earlier juvenile
justice system contact points to help prevent the
youth from continuing to engage in delinquent
behaviors and activities.
Cross-References
▶ Disability
References
American Psychiatric Association. (2000). The diagnostic
and statistical manual of mental disorders-IV – Text
revision. Washington, DC: American Psychiatric Asso-
ciation Press.
Chassin, L. (2008). Juvenile justice and substance abuse. The
Future of Children, 18(2), 165–184. Available at http://
www.futureofchildren.org/futureofchildren/publications
/journals/journal_details/index.xml?journalid=31.
Garland, A., Hough, R. L., McCabe, K. M., Yeh, M.,
Wood, P. A., & Aarons, G. A. (2001). Prevalence of
psychiatric disorders in youths across five sectors of
care. Journal of the American Academy of Child and
Adolescent Psychiatry, 40(4), 409–418.
Grisso, T. (2008). Adolescent offenders with mental disor-
ders. The Future of Children, 18(2), 143–164. Available at
http://www.futureofchildren.org/futureofchildren/publica
tions/journals/journal_details/index.xml?journalid=31.
Hawkins, J., Herrenkohl, T., Farrington, D., Brewer, D.,
Catalano, R. F., Harachi, T., & Cothern, L. (2000).
Predictors of youth violence. Office of Juvenile Justice
and Delinquency Prevention. Available at http://www.
ncjrs.org/html.ojjdp/jjbul2000_04_5/contents/html.
Individuals with Disabilities Education Act. (2004).
20 U.S.C. § 1400 et seq., revised and amended by
Pub L. No. 108–466, Stat. 34. Available at http://
www.ed.gov/legislation/FedRegister/finrule/2006-3/08
1406a.pdf.
Mallett, C. (2009). Disparate juvenile court outcomes for
disabled delinquent youth: A social work call to action.
Child & Adolescent Social Work Journal, 26(3),
197–208.
Mears, D., & Aron, L. (2003). Addressing the needs of
youth with disabilities in the juvenile justice system:
The current state of knowledge. Washington, DC: The
Urban Institute. Available at http://www.urban.org/pub
lications/410885.html.
National Institute on Drug Abuse. (2006). Principles of
drug treatment: A research based guide. Bethesda:
National Institutes of Health, U.S. Dept. of Health and
Human Services. Available at http://www.nida.nih.gov/
podat/PODAT1.html.
Pires, S. (2002). Building systems of care: A primer.
Washington, DC: Human Services Collaboration,
Substance Abuse and Mental Health Services
Delirium
Administration. Available at http://gucchd.george
town.edu/files/products_publications/TACenter/PRIM
ER_ALL.pdf.
Puzzanchera, C., & Adams, B. (2008). National dispro-
portionate minority contact databook. Developed by
the National Center for Juvenile Justice for the Office of
Juvenile Justice and Delinquency Prevention.
Washington, DC: U.S. Department of Justice. Avail-
able at http://ojjdp.ncjrs.gov/ojstatbb/dmcdb/.
Sickmund, M. (2009). Delinquency cases in juvenile court:
2005. Office of Juvenile Justice and Delinquency Pre-
vention. Washington, DC: U.S. Department of Justice.
Available at http://www.ncjrs.gov/pdffiles1/ojjdp/
224538.pdf.
Sickmund, M., Sladky, T. J., & King, W. (2008). Census of
juveniles in residential placement databook. Office of
Juvenile Justice and Delinquency Prevention.
Washington, DC: U.S. Department of Justice. Avail-
able at http://ojjdp.ncjrs.org/ojstatbb/Cjrp/.
Teplin, L., Abram, K., McClelland, G., Mericle, A.,
Dulcan, M., & Washburn, D. (2006). Psychiatric dis-
orders of youth in detention. Washington, DC: Office of
Juvenile Justice and Delinquency Prevention, Juvenile
Justice Bulletin. Available at http://www.ncjrs.gov/
pdffiles1/ojjdp/210331.pdf.
Tuell, J. (2002). Child maltreatment and juvenile delin-
quency: Raising the level of awareness. Washington,
DC: Child Welfare League of America. Available at
http://www.ncjrs.gov/App/Publications/abstract.aspx?
ID=199834.
Delirium
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Delirium is a cognitive disorder that involves an
acute and debilitating decline that results in an
altered form of semiconsciousness due to an indi-
vidual’s inability to pay attention, perceive, speak,
and think appropriately. It is a relatively global
impairment that may also involve impairment in
sleep–wakefulness cycles and abnormal psycho-
motor activity. Delirium may be either hyperactive
(marked by agitation, aggression, or combative-
ness) or hypoactive (marked by quiet confusion
or inability to focus or follow commands) (see
Karnik et al. 2007). Delirium is a set of symptoms
resulting from an underlying disease or impair-
ment; it is a symptom of a malfunctioning brain.
Delusion
The understanding of delirium derives mainly
from studies involving adults. Studies that do
examine the nature of delirium occurring during
childhood and adolescence reveal that they have
similar qualities to those of adults. For example, in
their important study, Turkel and Tavaré (2003)
found that adolescents’ symptoms included disor-
ganized behavior, sleep disturbance, disturbed
attention, altered state of consciousness, as well
as some hallucinations. Equally importantly, the
more delirious patients had a higher mortality rate,
as has been found with adults. They also found
that antipsychotics were sufficient in treating their
pediatric patients with delirium. In a later study,
Turkel et al. (2006) reaffirmed that many of the
same symptoms were reported regardless of age
but that they were often reported at significantly
different rates, with cases involving children
being more likely to report sleep–wake distur-
bance, fluctuating symptoms, impaired attention,
irritability, agitation, and confusion and adults’
cases more likely to involve impaired memory,
depressed mood, speech disturbance, delusions,
and paranoia. The authors, however, were unable
to determine whether these were true differences
attributable to the life cycle or to inconsistent
methodologies.
Despite potential controversies regarding the
nature of delirium in youth and adults, there is
no doubt that delirium has been found less fre-
quently in younger patients. Why that is the case
is not entirely clear. In their analysis of this
issue, Schieveld et al. (2007) provide reasons
to believe that the increase in delirium rates
following an increase in age could be the result
of its misdiagnosis. They reject the contention
that there actually could be a discrepancy in the
prevalence between aged populations. They
attribute the apparent differences to such possi-
bilities as the psychosocial interventions pro-
vided in pediatric intensive care units, the side
effect of analgosedative drugs that may reduce
delirium, doctor’s discomfort with stigmatizing
youth with the label and, lastly and according to
the authors most likely, is that doctors and
nurses do not recognize pediatric delirium.
Their studies confirm that delirium in critically
ill children is not negligible and highlight the
933
need for more prospective studies that would
examine the phenomenology, risk factors, and
treatment of delirium during childhood and
adolescence.
References
Karnik, N. S., Joshi, S. V., Paterno, C., & Shaw, R. (2007). D
Subtypes of pediatric delirium: A treatment algorithm.
Psychosomatics, 48, 253–257.
Schieveld, J. N. M., Leroy, P. L. J. M., Van Os, J., Nicolai,
J., Vos, G. D., & Leentjens, A. F. G. (2007). Pediatric
delirium in critical illness: Phenomenology, clinical
correlates and treatment response in 40 cases in the
pediatric intensive care unit. Intensive Care Medicine,
33, 1033–1040.
Turkel, S. B., & Tavaré, C. J. (2003). Delirium in children
and adolescents. Journal of Neuropsychiatry and Clin-
ical Neuroscience, 15, 431–435.
Turkel, S. B., Trzepacz, P. T., & Tavaré, C. J. (2006).
Comparing symptoms of delirium in adults and chil-
dren. Psychosomatics, 47, 320–324.
Delusion
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Delusions are false beliefs held even when
contradicted by reality. As misjudgments of real-
ity, delusions are idiosyncratic and individual
misinterpretations or misperceptions. A classic
example would be delusions of grandeur, which
are fantastical beliefs that one is famous, omnip-
otent, or otherwise powerful. Studies indicate
that these delusions are the most common
in adolescent psychiatric patients (Tillman
et al. 2008).
Delusions can be thought disorders with
enough import to interfere with normal function-
ing if individuals no longer share enough consen-
sually related reality with people around them.
Importantly, some delusions are normal, as many
individuals have mild subclinical experiences
of delusion. Community surveys, as opposed
to clinical ones, have long revealed that many
otherwise well individuals report delusional-like
934
experiences (Scott et al. 2009), and systematic
reviews of the literature reveal that approximately
75–90% of developmental psychotic experiences
are transitory and disappear over time (van Os
et al. 2009). It is clear that some delusions may
be part of mental health problems that adolescents
face, but not be severe enough to be part of full-
blown psychotic disorders. For example, one
important study found that many adolescents
(24%) experienced delusions in a sample not
meeting requirement for a psychotic disorder
(Altman et al. 1997). These adolescents had been
recruited at a day treatment center and a residen-
tial treatment facility. The authors concluded that
subclinical delusions and subclinical hallucina-
tions were related to different psychiatric ail-
ments. Subclinical delusions were more related
to schizotypal thought processes, while subclini-
cal hallucinations were most closely related to the
dissociative process. Findings like these are of
significance in that, even though some delusions
may be normal, for some individuals the episodes
may be the beginning of long-term impairments.
The transitory developmental expression of psy-
chosis may become abnormally persistent and
subsequently clinically relevant depending on an
individual’s exposure to environmental risk (van
Os et al. 2009).
References
Altman, H., Collins, M., & Mundy, P. (1997). Subclinical
hallucinations and delusions in nonpsychotic adoles-
cents. Journal of Child Psychology and Psychiatry,
38(4), 413–420.
Scott, J., Martin, G., Welham, J., Bor, W., Naman, J.,
O’Callaghan, M., et al. (2009). Psychopathology dur-
ing childhood and adolescence predicts delusion-like
experiences in adults: A 21-year birth cohort study. The
American Journal of Psychiatry, 166, 567–574.
Tillman, R., Geller, B., Klages, T., Corrigan, M., Bolhofner,
K., & Zimerman, B. (2008). Psychotic phenomena in
257 young children and adolescents with bipolar
I disorder: Delusions and hallucinations (benign and
pathological). Bipolar Disorders, 10, 45–55.
van Os, J., Linscott, R. J., Myin-Germeys, I., Delespaul, P.,
& Krabbendam, L. (2009). A systematic review and
meta-analysis of the psychosis continuum: Evidence
for a psychosis proneness-persistence-impairment
model of psychotic disorder. Psychological Medicine,
39, 179–195.
Dependency Court Processes
Dependency Court Processes
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
At the center of child welfare systems are depen-
dency courts, also referred to as juvenile or family
courts, that rule on cases of child maltreatment as
authorized by state law. While many states grant
dependency courts jurisdiction over children ages
birth until 18 and sometimes up to 21, all states
provide these courts with considerable power to
intervene in families to help care for children
deemed at risk. These courts thus are able to rule
on cases of abuse and neglect, children’s place-
ment, and the provision of services to families and
children as well as on whether parents’ ties with
their children should be permanently severed (for
thorough reviews, see Levesque 2002, 2008). The
court system often focuses on ensuring that ser-
vices are provided to youth and, when needed, to
their families. But, the reality is that a relatively
small percentage of child welfare cases require
court oversight and supervision. This is the case
because families receive voluntary services from a
variety of sources, and, as a result, the large major-
ity of cases served by child welfare agencies are
never adjudicated by the courts. Yet, the courts
still serve important functions in that they not only
provide general parameters for cases that do avoid
litigation but also seek to offer important protec-
tions for the youth and families that do have cases
processed through the courts. The wide variety of
cases involving child welfare challenges render it
difficult to provide an analysis of all the possible
scenarios that may be involved in cases that go
through dependency courts. As a result, this essay
briefly overviews dependency court processes to
provide a sense of the nature of this court system
devoted to child protection and, in a real sense, to
youth’s mental health and overall healthy
development.
State statutes inform pre-court involvement in
family cases. They define abuse and neglect and
they tend to do so in their reporting laws.
Reporting laws are those that specify when
Dependency Court Processes
professionals or others must report suspected
abuse. Laws also require the adoption of proce-
dures for reporting to child protection services
(CPS) and/or law enforcement, along with immu-
nity for those who report, and penalties for failing
to report suspicions of abuse or neglect. After
receiving a report, CPS or law enforcement must
expeditiously determine whether the allegations
are the type that need not be of concern, should
lead to an investigation, or might involve the
removal of children from their families. If the
children are removed, CPS files a petition seeking
continued removal or family reunification. Typi-
cally, however, if children are removed, parents
engage in voluntary services coordinated by child
welfare systems.
If children are removed by child welfare agen-
cies, courts hold an emergency hearing, usually
within 24–72 h, to determine the necessity of
more permanent removal. Parties are notified of
the need to appear, and the local child welfare
agency attempts to identify the children’s biolog-
ical mother and father. Around the time of the
emergency hearing, the child welfare agency
files the petition alleging abuse or neglect. Each
party is entitled to representation, as states provide
(with varying degrees of effectiveness) guardians
or attorney ad litem for the child and counsel to
the parents. Emergency hearings allow all parities
to present oral arguments regarding the alleged
abuse or neglect. To remove the child, the depen-
dency court must find that the child’s home is
contrary to the child’s welfare and must be
detailed regarding the reasoning supporting the
removal. At these hearings, courts must decide
whether the state made reasonable efforts to pre-
vent the child’s removal, including the provision
of services to facilitate the child’s continuing to
live at home, or family reunification. Services
may include visitation by a qualified social
worker, skills training, or support services. If the
case is especially severe, the court may decide that
no services need to be provided and the child
welfare agency rapidly develops alternative, per-
manent living arrangements. The emergency hear-
ing also includes a decision on parent–child
visitation, needs for psychiatric or psychological
evaluations, and where the child is to be placed.
935
Placement should be least restrictive. Again, how-
ever, many cases avoid entering the court system
given efforts to front-load services in a manner
that provides voluntary services prior to reaching
the point requiring a formal court action.
Adjudicatory hearings are scheduled expedi-
tiously (such as within 30 days) after the emer-
gency hearing. Adjudication hearings are bench
trials before judges (or masters) to determine D
whether the child is indeed dependent and thus
qualifies to be under the court’s supervision. This
phase involves the presentation of evidence
supporting or refuting allegations of abuse or
neglect. The typical standard of proof is “clear
and convincing” evidence that the child has been
(or will be) abused or neglected. And the rules
regulating the admittance of evidence, unlike for
criminal courts, are considerably lenient. If the
child is found dependent, then a dispositional
hearing is scheduled, often immediately following
the adjudication or within 40–60 days. Pending
this hearing, parties may be asked to submit to
evaluations of parental fitness or needs of a child.
The extra time ensures the child welfare agency’s
development of a case plan for the court to review.
Adjudications and disposition hearings are
separate processes and serve two different pur-
poses, one determines dependency and one deter-
mines what to do about that dependency. Yet,
jurisdictions can hold these hearings consecu-
tively for the purposes of timeliness and conve-
nience. Consecutive hearings occur since many, if
not all, of the parties are the same at both hearings,
the evidence presented to the court can be similar,
consecutive hearings expedite the process, and
some cases have overlapping outcomes. The
push toward greater timeliness also comes from
federal laws that have encouraged more expedited
dispositional hearings, mainly on the grounds that
waiting too long leaves children in limbo. The
move toward more expedient hearings and dispo-
sitions is counterbalanced by the reality that dis-
positional hearings allow courts to review plans
created by the child welfare agency and determine
whether child welfare services were provided
properly to address the determined needs. Plans
may contain one of many options, including fam-
ily reunification, termination of parental rights,
936
assigning legal guardianship, permanent place-
ment with an appropriate family member, or
placement in another setting. Families with con-
siderable needs likely require considerable time to
meet appropriate levels of care. The need for time
is highlighted by the manner that, historically,
agencies considerably focused on family
reunification and protecting parents’ rights to
raise their children (see Levesque 1995). That
approach, however, formally has been abandoned
in favor of quicker permanent dispositions, as
encouraged by the Adoption and Safe Families
Act (1997). The Act, for example, requires state
agencies to file a petition to terminate parental
rights and, at the same time, identify, recruit,
process, and approve a qualified adoptive family
on behalf of any child, regardless of age, that has
been in foster care for 15 out of the most recent
22 months. Thus, the system has grown to recog-
nize the need to move as expeditiously as possible
as it balances the rights of parents with those of
children deemed maltreated. The dual mandate for
family integration while planning for children’s
removal has been highly criticized. Yet, it still
remains and reflects the challenges facing depen-
dency courts charged with ensuring that child
welfare systems meet the needs of children and
their families. And it is that dual mandate, coupled
with the practical need to respond efficiently to
children’s developmental needs, that now pushes
courts to adjudicate and reach dispositions as
quickly as fairness permits.
If a child is in foster care or other out-of-home
care, a court must review their case periodically.
During a permanency hearing, the court ensures
that progress is being made toward the implemen-
tation of the permanency plans relevant parties
decided on in the dispositional hearing. For older
youth, courts also must ensure that they are able to
transition to adulthood through the agency’s offer-
ing of housing, work skills training, and mental
health counseling. In the case of adoption, the
courts must first terminate parental rights and
transfer the rights to another party. This includes
all ties, the right to visit, and any decisions regard-
ing care. Proceedings that may lead to the sever-
ing of parental rights place a heavy burden of
proof on the state and parents have the right to
Dependency Court Processes
be represented during the proceedings. Once paren-
tal rights are terminated, the state assumes the
child’s legal custody and frees the child for adop-
tions. Adoption, a separate legal proceeding, allows
courts to evaluate home environments and evidence
pertaining to prospective adoptive parents’ ability
to provide appropriate care for the child. Some
states allow older adolescents to consent to their
adoptions. Open adoptions are sometimes consid-
ered if the adoptive parents agree to specified
parent–child contact. In some cases of children
with disabilities, adoptive families may receive
financial and medical assistance after the adoption,
known as subsidized adoption. In addition to adop-
tion and termination of parental rights, court super-
vision can be terminated on several other grounds,
some of which can occur at any point in a case, such
as when the child reaches majority, an able parent
comes forward to care for the child, permanency
plans are completed, or the child enters prison,
military service, or dies. Still, a court action must
occur for the case to be terminated.
Dependency courts essentially rule on cases
involving child maltreatment. They intend to pro-
vide speedy mediation and intervention for chil-
dren and their families. These courts necessarily
make difficult choices as they seek to protect the
rights of parents and those of their children and
recognize that even though children have been
harmed or are at risk of harm, it may not neces-
sarily follow that it is in their best interests to be
without their parents, a recognition that leads to
the increasingly complex web of services that can
be provided to youth and families based on a large
continuum of both need and available services.
Cross-References
▶ Adoption
References
Adoption and Safe Families Act. (1997). Pub. L. No.
105–89, 111 Stat. 2115.
Levesque, R. J. R. (1995). The failures of foster care reform:
Revolutionizing the most radical blueprint. Maryland
Journal of Contemporary Legal Issues, 6, 1–35.
Dependency in Law
Levesque, R. J. R. (2002). Child maltreatment and the law:
Foundations in science, policy and practice. Durham:
Carolina Academic Press.
Levesque, R. J. R. (2008). Rethinking child maltreatment
law: Returning to first principles. New York: Springer.
Dependency in Law
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
One of the most important concepts relating to the
rights of youth is the concept of dependency and
how it infiltrates the legal system (see Fineman
2004). When relating to youth, dependency has
two important meanings. One meaning deals with
developmental matters, such as a child’s inherent
need to rely on others due to biological, emo-
tional, cultural, and mental immaturity. Another
meaning refers to dependency in the way that
rules, laws, and norms create and assert depen-
dency in the way that they foster or limit rights
and responsibilities, such as dependency on a
family member or the state. Notably, the legal
definition of dependence has integrated the con-
cept of gender equality and minority rights, as
indicated by efforts to remove adult women from
patriarchal control and efforts to provide more
rights to individuals with disabilities so that they
can act and live more independently. Both of these
views of dependency have important implications
for youth.
In the United States, youth are assumed to be
dependent in all senses of the term. Children are
considered to be incapable of acting in their own
best interests due to physical, emotional, and men-
tal immaturity and cultural construction of the role
of youth in America. Biological parents are
assumed best able to provide for their child due
to their greater experience and maturity, and are
accordingly granted pervasive authority over their
children that would not be granted in any other
relationship. When the biological parents are
found to be incapable of minding their children,
relevant social service agencies will seek to place
the child with a relative before attempting
937
nonrelative placements, unless the children have
special needs preventing them from being with
their relatives. Precisely when others can interfere
in parent–child relationships has shifted consider-
ably over the past several decades, and that shift
has allowed considerably more intervention
(Levesque 1994).
A look at the history of dependency in law
reveals that the privileges of caretakers over their D
dependents have become more limited in the past
several decades. An obvious example involves
more restrictions toward the use of corporal pun-
ishment; where previously a father could legally
expect to compel obedience from his wife and
children with threats and actual use of violence,
now he would face abuse charges. Even with these
modern attitudes toward egalitarianism, however,
children still tend to be considered a class below
adults. In many ways, children still are viewed as
property, although that view continues to change
and evolve (see Woodhouse 1992).
One of the most powerful legal mechanisms
for fostering and protecting the dependency of
youth is a vision of family life that views the
decision making and control within families as
matters of privacy. In the United States, for exam-
ple, expectations of family privacy, coupled by the
expectation that parents will provide for youth,
foster the notion that youth are dependent on
their families. As a result, social services for chil-
dren are intended to supplement rather than sup-
plant the family, and such agencies are only able
to take an active protective role for a child if they
can prove that the parents have insufficiently pro-
vided for their child. This concept is based in the
belief that a family should be economically and
personally capable of caring for its children; as a
result, families that require social services or
“welfare” are stigmatized for being unable to pro-
vide. In contrast to the United States’ focus on the
“individualism” of families, other countries take a
more active role in supporting families and adopt
a much more open view of families. Notably,
several Western countries have incorporated the
responsibilities of United Nations or international
principles of children’s rights into their laws.
These principles view children as individuals
with rights within their families. This approach
938
to children’s rights requires the government to
take greater responsibility for a child’s primary
needs, such as their education, even over the
objections of their parents.
Although much is made of differences between
different systems’ ways to approach dependency, it
is important to highlight similarities and how dif-
ferences can lead to important differences in the
way that adolescents are free to exercise indepen-
dent rights and even recognize that they do have
rights in the first instance. The notion of depen-
dence in US law, for example, does serve important
purposes and the distinction between private fam-
ilies and the state is not as clear as some commen-
taries might suggest (see Levesque 1994). The
US approach still fosters the rights of youth
(as highlighted by the right to education), for exam-
ple, and it does provide for limiting the govern-
ment’s intrusion into their lives. Despite those
realities, the nature of those rights are framed dif-
ferently and the notion of dependency tends to give
considerably more power to the rights of parents to
control their children as they deem fit. Perhaps for
the vast majority of circumstances the rights of
individuals within families may not clash with
those of the entire family or of parents within
those families; it is when there are potential clashes
that the default of dependency can make an impor-
tant difference, as in instances involving how youth
are treated by mental health, education, medical,
child welfare, and juvenile justice systems. Some
of those systems were designed to address parental
failures, including the need to prevent failures,
which can result in challenging circumstances
when states need to protect the rights of parents
as well as those of their children.
References
Fineman, M. A. (2004). The autonomy myth: A theory of
dependency. New York: Free Press.
Levesque, R. J. R. (1994). The internationalization of
children’s human rights: Too radical for American ado-
lescents? Connecticut Journal of International Law, 9,
237–293.
Woodhouse, B. B. (1992). Who owns the child?: Meyer
and Pierce and the child as property. William and Mary
Law Review, 33, 995–1122.
Depressive Symptoms
Depressive Symptoms
Brandyn M. Street and Judy Garber
Department of Psychology and Human
Development, Vanderbilt University, Nashville,
TN, USA
Feelings of sadness and despondency in the face
of a disappointment or loss are both natural and
expected. All adolescents occasionally experience
distress and sadness. When such dysphoria lingers
for weeks, months, or longer and limit a person’s
ability to function, then the person may be suffer-
ing from major depressive disorder (MDD),
which is the most common mental health disorder
in the United States (Kessler et al. 2005). MDD
can have adverse consequences on an adolescent’s
academic performance, social life, and family
relationships (Bean et al. 2006; Shahar et al.
2006) and is associated with other mental health
problems, suicide, and hospitalizations (Jacobson
and Gould 2009; Ohayon and Schatzberg 2010;
Wolff and Ollendick 2006).
Given the severity and persistence of depres-
sion, health providers need to learn to identify
mood disorders and to provide evidence-based
treatments. This essay reviews the epidemiology,
phenomenology, diagnosis, course, and preven-
tion of depression in adolescents. This essay
begins with a discussion of the nature, core fea-
tures, and phenomenology of depression. Next, it
reviews issues concerning the detection of MDD
in community settings and provides an overview
of current empirically supported depression pre-
vention programs. It ends with suggestions for a
research agenda concerning depression in
adolescents.
Epidemiology
Depression is a common disorder in both commu-
nity (Lewinsohn et al. 1998) and clinical
populations (Birmaher et al. 2002). Rates of
depressive disorders increase during early to mid-
dle adolescence, particularly in females (Costello
Depressive Symptoms
et al. 2003; Hankin et al. 1998), with the peak age
of onset occurring at about 13–15 years old.
Whereas the rates of depression in prepubescent
children are about equal in boys and girls (Nolen-
Hoeksema and Girgus 1994), by about age 14 the
2:1 female to male ratio begins to emerge (Angold
et al. 2002; Costello et al. 2003).
Depressed adolescent females are more likely
to experience appetite or weight disturbances,
worthlessness or guilt, and suicidal ideation
(Alloy and Abramson 2007; Bearman and Stice
2008; Bennett et al. 2005) and to have more recur-
rences than males (Lewinsohn and Essau 2002).
Explanations for the increased rate of depression
in adolescent females have included interactions
among biological, psychological, and sociologi-
cal factors that emerge over time (Cyranowski
et al. 2000; Hyde et al. 2008; Nolen-Hoeksema
and Girgus 1994).
Lifetime prevalence rates of MDD in adoles-
cents range from 1.9% to 18.4% (Lewinsohn and
Essau 2002; Lewinsohn et al. 2000; Rao et al.
1999). In one of the most comprehensive epide-
miological surveys in the United States, the
National Comorbidity Study, the lifetime preva-
lence rate of MDD in adolescents was reported to
be 14%, and subsyndromal or minor depression
was found in 10–20% of youth (Kessler and
Walters 2002) An even higher percentage of ado-
lescents (20–50%) report significant levels of
symptoms on questionnaires (Kessler et al.
2001). Depressive symptoms show an increasing
trajectory during adolescence (Costello et al.
2006), are associated with significant impairment
(Chabrol 2007; Shahar et al. 2006) and predict the
onset of subsequent clinical disorders (Costello
et al. 2003; Sung et al. 2004).
Major depressive episodes (MDEs) during
adolescence last about 7–9 months in clinical
samples (Birmaher et al. 2002), about 26 weeks
in community samples (Lewinsohn et al. 1994),
and about 24 weeks in high-risk offspring
(Kaminski and Garber 2002). Although most
MDEs remit within 2 years, depression during
adolescence is highly recurrent, with as many as
40% of youth experiencing another MDE within
2–5 years after recovery (Birmaher et al. 1996;
Rao et al. 1999). Among psychotic or otherwise
939
severely depressed adolescents, approximately
25% develop bipolar disorder within 5 years
(Birmaher et al. 1996).
Longitudinal studies have found that the con-
tinuity of depression from adolescence to adult-
hood (e.g., Lewinsohn et al. 1999; Rao et al. 1999)
is stronger than for prepubertal-onset to adoles-
cent or adult depression (Weissman et al. 1999b).
Moreover, individuals who were depressed as D
adolescents have two to seven times increased
odds of having an episode in adulthood as com-
pared to individuals who did not have depression
during adolescence (Rutter et al. 2006). Evidence
of age differences in heritability (Lau and Eley
2008) and in neurobiological correlates (Kaufman
et al. 2001) may account for the different course
of child- as compared to adolescent-onset
depression.
Onset and Course
The first onset of depression often occurs between
15 and 19-year olds (Haarasilta et al. 2001;
Lewinsohn et al. 1998). Earlier age of onset is
associated with lifetime medical problems, sui-
cidal ideation, anxiety disorders, and a familial
history of depression (Klein et al. 2009). Although
adolescence often is a time of increasing self-
awareness, young people with MDD and their
parents may not recognize or acknowledge the
possible seriousness of persistent sadness and
the need for evaluation and treatment. Addition-
ally problematic is the perceived stigma many
adolescents associate with mental health care
(Jaycox et al. 2006). Jaycox and colleagues
found that nearly half of adolescents who
screened positive for depression reported that
their relationships with friends would suffer
more if their friends knew that they had a recent
history of depression or had visited a mental
health professional than if they had asthma or
HIV/AIDS.
The course of MDD in adolescents is charac-
terized by frequent recurrences (Dunn and
Goodyer 2006; Weissman et al. 1999a). Emslie
et al. (1997) reported that 61% of their sample of
depressed youth experienced an additional
940
depressive episode within 2 years. Rao et al.
(1999) reported that 47% of their sample experi-
enced a recurrence of another episode of MDD
within 5 years, with the first year following recov-
ery being the time of highest risk. Variables asso-
ciated with recurrence include parental
psychopathology, family conflict, and negative
cognitive style (Birmaher et al. 2002).
Untreated depression has been found to be a
risk factor for conduct problems, substance use,
interpersonal conflict, and educational under-
achievement, (Birmaher et al. 2004; Clark et al.
2007; Rohde et al. 2004; Shahar et al. 2006). In
addition, adolescents experiencing severe depres-
sion are at increased risk for suicidal ideation and
behavior (Gould et al. 2003). According to the
Centers for Disease Control and Prevention
(2004), suicide is the third most common cause
of death among adolescents and depression is the
second highest predictor of completed suicide in
adolescent males (Shaffer and Craft 1999).
Adolescent depression also has been linked
with subsequent medical problems including
migraine headaches, allergies, asthma, and
smoking progression (Audrain-McGovern et al.
2009; Egger et al. 1998; Waxmonsky et al.
2006). The association between adolescent
depression and medical problems may be due to
common biological, behavioral, cognitive, and
social factors. For example, depression may
undermine the immune system, thereby increas-
ing susceptibility to disease (Kiecolt-Glaser and
Glaser 2002). Symptoms and behaviors that char-
acterize depression and that can exacerbate risk
for medical problems include sleep problems, lack
of exercise, and poor appetite and nutrition
(Cohen and Rodriguez 1995). Further, depression
is associated with maladaptive social functioning,
which likely disrupts the social connectedness
that can be beneficial to physical health (Cohen
2004). Thus, adolescent depression may lay the
foundation for the development of physical disor-
ders and functional impairment.
Depressive symptoms among adolescents also
are quite common and subclinical levels of symp-
toms significantly predict the onset of a full MDE
(Rutter et al. 2006). However, 70% of depressed
youth go without appropriate treatment (Kataoka
Depressive Symptoms
et al. 2002) because of multiple family, child, and
health care system factors. Parents often do not
recognize affective problems in their children
(Cantwell et al. 1997) and may mistake a child
with depressive symptoms as just “going through
a stage.” In addition, youth may not communicate
mental health concerns to their primary care pro-
vider, particularly when practitioners have limited
time and experience with evaluating and treating
depressive disorders (Jaycox et al. 2006).
Clinical Presentation
Depression in adolescents is characterized by a
pervasive and persistent unhappy or irritable
mood and/or loss of interest or pleasure in usual
activities (i.e., anhedonia). According to the Diag-
nostic and Statistical Manual, fourth edition in
revision (DSM-IV-TR; American Psychiatric
Association 2000), the same criteria are used to
diagnose depression across development, except
that in children and adolescents irritability can be
one of the mood symptoms, and only 1-year dura-
tion is required for dysthymia. To qualify for a
diagnosis of MDD, five of the following symp-
toms are required, at least one of which must be
either a mood disturbance or a anhedonia:
(1) depressed and/or irritable (in children and
adolescents) mood for most of the day, (2) loss
of interest or pleasure in most activities,
(3) decreased or increased appetite and/or signif-
icant weight gain or weight loss, (4) insomnia
and/or hypersomnia, (5) psychomotor agitation
and/or retardation, (6) fatigue, loss of energy,
(7) feelings of worthlessness and/or inappropriate
guilt, (8) difficulty concentrating and/or making
decisions, and (9) recurrent thoughts of death
and/or suicidal ideation (American Psychiatric
Association 2000). These symptoms should rep-
resent a change from previous functioning, be
impairing, and persist for at least 2 weeks. The
average duration of an episode of MDD in youth
is between 3 and 9 months; 50–90% can be
expected to recover by 12–72 months from onset
(Birmaher et al. 2002).
Dysthymic disorder (DD) is a chronic form of
depression with fewer symptoms but lasting for at
Depressive Symptoms
least 1 year in children and adolescents. Depres-
sion not otherwise specified (DNOS) is defined by
depressed mood, anhedonia, or irritability
(in children and adolescents) and up to three
symptoms of major depression. Adjustment dis-
orders with depressed mood are characterized by
fewer than five depressive symptoms that occur
within 3 months of the onset of a specific stressful
situation, and last no longer than 6 months.
Some debate exists in the literature regarding
whether the experience and expression of depres-
sive symptoms change with development. In a
meta-analysis of studies comparing the occur-
rence of depressive symptoms across age groups,
Weiss and Garber (2003) found age differences in
many core (e.g., agitation, retardation, fatigue,
guilt, and sadness) and associated symptoms
(e.g., anxiety, somatic complaints). In particular,
depressed adolescents were more likely than pre-
adolescents to experience hopelessness/helpless-
ness, lack of energy, hypersomnia, weight loss,
and suicidality (Yorbik et al. 2004), although not
all of these age differences have been found in
studies using longitudinal analyses. Evidence also
is mixed regarding whether the underlying factor
structure of the depressive syndrome is similar
across ages (Weiss and Garber 2003). That is, do
the same symptoms comprise MDD in children
versus adolescents?
Comorbidity
In both clinic and community samples of adoles-
cents (Angold et al. 1999; Essau et al. 2000;
Lewinsohn et al. 1998), depression is associated
with significant comorbidity. Adolescents who
have depression are approximately 20 times
more likely to meet diagnosis for an additional
disorder (Angold and Costello 1993). In the Ore-
gon Adolescent Depression Project (OADP)
(Lewinsohn et al. 1998), 43% of the adolescents
with MDD also had a lifetime occurrence of
another mental disorder.
Among clinical samples of adolescents, the
most common comorbidity is anxiety disorders,
particularly generalized anxiety disorders (55%),
phobias (45%), and separation anxiety disorder
941
(9%) (Birmaher et al. 1996; Simonoff et al.
1997); indeed, anxiety disorders may serve as a
risk factor for depression (Zalsman et al. 2006).
Comorbidity rates for dysthymia (30–80%), con-
duct problems, and attention-deficit hyperactive
disorder (ADHD) (10–80%), and substance use
disorder (20–30%) also are quite high.
Corresponding comorbidity rates for anxiety dis-
orders, disruptive behavior disorders, substance D
use disorder, and ADHD (18%, 8%, 14%, and
21%, respectively) are lower in community com-
pared to clinical samples of adolescents (Jensen
et al. 1993; Lewinsohn et al. 1991), although still
quite high. A meta-analysis of studies of commu-
nity samples of children and adolescents revealed
that the odds ratios for comorbid disorders with
MDD were 8.2 for anxiety disorders, 6.6 for con-
duct/oppositional defiant disorders, and 5.5 for
ADHD (Angold et al. 1999).
Adolescent depression often co-occurs with
externalizing and substance use disorders, partic-
ularly in males (Lewinsohn et al. 1993; Yorbik
et al. 2004), and eating disorders, particularly in
females (Lewinsohn et al. 1993). Depression typ-
ically develops after the other comorbid disorder
(Lewinsohn et al. 1998), with two exceptions.
MDD typically precedes the onset of substance
use disorders (Birmaher et al. 1996). Second,
comorbid conduct disorder often represents a
complication of depression with the conduct prob-
lems persisting after the depression remits
(Birmaher et al. 1996). 61, 93–95.
Impairment in cognitive and social functioning
in individuals with MDD is intensified by comor-
bid conditions (Biederman et al. 2008; Fergusson
and Woodward 2002; Rudolph and Clark 2001).
For example, depressed adolescents with ADHD
have been found to be at increased risk for longer
episode duration, a higher rate of suicidiality, and
a greater likelihood of requiring psychiatric hos-
pitalization (Biederman et al. 2008). Depression
comorbid with other disorders tends to be more
severe and recurrent, and is less responsive to
treatment (Birmaher et al. 1996). Depressed ado-
lescents with comorbid externalizing disorders
have more interpersonal impairment (Rudolph
and Clark 2001), experience more stressful life
events (Daley et al. 1997; Rudolph et al. 2000),
942
and show lower rates of depression and higher
rates of criminality/antisocial personality disorder
and alcohol abuse in adulthood (Harrington et al.
1991) compared to those without such
comorbidity.
Assessment
Age-appropriate assessment of depressive symp-
toms and disorders is a key part of the treatment
process. Obtaining information from multiple
informants and using a variety of assessment
methods including clinical interviews, question-
naires, and behavioral observation provide a com-
prehensive evaluation needed to make accurate
diagnoses and treatment plans. Even when infor-
mation from multiple sources is available, getting
report directly from the adolescent is important
(Ferdinand et al. 2004). Parents often are unaware
of their child’s inner experience and therefore may
be less accurate reporters about their child’s sub-
jective distress (Ferdinand et al. 2004).
Clinical Interviews
Psychiatric interviews typically are conducted
with the parent and adolescent separately
and sequentially. Such detailed inquiry can help
establish rapport with the adolescent and family.
Observations of adolescents’ nonverbal commu-
nications such as affective expressions, psycho-
motor restlessness or agitation, and listless speech
also can be helpful in making an accurate diagno-
sis (Garber and Kaminski 2000).
Several psychometrically adequate diagnostic
interviews exist to assess depressive disorders in
adolescents. The Schedule for Affective Disorders
and Schizophrenia for School-Age Children
(K-SADS; Ambrosini 2000; Kaufman et al.
1997) is one of the most widely used and compre-
hensive clinician-administered interviews for
diagnosing depression in youth (Hodges 1994).
Disadvantages of the K-SADS are that it can be
time-consuming and resource demanding; that is,
it requires extensive training and supervision
(Reynolds and Kamphaus 2003).
Other available structured interviews include
the Interview Schedule for Children and
Depressive Symptoms
Adolescents (ISCA; Kovacs 1997), the Diagnos-
tic Interview Schedule for Children Version IV
(DISC IV; Shaffer et al. 2000), the Diagnostic
Interview for Children and Adolescents-Revised
(DICA-R; Reich 1991), and the Child and Ado-
lescent Psychiatric Assessment (CAPA; Angold
and Fisher 1999). Like the K-SADS, these struc-
tured interviews require training and are routinely
used in clinical research settings.
Self-Report Questionnaires
The Center for Epidemiological Studies Depres-
sion Scale (CES-D; Radloff 1991) is a 20-item
self-report measure of depressive symptoms
developed for use with adults, but has been
found to be reliable and valid with adolescents
also (Roberts et al. 1990). The CES-D assesses
the degree to which individuals have had the core
symptoms of depression including negative
affect, thoughts, and behaviors during the past
week. Representative statements include “I felt
sad” and “I did not feel like eating; my appetite
was poor.” Respondents rate each statement using
a four-point Likert Scale from 0 (rarely or never)
to 3 (most of the time). Items are summed to create
a total score; total scores of 16–23 indicate mild
depression, 24–30, moderate depression, and
scores over 30 reflect more severe levels of
depression (Roberts and Chen 1995). Other self-
report measures of depressive symptoms for ado-
lescents include the Children’s Depression Inven-
tory (Kovacs 1985), the Beck Depression
Inventory (Beck et al. 1961), the Reynolds Ado-
lescent Depression Scale (Reynolds 1987), the
Mood and Feelings Questionnaire (Angold et al.
1987), the Depression Self-Rating Scale (Birleson
1981), and the Dimensions of Depression Profile
for Children and Adolescents (Harter and
Nowakowski 1987).
Depression self-report measures can be used as
quick screening tests that patients can complete
while in the waiting room at intake and also can be
used to monitor changes in symptoms over the
course of treatment (Spitzer et al. 1994). Recog-
nition and treatment of depression are especially
important in primary care settings because for
most adolescents, their primary care provider
may be the only health professional seen within
Depressive Symptoms
the course of a year (Gans et al. 1991). One study
conducted in a primary care setting found that
20% of youth met criteria for a depressive disor-
der (Kramer and Garralda 1998). Thus, primary
care settings may be the first place that depres-
sion in an adolescent is recognized. Unfortu-
nately, youth seen in primary care for
depression are less likely to receive follow-up
care compared to children presenting with
behavioral and/or attentional problems (Wren
et al. 2005), and they typically do not receive
treatment until their problems have begun to
severely impact functioning (i.e., suicidal behav-
ior) (Essau 2005).
Prevention of Depression in Adolescents
Given that only a small proportion of adolescents
with depressive disorders receive treatment
(Kataoka et al. 2002), prevention programs have
a unique opportunity to reach children before the
age of greatest risk, before their symptoms
increase in severity, and/or before risk factors
culminate in disorder onset. Historically, preven-
tion was categorized as primary, secondary, or
tertiary (Caplan 1964). Reducing the incidence
of new cases of disorder in individuals who have
not had the disorder is primary prevention; reduc-
ing the duration and severity of symptoms is sec-
ondary prevention (i.e., treatment); and reducing
the recurrence of the disorder and its associated
impairment in those who have already had it is
tertiary prevention (maintenance). The Institute of
Medicine (IOM) found this distinction to be too
broad, and instead introduced the classification of
prevention based on the population groups to
whom the interventions are directed (Mrazek and
Haggerty 1994). Universal prevention is adminis-
tered to all members of a population and does not
target particular individuals based on risk. Selec-
tive prevention is given to subgroups of a popula-
tion whose risk is deemed to be above average
(e.g., offspring of depressed parents). Indicated
prevention is provided to individuals who have
subthreshold levels of signs or symptoms of the
disorder, but who do not currently meet criteria for
the diagnosis.
943
Qualitative (e.g., Gillham et al. 2000; Merry and
Spence 2007; Sutton 2007) and quantitative (e.g.,
Brunwasser et al. 2009; Horowitz and Garber
2006; Merry et al. 2004a) reviews of studies testing
interventions to prevent depression in children and
adolescents have concluded that: (a) some targeted
(i.e., selective, indicated) depression prevention
programs are efficacious; (b) targeted preventions
have effect sizes greater than those found for uni- D
versal programs; (c) the effect sizes for targeted
prevention programs generally have been small to
moderate; and (d) the effects tend not to endure.
Most studies have measured change in depressive
symptoms; far fewer studies have prevented the
onset of depressive disorders.
Central to the prevention of depression is
a recognition that dysfunctional thoughts and
interpersonal relationships characterize depres-
sion. Both Cognitive Behavioral Therapy
(CBT)-based preventive interventions, which
combine cognitive restructuring techniques and
behavioral activation, and Interpersonal Therapy
for Depressed Adolescents (IPT-A)-based
approaches, which emphasize building and
strengthening interpersonal relationships, have
been found to be efficacious. The two approaches
share a number of components (problem solving,
time-limited, attention to increasing engagement
in pleasurable activities), which may explain why
both produce beneficial adolescent outcomes
(Clarke et al. 2001; Young et al. 2006).
The most extensively tested preventive inter-
vention with youth is the CBT-based Penn Pre-
vention Program (PPP) (see Brunwasser et al.
2009 for a review), which has been administered
to universal, selective, and indicated samples. PPP
has shown both short- and long-term significant
effects, and has been replicated several times in
different samples (e.g., Cardemil et al. 2007;
Quayle et al. 2001; Yu and Seligman 2002).
Most studies of PPP have assessed depressive
symptoms, although a few have evaluated depres-
sive disorders (Gillham et al. 2006b). Samples
sizes have been generally adequate, and evidence
of satisfactory fidelity has been demonstrated.
A recent meta-analysis (Brunwasser et al. 2009)
indicated that youth participating in PPP experi-
enced fewer depressive symptoms at post-
944
intervention, and at 6-, 8-, and 12-month follow-
ups compared to youth receiving no intervention.
The strongest effects were found among studies
with selective and indicated approaches im-
plemented by research team members.
Another replicated depression prevention pro-
gram in youth is based on the Coping with Depres-
sion course developed by Clarke et al. (1990). The
program focuses on monitoring negative moods,
changing maladaptive thought patterns, and prob-
lem solving. Short-term efficacy was found when a
modified version of the program was tested in a
universal sample (Horowitz et al. 2007), and both
short- and longer-term efficacy have been found in
selective and indicated samples (Clarke et al. 2001;
Garber et al. 2009); adolescents in the CBT pre-
ventive intervention experienced significantly
fewer episodes of depression compared to adoles-
cents in the usual care condition. In addition,
Garber and colleagues showed that the intervention
effects were larger for adolescents whose parents
were not depressed at baseline.
Other noteworthy depression prevention pro-
grams have been developed and evaluated in
Australia and New Zealand. The Resourceful Ado-
lescent Program (RAP) (Merry et al. 2004b;
Shochet et al. 2001) has been tested in large uni-
versal samples, was found to be efficacious both at
post-intervention and follow-up, was replicated by
independent researchers, and was found to have
satisfactory adherence. The Problem Solving for
Life program (PSFL) (Spence et al. 2003) focuses
on cognitive restructuring and problem solving, is
administered by teachers, and has been tested in
large universal school samples. PSFL was found to
have significant short-term effects (Spence et al.
2003), although this was not replicated (Sheffield
et al. 2006), and it has not shown significant long-
term effects (Spence et al. 2005).
Evidence of short-term efficacy of the Interper-
sonal Psychotherapy-Adolescent Skills Training
program (IPT-AST) in both a large universal
(Horowitz et al. 2007) and a small indicated
(Young et al. 2006) sample has been found. Young
and colleagues also showed that the significant
effects endured through the 6-month follow-up.
Recently, Compas et al. (2009) tested a
12-session family cognitive-behavioral group
Depressive Symptoms
that focused on the prevention of depression
among offspring of depressed parents. The inter-
vention was compared with a written information
self-study control condition. Youth in the family
group intervention reported significantly fewer
internalizing and externalizing symptoms, partic-
ularly at 12-month follow-up. In addition, parents
in the family intervention reported significantly
fewer symptoms of depression at 2-, 6-, and
12-month follow-up. These findings support the
involvement of parents in prevention work with
adolescents.
Overall, results of prevention studies with ado-
lescents indicate benefits of CBT-based interven-
tions and interpersonal-based approaches. The
results also underscore the value of conducting
follow-up assessments and the limitations of uni-
versal approaches. In light of recent evidence
favoring family group intervention, further study
of the inclusion of parents and/or family compo-
nents in preventative interventions for youth
is warranted. Modification and evaluation of
depression prevention programs with children
and adolescents from diverse ethnic and racial
backgrounds also is needed (see Cardemil
et al. 2007).
Depression and Real-World Settings
Fox et al. (2008) recently called for school-based
mental health checkups (screenings) for internal-
izing disorders. Borrowing from Shaffer et al.’s
(2004) Columbia Suicide Screen, which assesses
adolescents’ risk of suicide, Fox and colleagues
proposed a stepped care approach to assessment,
prevention, and treatment that includes the fol-
lowing: (1) entire classes or groups of adolescents
completing a self-report battery assessing inter-
nalizing symptoms and risk factors (e.g., negative
self-cognitions, stressful life events), (2) mental
health professionals scoring the measures and
submitting written summaries of the results, and
(3) mental health professionals contacting parents
of adolescents who score above established
cutoffs to schedule follow-up assessments, rec-
ommend prevention/early intervention, or refer
for treatment.
Depressive Symptoms
Barriers to implementation of such school-
based mental health checkups include, but are
not limited to, cost, consistency with other school
directives, and the need to make the benefits clear
to policymakers, educators, and parents. To
address these issues, studies should examine the
clinical impact relative to the financial expenses of
such mental health checkups in terms of reducing
symptoms of depression and the prevention of
internalizing problems.
Some adolescents and their parents may feel
more comfortable discussing mental health con-
cerns with their primary care provider as opposed
to being assessed at school. Given that 70% of
youth visit primary care providers within the
course of a year, primary care settings may be
an ideal setting for early identification and inter-
vention with adolescents experiencing emotional
distress (Monheit and Cunningham 1992). Unfor-
tunately, due to features of managed care, the time-
limited nature of pediatric visits, and the low rates
of specialty referral from primary care settings, the
detection rates and outcomes for adolescents with
mental health needs in primary care have tended to
be poor (Chang et al. 1988; Lavigne et al. 1993;
Burns 1996; Wells et al. 1989).
To address these assessment issues, Zuckerbrot
et al. (2007) evaluated the feasibility and accept-
ability of a two-stage adolescent depression iden-
tification method at three sites of a pediatric
primary care practice. First, adolescents com-
pleted the Columbia Depression Scale (CDS)
while in the waiting room. Providers then
reviewed the screens and could request that the
patient take the youth-informant Columbia voice
DISC-IV, a computer assisted self-interview ver-
sion of the present state version of the Columbia
Diagnostic Interview Schedule for Children,
which generates a diagnostic report for providers.
Patients expressed satisfaction with the procedure
and providers expressed a desire to continue to use
the CDS (Zuckerbrot et al. 2007).
In a study testing the effectiveness of PPP
delivered by therapists in a primary care setting,
Gillham et al. (2006a) randomized 271 children
(11–12 years old) with elevated depressive symp-
toms on the CDI to either PPP or usual care. Over
the 2-year follow-up, PPP significant prevented
945
depression, anxiety, and adjustment disorders
(when combined) among high-symptom children.
Stronger effects were found when the intervention
was delivered with high compared to low fidelity,
and girls benefited more from PPP than boys.
Asarnow et al. (2005) also conducted a study
for youth depression in primary care. Primary care
clinics were randomized to treatment as usual
(TAU) or a quality improvement program (QIP). D
The QIP involved training depression care man-
agers in CBT, patient and clinician choice regard-
ing treatment modality, and educating
participating clinicians in depression evaluation,
management, and pharmacological and psychoso-
cial treatments. Asarnow and colleagues demon-
strated that depression and functioning were
significantly better for youth in the QIP condition
compared to those receiving TAU.
One concern about providing intervention in
managed care settings is the issue of safety. When
teens are at risk of harming themselves or others,
the option for hospitalization needs to be available
to provide treatment and ensure safety. Some
communities, however, lack inpatient beds for
the crisis care of youth (Thomas 1999). This
unmet need might be addressed by extending
health coverage to the uninsured and establishing
parity laws that mandate equivalent coverage for
mental and physical health conditions (Wells et al.
2001). Many low-income youth have decreased
access to mental health services because they are
uninsured, and for those who are insured, costs for
mental health services commonly exceed cover-
age limits (Sturm 1997).
Primary care settings hold considerable prom-
ise for addressing unmet needs for treatment of
adolescent depression. Unfortunately, there is a
serious dearth of information about how to
implement and maintain depression screening
as part of routine clinical practice. Additional
research on the financial implications and clini-
cal benefits of such screening is needed
(Zuckerbrot et al. 2007). In addition, longitudi-
nal studies within primary care settings should
develop and test the effectiveness of intervention
strategies for youth with depression and address
issues of sustainability and dissemination (Wells
et al. 2001).
946
Summary and Future Directions
Depression among adolescents is common, recur-
rent, highly comorbid with other disorders, and
associated with significant impairment. Most
depressed youth do not receive any or appropriate
treatment (Kataoka et al. 2002). Multiple
approaches to assessment of depression include
clinical interviews, behavioral observation, and
questionnaires completed by adolescents, parents,
and teachers.
Prevention of depression is possible, particu-
larly among at-risk youth. Evidence of short-term
effects of some preventive interventions has been
found, particularly cognitive and/or interpersonal
approaches with high-risk populations
(Brunwasser et al. 2009; Horowitz and Garber
2006). Further research is needed to develop and
evaluate depression prevention programs that
have enduring effects as well.
There has been growing interest in early inter-
vention and prevention of depression in both
school and primary care settings (Fox et al.
2008; Walker et al. 2002; Zuckerbrot et al.
2007). Several barriers to practical action exist
including cost, absence of on-site therapists
trained in evidence-based interventions, short
duration of pediatric visits, and limited insurance
coverage (Burns 1996; Sturm 1997). Neverthe-
less, these settings represent logical contexts to
reach the largest number of adolescents, and
thereby reduce the burden of depression.
Cross-References
▶ Externalizing and Internalizing Symptoms
Acknowledgment Street was supported in part from an
NIMH-funded training grant (T32MH18921); Garber was
supported in part from an NIMH Independent Scientist
Award (K02 MH66249) and grants from the National
Institute of Mental Health (R01 MH57822) and the
William T. Grant Foundation (173096).
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Designer Drugs
childhood mood and anxiety syndromes? International
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Designer Drugs
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
The term designer drugs refers to any kind of
regulated drug chemical substance that has had
its structure modified so that it can be trafficked
outside of restrictions placed on the regulated
drug it resembles. Current regulations stipulate
that the precise chemical structure and label
attached to a unique compound must be specified
before it can fall under the purview of controlled
substances and the regulations associated with
them. With the easy accessibility of the Internet
and potentially far reach of peer groups, many
adolescents have found increased availability of
a wide spectrum of recreational drugs, including
Ecstasy and hallucinogenic amphetamines (see
Wax 2002). In addition to increased access to
these new types of drugs, adolescents report
increased use of them and appear to use them for
reasons similar to more traditional substances. In a
study of illicit drug use among adolescents, for
example, many specified that they had specific
951
reasons for engaging in the habitual usage of
such substances. As expected, respondents who
used amphetamines, cocaine, hallucinogens,
and/or designer drugs tended to use drugs for
social or psychological enjoyment (Spooner
1999). Notably, adolescents who had particular
motivations for their drug usage also tended to
adhere to a certain type of substance. Large stud-
ies of youth at risk, such as those who have been D
involved in the juvenile justice system, indicate
that alcohol and marijuana use are the substances
of choice (with over 70% reporting use), followed
by powder cocaine and ecstasy and other designer
drugs (with approximately 10% of youth using
them) (Braithwaite et al. 2003). Although preva-
lence rates of designer drug use may be relatively
low in comparison to the use of many other sub-
stances, they still represent a wide range of serious
health risks. For example, since no one can reli-
ably assess or confirm a kitchen chemist’s knowl-
edge and abilities, as well as the manner the drug
reached and circulated in the market, it is impos-
sible to determine their products’ potency, purity,
or toxic potentiation for physical and psycholog-
ical damage, let alone the other types of effects
associated with drug use. The relative lack of
information about these types of drugs provides
challenges for basic researchers seeking to fill
the void in the understanding about them and
poses problems for practitioners confronted with
treating and responding to users of these
substances.
Cross-References
▶ Substance Use Risk and Protective Factors
References
Braithwaite, R. L., Conerly, R. C., Robilliard, A. G., Ste-
phens, T. T., & Woodring, T. (2003). Alcohol and other
drug use among adolescent detainees. Journal of Sub-
stance Use, 8, 126–131.
Spooner, C. (1999). Causes and correlates of adolescent
drug abuse and implications. Drug and Alcohol Review,
18, 453–475.
Wax, M. (2002). Just a click away: Recreational drug web
sites on the Internet. Pediatrics, 109, 1–4.
952
Desistance from Crime and
Delinquency
Lila Kazemian
Department of Sociology, John Jay
College of Criminal Justice, New York,
NY, USA
Overview
The association between age and crime is one of
the most established facts in the field of crimi-
nology. It is generally agreed that aggregate
crime rates peak in late adolescence/early adult-
hood and gradually drop thereafter, but there is
still very little consensus regarding the cause of
this decline. In the field of Criminology, desis-
tance is generally defined as the cessation of
offending or other antisocial behavior. Desis-
tance is one of the central dimensions studied
in life-course criminology and is also one of the
key criminal-career parameters. In recent years,
the growing literature on the topic of desistance
from crime and deviant behavior has generated a
large body of knowledge on this dimension of
the criminal career. Despite these efforts, it has
been suggested that our understanding of the
processes underlying desistance remains lim-
ited. The topic of desistance is particularly
important for intervention and prevention pur-
poses, as it guides post-onset efforts aiming to
limit the intensity, seriousness, and duration of
criminal careers. The main correlates of desis-
tance identified in the literature include the
development of stronger bonds to sources of
informal social control (namely marriage, chil-
dren, employment), associations with prosocial
peers and shifts in routine activities, the cessa-
tion of substance use, and cognitive changes
(i.e., increased maturation, determination to
cease offending, willingness to change, and
shifts in identity). It has also been suggested
that desistance is most likely to occur if cogni-
tive changes occur in conjunction with a strong
social support system.
Desistance from Crime and Delinquency
Foundational Research on Desistance
One of the most comprehensive reviews of the
desistance literature can be found in Laub and
Sampson (2001). The authors discuss various the-
oretical, conceptual, and methodological issues
relevant to this topic, highlight the limitations of
past studies on desistance, provide an overview of
the theoretical frameworks developed to explain
desistance, and report empirical findings on the
predictors of desistance. While relatively few
texts have focused solely on the topic of desis-
tance, sources on developmental, life-course, and
criminal-career research often include a segment
on desistance. Sampson and Laub (1993) and
Laub and Sampson (2003) are essential readings
in the area of desistance. The authors present
findings from their follow-up of the males
involved in the Gluecks’ original study (Glueck
and Glueck 1950). Sampson and Laub (1993)
present findings from the first major reanalysis
of the Glueck data, with a particular emphasis on
the role of social bonds in the explanation of crime
and desistance. In the second major reanalysis,
Laub and Sampson (2003) extend the follow-up
period to age 70, investigate trajectories of
offending, and address the issue of prediction.
Two other reports also offer key research in this
area. Maruna (2001) reports results from the Liv-
erpool Desistance Study, a follow-up study of
desisting former offenders and persisting
offenders. This text offers a qualitative analysis
of the desistance process among a group of for-
merly incarcerated individuals by examining the
narratives of “desisting” and “persisting”
offenders. Ezell and Cohen (2005) address vari-
ous key questions in desistance research, such as
individual distributions of the age-crime curve
and the degree of stability and change in offending
behavior across time. The authors conduct thor-
ough analyses using three samples of high-rate
offenders under the jurisdiction of the California
Youth Authority to elucidate some of these impor-
tant issues. In addition to that study, the National
Research Council published a policy-oriented
report in 2007, which reviewed current reentry
practices, resources, and services available to for-
merly incarcerated individuals. A discussion of
Desistance from Crime and Delinquency
some of the major limitations of research on
parole, desistance, and reintegration is presented,
including shortcomings relating to parole hetero-
geneity, intervention effects, and methodological
flaws. Recommendations for policy and research
are laid out in this publication.
Populations Generally Studied
While adolescent samples are highly relevant to
the study desistance, it is also crucial to study this
dimension of the criminal career beyond adoles-
cence. One of the key issues in desistance research
is the length of follow-up required to study desis-
tance. Estimates of the age of termination are
dependent on the length of the follow-up period
(Bushway et al. 2003; Le Blanc and Loeber 1998).
Farrington and Wikström (1994) argue that short
follow-up periods can result in misleading find-
ings. In a follow-up of adjudicated men up to age
25, Le Blanc and Fréchette (1989) found that the
average age at last conviction was 19.9 years.
When the follow-up extended to the early 40s,
the average age at last conviction was 31 years.
One of the strongest arguments supporting the
need to study desistance beyond adolescence is
portrayed through the fact that most juvenile
delinquents do not become adult offenders
(Moffitt 1993). In this regard, it is important to
collect longitudinal data about offending and
other developmental measures in order to better
understand patterns of desistance and persistence
during and after adolescence. Although it is
possible to study the desistance process using
cross-sectional or retrospective data, long-term,
prospective follow-ups help to establish with
increased certainty whether desistance has actu-
ally occurred. The intermittent character of
offending patterns may sometimes lead to the
illusion of desistance. This issue will be discussed
in a subsequent section.
While the body of research on desistance is
growing, data from these studies are not consis-
tently accessible to the public. In many instances,
these data are collected in the context of larger
longitudinal studies, generally as part of more
extensive analyses on life-course and criminal-
953
career patterns. As such, these studies are well
equipped to investigate the desistance process,
particularly during the transition period between
adolescence and early adulthood. Some of these
data are available through the Interuniversity Con-
sortium for Political and Social Research
(ICPSR). This section highlights some of the key
longitudinal studies that have accessible data.
There are several important longitudinal studies D
in this area. The Cambridge Study in Delinquent
Development is a longitudinal follow-up of
411 working-class males from London, first
contacted in 1961–1962 when the boys were 8–9
years old, and interviewed on eight subsequent
occasions (up to age 46). Parent and teacher
reports were documented at younger ages. These
data are particularly useful for the study of desis-
tance in adolescence and early adulthood; compre-
hensive interviews were conducted at ages 14, 16,
and 18. Data include psychological, social, behav-
ioral, and offending variables. ICPSR includes
CSDD data up to 1981 (see Farrington et al.
(2006), for an overview of the study). The
National Youth Survey collected both self-reported
and official information about offending over var-
ious periods of the life course, and the data from
this study has produced numerous publications.
The NYS began in 1977, with an initial random
sample of 1,725 youths (11–17 years) from US
households. Data for the NYS for waves I (1976)
through VII (1987), as well as a compilation of
studies that have been published with these data,
are available on ICPSR. The Philadelphia Birth
Cohort studies consist of two follow-ups of dis-
tinct Philadelphia cohorts, one born in 1945 and
another in 1958. The first cohort includes 9,945
Philadelphia males born in 1945. The second
cohort consists of 27,160 Philadelphia males and
females born in 1958. Data includes demographic
and social variables, as well as measures of
offending (see Wolfgang et al. (1972) and Tracy
et al. (1990) for a description of the study).
Unraveling Juvenile Delinquency is a longitudinal
study of 500 adjudicated and 500 representative
Boston males, led by Sheldon and Eleanor Glueck.
Information was collected through official records,
self-reports, and teacher and parent reports. These
data have been analyzed extensively in Sampson
954
and Laub’s various works on desistance. Data
from 1939 through 1963 are available on ICPSR
(see Glueck and Glueck 1950). The Longitudinal
Study of Criminal Career Patterns of Former Cal-
ifornia Youth Authority Wards is a longitudinal
study of serious juvenile offenders released from
the California Youth Authority between 1965 and
1984. Information about offending, substance use,
and life events is documented. Only official infor-
mation is available. These data have been used in
publications on desistance (e.g., see Ezell and
Cohen 2005).
Other longitudinal studies have contributed to
the literature on desistance, with follow-ups
extending from childhood or adolescence into
adulthood. While these data are not available to
the public, these studies are noteworthy. These
include the Pittsburgh Youth Study, the Rochester
Youth Development Study, the Denver Youth Sur-
vey, the Montreal Longitudinal and Experimental
Study, the Montreal Two Samples Longitudinal
Study, and the Seattle Social Development Pro-
ject. These studies have made important contribu-
tions to the literature on persistence and desistance
from crime across various periods of the life
course, including adolescence and the transition
to adulthood.
Conceptual, Measurement, and
Methodological Issues
Issues relating to the definition, measurement, and
operationalization of desistance have been raised
in the desistance literature. Laub and Sampson
(2001) and Kazemian (2007) offer an overview
of some of these issues. Among the issues that
they address are questions such as the definition of
desistance, the length of follow-up required to
study desistance, and the type of data (self-report
versus official) employed for this type of analysis.
Many studies on desistance have adopted a
dichotomous or static measure of desistance. As
a result, these studies have not accounted for
changes in rates of offending. An increasing num-
ber of researchers have acknowledged the rele-
vance of perceiving desistance as a gradual
process (see Bushway et al. 2001, 2003; Laub
Desistance from Crime and Delinquency
and Sampson 2001, 2003; Maruna 2001). The
complete cessation of offending activities is
unlikely to occur suddenly, especially among
individuals who have been highly active in
offending from a young age. For this reason, static
definitions of desistance (i.e., termination) may
mask the progress exhibited by individuals across
various stages of the desistance process (see
Bushway et al. 2001, for a discussion on this
topic). Therefore, focusing solely on the final
state of termination provides little guidance for
intervention initiatives, neglecting to offer support
and reinforcement in periods when they are most
needed (i.e., periods of reassessment and ambiva-
lence toward desistance/persistence). Although
different individuals may cease offending at the
same age, their criminal careers may be distin-
guished by very different processes (in terms of
frequency, seriousness, and length).
Bushway et al. (2001) present a thorough
discussion on the importance of studying desis-
tance as a process and develop a statistical frame-
work for analyzing the process of desistance. On
the premise of this argument, Bushway et al.
(2003) conduct analyses to compare the predic-
tors of desistance using static (cessation of
offending) and dynamic (changes in offending)
definitions, and show that the two operationa-
lizations of desistance may yield different
findings.
Uggen and Kruttschnitt (1998) contrast predic-
tors of self-reported and official desistance, and
make the distinction between two types of desis-
tance: behavioral desistance refers to the shift
from self-reported crime to noncrime, whereas
official desistance refers to the absence of official
offending (measured through arrests or convic-
tions). Conclusions drawn about desistance seem
to vary according to the type of measurement
method privileged (i.e., official vs self-reported
desistance; see Le Blanc and Fréchette 1989;
Nagin et al. 1995; Uggen and Massoglia 2003).
Laub and Sampson (2001) argue that few stud-
ies have offered an operational definition of desis-
tance, and that there is currently no consensus on
this issue (see also Maruna 2001; Piquero et al.
2003). Various definitions of desistance have been
developed in the literature. Meisenhelder (1977,
Desistance from Crime and Delinquency
p. 319) defined desistance as exiting, i.e., the
“successful disengagement from a previously
developed, and subjectively recognized, pattern
of criminal behavior.” Drawing on ideas devel-
oped by Le Blanc and Fréchette (1989), Loeber
and Le Blanc (1990) offered a definition of desis-
tance that integrates four dimensions; the authors
argue that before criminal activity ceases
completely, lambda declines, offenders become
increasingly specialized and engage in more
minor offenses, and a culmination point is
reached. Uggen and Kruttschnitt’s (1998) defini-
tion of behavioral desistance implies a shift from a
state of offending to a state of non-offending, and
its maintenance. Maruna (2001) argues that the
definition of desistance needs to emphasize
maintenance rather than termination. Bushway
et al. (2001, p. 500) define desistance as “the
process of reduction in the rate of offending
(understood conceptually as an estimate of crim-
inality) from a nonzero level to a stable rate
empirically indistinguishable from zero.” Indis-
tinguishable from zero refers to the idea that
offending rates become indistinguishable from
those of non-offenders. Because criminal events
often are dependent on circumstantial factors and
chance, the authors further argue that the desis-
tance process should focus on changes occurring
in the propensity to offend (i.e., criminality)
rather than on changes in crime.
Other operationalizations of desistance include
convictions at age 21, but not between 21 and
32 (Farrington and Hawkins 1991), the absence
of new officially recorded offenses or probation
violation over a 2-year period (Kruttschnitt et al.
2000), juvenile delinquents who were not arrested
as adults (Sampson and Laub 1993), and the
absence of self-reported illegal earnings
(behavioral desistance) or arrests (official desis-
tance) over a 3-year follow-up period (Uggen and
Kruttschnitt 1998). Bushway et al. (2003) argue
that the selection of cutoff points is arbitrary and
varies from one study to another, making it diffi-
cult to compare findings. Given these conceptual
disparities, Uggen and Massoglia (2003,
pp. 316–317) have argued that “. . .it is difficult
to draw empirical generalizations from the grow-
ing literature on desistance from crime.”
955
The Issue of False Desistance
False desistance refers to the erroneous assump-
tion that individuals have ceased offending.
Desistance often is defined as the last officially
recorded or self-reported offense. Because desis-
tance studies may employ cross-sectional data or
relatively short follow-up periods, researchers
may draw misleading conclusions about whether D
study participants have truly ceased offending. It
has been argued that definite desistance only
occurs with death (Blumstein et al. 1982; Elliott
et al. 1989; Farrington and Wikström 1994).
Piquero (2004, p. 108) defines intermittency as
“the time between successive criminal events,
controlling of course for exposure time.” Mis-
chkowitz (1994) makes the distinction between
desistance and interruptions in the criminal career.
Elliott et al. (1989) refer to a “suspension” from
criminal activity, implying that the discontinua-
tion of offending activity is not permanent. Bur-
nett (2004, p. 169) describes ambivalence in the
decision to desist from crime and argues that
“desistance is a process which involves reversals
of decisions, indecision, compromise, and lapses”
(see Horney et al. 1995, for similar results). Inter-
mittent patterns of offending in criminal careers
may lead to the false interpretation that offenders
have ceased offending (Piquero 2004). This issue
of temporary versus permanent desistance
(or “zigzag” patterns; see Laub and Sampson
2003; Piquero 2004) has been highlighted by
criminal-career researchers (e.g., Barnett et al.
1989; Piquero et al. 2003), although very few
studies have explored this question in depth
(Piquero 2004). The issue of false desistance is
particularly relevant to studies that focus exclu-
sively on studying desistance during adolescence,
without follow-ups into adulthood.
Typologies in Desistance Research
In recent years, empirical evidence in criminal-
career research has “suggested the existence of
distinct types of offenders such as early starters,
late starters, persisters, desisters, occasionals, and
chronics” (Paternoster and Brame 1997, p. 236).
956
Limitations of the typological approach, mainly
issues linked to parsimony, offender heterogene-
ity, and overlap between the groups have often
been raised. Maruna (2001) argues that the dichot-
omy between persisters and desisters is useful for
statistical purposes, but that it is subject to con-
siderable intra-group variability. Maruna further
maintains that “the two groups (desisting and
persisting offenders) represent similar individuals
in different stages of the process of change... and
not two starkly different ‘types’ of people” (p. 74).
In their analyses of life narratives, Laub and
Sampson (2003, p. 240) also demonstrate the
ambiguities associated with defining groups as
persisters or desisters, and argue that classifica-
tions grow increasingly complex as the length of
the observation period increases. The authors
reject the idea that “offenders can be neatly
grouped into distinct categories, each displaying
a unique trajectory and etiology of offending”
(p. 4). They further add that offender typologies
“do not capture the patterning or complexity of
criminal offending over the full life course”
(p. 248), and that this issue cannot be resolved
with the use of more sophisticated statistical tech-
niques. The rationale underlying the use of
offender typologies relates to the idea that explan-
atory and causal mechanisms for desistance are
distinct from those of persistence. Empirical
research has yet to establish whether clear differ-
ences exist between desisters, persisters, and
non-offenders.
Explanatory Frameworks for Desistance
Various explanatory frameworks have been devel-
oped to explain the desistance process; these have
been discussed more extensively in Laub and
Sampson (2001). The maturation framework,
discussed in Glueck and Glueck (1940), stipulates
that physical, intellectual, and emotional develop-
ment (i.e., maturation) is the main cause for
decline or cessation of offending behavior.
Gottfredson and Hirschi (1990) present their gen-
eral theory of crime and argue that aging is a major
reason for the decline in crime observed over time,
and that offending declines for all offenders with
Desistance from Crime and Delinquency
age. This framework is more relevant to the expla-
nation of desistance in adulthood.
Two major developmental explanations of
desistance have been developed. Moffitt (1993)
presents a taxonomy that includes two groups of
offenders: adolescence-limited and life-course
persisters. The author explains that desistance is
more likely for the adolescence-limited offenders
because they are capable of reintegrating them-
selves into a conventional lifestyle; they are also
characterized by less “injurious childhoods.” The
life-course-persistent offenders show increased
continuity in their offending habits and manifest
early onset, high offending frequency, and later
desistance. This typology has been tested empiri-
cally using various data. Studying the narratives
of “desisting” and “persisting” Liverpool males,
Maruna (2001) offers another developmental
framework for the study of desistance. He sug-
gests that desistance occurs as a result of is
explained by cognitive changes in cognition,
thinking styles, and self-perception (such as
changes in perceptions of identity).
Various authors have emphasized the link
between different forms of social bonds and desis-
tance, and this framework has produced an abun-
dance of empirical research. This perspective is
best summarized in Sampson and Laub (1993).
Drawing on Travis Hirschi’s earlier work,
Sampson and Laub’s (1993) age-graded theory
of informal social control theory emphasizes the
importance of age-graded informal social controls
(i.e., bonds to conventional social institutions) in
the explanation of desistance. In adolescence,
bond to parents, school, and friends are particu-
larly influential. The authors explain that while
there is some degree of stability in offending
behavior, there is also a substantial degree of
variation in offending patterns across the life
course. In this text, Sampson and Laub argue
that changes in the strength and structure of social
bonds may explain the intermittent character of
offending patterns across the life course.
Whereas Sampson and Laub argue that desis-
tance from crime occurs as a result of strong bonds
to social institutions, Gottfredson and Hirschi
(1990) maintain that crime is dependent on the
individual’s level of self-control, and that
Desistance from Crime and Delinquency
individuals with low self-control are less likely to
desist from crime. The authors argue that the
association social bonds do not exert a direct
effect on desistance, but rather that this associa-
tion occurs through a process of self-selection.
Rational choice theory is another framework
used to explain desistance. Gartner and Piliavin
(1988) discuss the effects of age on life-course
offending patterns and suggest that the decision
to desist or persist in crime is a result of an assess-
ment of costs and benefits associated with given
behaviors. In a theoretical piece contrasting ratio-
nal choice and social boding theories, Hirschi
(1986) suggests that there is a tendency to over-
estimate the offender’s ability to make rational
decisions, and that desistance is likely to be
impacted by the fact that offenders do not always
make accurate assessments of the costs and bene-
fits of crime.
Correlates of Desistance Identified in the
Literature
While there is still no general consensus regarding
the causes of desistance, some general themes
have emerged from the literature. The study of
predictors of desistance has been investigated
through three main lenses: life events, individual
predictors, and interactions between social and
cognitive indicators. An overview of some of
these findings can be found in Laub and
Sampson (2001).
Social Predictors
Numerous studies have examined the effects
of social bonds on crime and desistance.
Savolainen (2009) examines the impact of mar-
riage, cohabitation, parenthood, and employment
on reconvictions among a sample of Finnish fel-
ony offenders, and finds that strong social bonds
lead to reduced incidences of reconviction. Using
a retrospective survey of 600 serious offenders,
Horney et al. (1995) examine variations in crimi-
nal behavior in the short-term and find that social
bonds contribute to the explanation of these vari-
ations. Sampson and Laub’s (1993) analysis of the
Gluecks’ data strongly emphasizes the crucial role
957
of strong social bonds in the desistance process,
and the authors argue that the degree of attach-
ment to the spouse and employment promote
desistance. Farrington and West (1995) and Laub
et al. (1998) study the effects of marriage as
well as the timing and quality of marriage, on
offending behavior and desistance. Using data
from the Cambridge Study in Delinquent Devel-
opment, Farrington and West (1995) find that the D
stability of marriage impacts desistance. Laub
et al. (1998) highlight the gradual nature of
developing social relationships as well as the
ongoing and cumulative effect of marriage on
the desistance process. The influence of the
quality of marital bonds in promoting desistance
is also discussed in this study. Ouimet and Le
Blanc (1996) find that cohabitation with a part-
ner may exert a criminogenic effect before the
age of 21 years, but that this variable is posi-
tively associated with desistance after this age.
Bersani et al. (2009) find that while marriage
reduces the odds of conviction for both males
and females, there is a reduced effect of marital
status on desistance among women when com-
pared to their male counterparts. Their results
also show that marriage exerts a more substan-
tial effect on the odds of conviction among the
youngest age group.
Kruttschnitt et al. (2000), Uggen (2000), and
Sampson and Laub (1993) investigate the role of
employment on crime and recidivism. Using data
from the National Supported Work Demonstration
Project, Uggen (2000) identifies age-graded
effects of employment on recidivism (with a
more substantial effect observed on older individ-
uals, over 26 years of age), raising the question of
whether the impact of employment on desistance
may be different with adolescent and adult
populations. Warr (1998) and Wright and Cullen
(2004) adopt a social learning or differential asso-
ciation position, and argue that the effects of mar-
riage and employment on crime are mediated by
peer associations.
Cognitive Predictors
The cognitive predictors of desistance have been
discussed in literature of diverse nature. Gove
(1985) presents five key internal changes that
958
promote desistance: a shift from self-
centeredness to consideration for others, the
development of prosocial values and behavior,
an increasing ease in social interactions, a greater
consideration for other members of the commu-
nity, and a growing concern for the “meaning of
life.” Giordano et al. (2002) present a theory of
cognitive transformation and discuss its four
underlying processes, which include openness
to change, exposure to prosocial experiences,
the development of a new prosocial and non-
criminal identity, and a shift in the perception of
the criminal lifestyle. Burnett (2004) and Shover
and Thompson (1992) argue that the degree of
optimism regarding cessation of offending
behavior and individual determination to cease
offending are important cognitive factors that
promote the desistance process. The importance
of identity transformation in the process of desis-
tance has been discussed by Bottoms et al.
(2004), Burnett (2004), Giordano et al. (2002),
Maruna (2001), and Shover (1996). Bottoms
et al. (2004) develop a theoretical framework
for understanding desistance and offer a discus-
sion of the gradual nature of desistance as well as
the cognitive processes that are crucial to
enabling this process. Using data from the
Oxford Recidivism Study, Burnett (2004)
addresses various issues relating to desistance
from crime, including the intermittent patterns
of offending and the effects of optimism on
desistance outcomes. Giordano et al. (2002)
develop a theory of cognitive transformation,
defined as the cognitive shifts that promote the
process of desistance. Maruna’s (2001) central
thesis revolves around the idea that individuals
need to develop a prosocial identity in order to
desist from crime and to make progress in the
process of “making good.” Shover (1996) also
addresses the association between change in
identity and variations in patterns of offending
among persistent property offenders.
Interaction Between Internal and
External Changes
Various authors have stressed the importance of
considering both social and cognitive dimensions
in the explanation of desistance. Giordano et al.
Desistance from Crime and Delinquency
(2002) analysis of narratives suggests that perma-
nent desistance from crime may be a result of both
cognitive changes and turning points (“hooks for
change”). Shover (1996) interviews a sample of
incarcerated burglars and identifies two dimen-
sions explaining changes in criminal careers: the
strengthening of conventional bonds, activities
and rewards, and resolve and determination.
Focusing on family violence, Fagan (1989)
describes a three-stage process explaining desis-
tance. LeBel et al. (2008) discuss three models
explaining the interaction between social and sub-
jective factors: the strong subjective model
(emphasis on individual motivation and desire to
change), the strong social model (direct effect of
life events on desistance), and the subjective
social model (interaction between life events and
the mindset of the individual). Bottoms et al.
(2004) offer a discussion on the interaction
between the desire to change and the magnitude
of social problems. Beaver et al. (2007) investi-
gate the respective effects of marriage and genetic
dispositions on desistance from crime, and their
findings highlight the importance of integrating a
biosocial framework in the explanation of
desistance.
Substance Use
Some recent studies have investigated different
dimensions of the relationship between substance
use and desistance. Hussong et al. (2004) employ
data from the Dunedin Multidisciplinary Health
and Development Study to investigate the sub-
stance use-desistance link and find that substance
use exerts both distal and contemporaneous
effects on desistance efforts. In a replication of
Hussong et al. (2004) hypotheses, Morizot and Le
Blanc’s (2007) findings also suggest that sub-
stance use may constitute an important inhibitor
to desistance, both in the short and long term.
Schroeder et al. (2007) use data from the Ohio
Life-Course Study to assess the mediating role of
social networks in the relationship between drug
use and desistance. The authors find that drug
use exerts a stronger and more sustained impact
on offending behavior when compared to alcohol
use. The study highlights the criminogenic
effect of drug use and its associated lifestyle
Desistance from Crime and Delinquency
characteristics, as well as the mediating role of
some forms of social networks that may also ham-
per desistance efforts.
Gaps in Knowledge
Self-Selection and Sequencing
Gottfredson and Hirschi (1990) argue that life
events do not exert a direct causal impact on
desistance and rather reflect levels of self-control.
Because turning points and life events are not
randomly assigned among individuals, it is diffi-
cult to assess whether these events are causes or
correlates of desistance. Knowledge about inter-
actions between levels of self-control and social
bonds is still limited. One area that deserves more
attention in desistance research relates to whether
the impact of social bonds on desistance is
maintained when accounting for cognitive predis-
positions, and vice versa. Evans et al. (1997,
p. 491) found that when including a measure of
self-control, “the effects of the social bonds mea-
sures (quality of relationships, marital status,
attachment to church, occupational attainment)
in the equation are minimal.”
The way in which individual predispositions
and life events converge to promote the desistance
process is a complex problem, one that is further
complicated by the issue of self-selection
(Kazemian 2007). Many authors have discussed
the complexity of establishing temporal or causal
order between cognitive processes, situational cir-
cumstances, and desistance from crime (Bottoms
et al. 2004; Laub and Sampson 2001). The
unraveling of these sequences is thorny, mainly
because situational and cognitive changes are
often interdependent and may occur simulta-
neously (Maruna 2001). Le Blanc (1993, p. 56)
argues that “Some potential variables may occur
in such close proximity to desistance that. . .it is
impossible to measure which comes first,” and
adds that this issue is even more complicated by
the presence of “reciprocal influences.”
Long-Term Predictions
Another contentious issue relates to the ability
to make accurate long-term predictions about
959
desistance, or offending behavior in general. In
a recent analysis of the Glueck men, Laub and
Sampson (2003) find evidence which refutes
some of the basic principles put forth by devel-
opmental criminologists, namely the ability
of risk factors measured in childhood and
adolescence to predict desistance in adulthood.
According to Moffitt (1993), life-course-
persistent offenders are characterized by an D
early onset, high offending frequency, and
delayed desistance. Moffitt argues that there is a
great degree of continuity in the offending habits
of the life-course-persistent group, although she
also acknowledges that the propensity to offend
may vary with the availability of opportunities
for crime. In contrast, Laub and Sampson (2003,
p. 588) “. . .failed to find convincing evidence
that a life-course-persistent group can be pro-
spectively or even retrospectively identified
based on theoretical risk factors at the individual
level in childhood and adolescence.” In a com-
parative analysis of patterns of de-escalation
between ages 17–18 and 32, Kazemian et al.
(2009) find that social bonds and cognitive pre-
dispositions measured at age 17–18 are generally
better predictors of between- rather than within
individual differences in offending gravity at age
32, highlighting the difficulties in making accu-
rate long-term predictions about changes in indi-
vidual offending patterns early in the criminal
career.
Gender and Desistance
Few studies have investigated the link between
gender and desistance. Bersani et al. (2009) con-
trast the effect of marriage on desistance between
male and female Dutch offenders. Sommers et al.
(1994) analyze narratives to shed some light on
the desistance process of high-rate female
offenders. Giordano et al. (2002) and Uggen and
Kruttschnitt (1998) also compare the cognitive
and social predictors of desistance between male
and female offenders.
Cross-References
▶ Abstention
960
Acknowledgment Some excerpts from this essay were
originally published in Kazemian (2007) and Kazemian
et al. (2009).
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Mortimer & M. J. Shanahan (Eds.), Handbook of the
life course (pp. 311–329). New York: Kluwer/Plenum
Publishers.
Warr, M. (1998). Life-course transitions and desistance
from crime. Criminology, 36(2), 183–216.
Wolfgang, M. E., Figlio, R. M., & Sellin, T. (1972). Delin-
quency in a birth cohort. Chicago: University of Chi-
cago Press.
Wright, J. P., & Cullen, F. T. (2004). Employment, peers, and
life-course transitions. Justice Quarterly, 21(1), 183–205.
Detention of Alien Juveniles
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Adolescents who have not reached the age of
majority and who are not under the control or
custody of their parents pose important challenges
for legal systems. Those challenges are even
greater when the adolescents are in the
962
government’s custody because they are suspected
of being illegal immigrants. In the United States,
approximately seventy percent of the juveniles
arrested for violation of immigration laws are unac-
companied by their parents or guardians, and they
are unaccompanied typically because they have
been sent in advance or have been separated from
them when they entered the country illegally (Reno
v. Flores 1993). Given that they have not reached
the age of majority, immigrant minors have reduced
rights and, equally importantly, the government has
increased responsibilities to protect them. This ten-
sion marks and shapes immigration law relating to
juveniles, with the current tendency moving toward
the need to detain unaccompanied alien youth.
Immigration policies relating to minor adoles-
cents have undergone important transformations
since the 1980s. Before the mid-1980s, minors
were customarily released on bond to their parents
or other responsible adults who would care for
them and ensure their attendance at future depor-
tation proceedings. In 1984, a regional Immigra-
tion and Naturalization Service (“INS”)
commissioner instituted a new policy providing
that minors only would be released to a parent or
lawful guardian, except in “unusual and extraor-
dinary circumstances.” The justifications offered
were the need to protect the INS from potential
legal liability and to assure the minor's welfare.
The new policy resulted in no longer releasing
children to anyone but a parent or legal guardian,
and the “unusual and extraordinary” exception
was limited only to minors requiring medical
care. The INS refused to hold hearings to deter-
mine whether detention would be in a child’s best
interest and refused to provide procedures by
which its initial, automatic detention orders
could be reviewed regularly. As a result, and
sometimes because parents feared deportation if
they claimed their children, minors were summar-
ily detained even though they posed no risk to the
community and whose attendance at deportation
hearings could be assured by responsible individ-
uals. The policy eventually became a formal INS
regulation, which required detention unless an
adult relative or legal guardian was available to
assume custody, even where there was another
responsible adult willing and able to care for the
Detention of Alien Juveniles
child and able to ensure the minor’s attendance at
a deportation hearing. This regulation was chal-
lenged, and in Reno v. Flores (1993), the Supreme
Court found it constitutional.
In Flores, a 15-year-old girl was one of four
juveniles who filed a class action suit against the
attorney general of the United States, Janet Reno.
The four juveniles had been arrested and held by
the INS pending deportation hearings. Among
other claims, their challenge to the INS regulation
argued that both the United States Constitution
and federal immigration laws required that they
be released into the custody of “responsible
adults.” They also claimed that they posed no
risk of flight or harm to the community, and all
had responsible third parties available to provide
for them. Given their circumstances, they asserted
that the release conditions and their confinement
violated their due process and equal protection
rights under the Constitution’s Fifth Amendment.
In a seven-to-two decision, the Supreme Court
rejected the detained juveniles’ argument that they
had a fundamental right to freedom from physical
restraint and that their procedural due process
rights had been violated. To prevail in their chal-
lenge, the Court noted, the juveniles would need
to establish that no set of circumstances existed
under which the regulation would be valid. They
were unable to do so. The Court held that the best
interest of the child was not an absolute and
exclusive constitutional criterion for the govern-
ment’s exercise of the custodial responsibilities. If
a juvenile has no available parent or legal guard-
ian, INS custody does not violate the Constitution
as long as the government has no intention of
punishing the child and the conditions of the gov-
ernment detention facility are decent and humane.
Although the Court recognized that the Fifth
Amendment entitles aliens to procedural due pro-
cess of law in deportation proceedings, it con-
cluded that the requirements of due process were
satisfied by giving the detained juveniles the right
to a hearing before an immigration judge. That
hearing, as long as a waiver of it is revocable and
there is no evidence of excessive delay in holding
it, assured the alien's due process rights. The Court
also held that the Attorney General had the power
to use discretion to continue custody over arrested
Developmental
aliens. The Attorney General had struck an appro-
priate balance between the INS’s concern that the
juveniles’ welfare will not permit their release to
just any adult and the INS’s assessment that it has
neither the expertise nor the resources to conduct
individual child placement studies.
The concurrence and dissenting court opinions
gave more credence to the juveniles’ claims. The
concurring opinion emphasized the view that the
minors had a constitutionally protected interest in
freedom from institutional confinement. The dis-
senting opinion characterized the right at issue as
the right not to be detained rather than the right of
detained juveniles to be released to one custodian
over another. The dissenting opinion criticized the
incarceration of minor children as serving no
legitimate governmental purpose, arguing that,
as aliens, the detained minors sought the same
equal justice before the law that is enjoyed by all
persons present in the United States, including
procedural protections in conjunction with any
deprivation of liberty. The majority, however,
was not persuaded by these arguments.
The case is of significance, in addition to illus-
trating the workings of immigration law, for the
manner the legal system can approach the rights of
adolescents. The case reveals how the law can
presume that minors should be held under the
state’s control in the absence of a parent or other
legally recognized caretaker. The preference for
parents and other legally recognized caretakers is
not unusual; what is unusual is the preference that
a juvenile be detained in a governmental institu-
tion over release to responsible adults. As noted
above, this preference is particularly problematic
for youth given that they are more likely to be
unaccompanied by parents or those deemed
legally responsible for their care.
Cross-References
▶ Immigration
References
Reno v. Flores. (1993). 507 U.S. 292.
963
Developmental
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
The term developmental refers to the process of
maturation and the changes that occur (or not) in D
an organization, a structure, or an individual over
time. The term can be applied in one of two ways.
First, it can be applied in a temporal sense, which
would involve descriptions of changes that take
place over an extended period of time. Second, it
could also refer to the process of development itself,
such as the factors that affect one’s development.
For example, developmental science describes
changes that occur, and investigate the potential
causes of differences and similarities in various
modes of development. It also describes the changes
that do not occur when they would have been
expected. Thus, examining development means
focusing on both continuity and discontinuity.
The complex changes that occur during ado-
lescence consist of biological changes, sexual
development, social progression, identity
changes, cognitive changes, and physical growth
(see Gowers 2005). Although past research has
focused on psychological, physical, and social
development, recent research has moved toward
examining how the brain affects these domains.
These multiple ways of looking at adolescent
development focus on, for example, the effects
of changes that can occur due to cognitive brain
structures or the lack of changes that can be
expected due to those structures (Steinberg
2005). Importantly, despite the focus on neurolog-
ical aspects of development, there remains a
strong recognition that the timing, length and
experience of adolescence highly depends on cul-
tural forces (Gowers 2005). Although there is a
belief that adolescent research is dominated by
research in the United States, and that it presents
a narrow view of adolescent experiences, even
researchers in the United States now focus con-
siderably on cultural diversity and the leading
journals that publish research on adolescence are
increasingly international (see Levesque 2007).
964
References
Gowers, S. (2005). Development in adolescence. Psychia-
try, 4, 6–9.
Levesque, R. J. R. (2007). The ethnicity of adolescent
research. Journal of Youth and Adolescence, 36,
375–389.
Steinberg, L. (2005). Cognitive and affective development
in adolescence. Trends in Cognitive Science, 9, 69–74.
Developmental Assets
Peter L. Benson1 and Peter C. Scales2
1
Search Institute, Minneapolis, MN, USA
2
Search Institute, Manchester, MO, USA
Overview
The concept of developmental assets, first
introduced in 1990, links positive features of
developmental ecologies with personal skills and
competencies in order to further the understand-
ing of healthy development. Each of the 40 devel-
opmental assets in the model is a characteristic of
the individual (internal assets) or his/her ecologi-
cal settings (external assets) that is related to the
increased probability of positive outcomes.
Developmental assets complement the extensive
research on risk factors. The former represent
“nutrients” that promote healthy development;
the latter represent impediments that reduce the
probability of health and wellbeing. In this essay,
the authors explain how the developmental asset
model was developed, review the extensive
research that documents the impact of develop-
mental assets on both the reduction of risk behav-
iors and the promotion of thriving (including
school success), document subsets of assets
related to specific outcomes, review how the
model applies cross-culturally, and discuss
the use of the model in programs and policy.
The essay concludes with a discussion of
recommended next steps in research and practice.
Two interdisciplinary arenas of scholarship and
practice are gaining greater prominence in child
and adolescent psychology. As described by
Developmental Assets
Benson et al. (2003), the first focuses on develop-
mental opportunities, experiences, and resources
that enhance educational, socioemotional, and
health outcomes for children and adolescents.
This conceptual territory of developmental
strengths is sometimes characterized as “the other
side of the coin” to approaches that focus on
developmental risks, deficits, and problems. The
organizing principle in this latter approach is to
reduce threats to human development (e.g., pov-
erty, family dysfunction, victimization, neglect,
abuse) and/or to reduce health-compromising
behaviors (e.g., alcohol and other drug use, vio-
lence, adolescent pregnancy). In contrast, the
developmental strength approach is organized
around promoting or increasing concepts such as
competence, mastery, caring, connection, belong-
ing, skill, and resilience. Although both deficit
reduction and strength building are necessary and
complementary human development strategies,
the former approach has in recent decades domi-
nated the national research and policy agenda
(Scales 1999).
Community frames a second line of inquiry
and action assuming a greater presence in the
intellectual and policy limelight. Concepts such
as community development, community building,
and healthy communities have their origins in
urban and neighborhood renewal and the attention
social science has paid to neighborhood effects on
juvenile delinquency and crime (see Leventhal and
Brooks-Gunn 2000). Increasingly, however, com-
munities understand the contexts that shape posi-
tive adolescent development as well as an arena for
comprehensive, community initiatives that pro-
mote child and adolescent well-being (Benson
2006; Damon and Gregory 2003; Lerner 2003).
The framework of developmental assets, first
posited in 1990 (Benson 1990) and refined in
2005 (Benson 2006), was explicitly designed to
address these two issues. As described in a series
of publications (Benson 2002, 2003a; Benson
et al. 1998; Scales et al. 2000; Scales and Leffert
1999, 2004), the framework establishes a set of
developmental experiences and supports hypoth-
esized to have import for all young people during
the second decade of life. Recent work is taking a
broader life span perspective, positing that
Developmental Assets
developmental assets reflect developmental pro-
cesses that have age-related parallels in infancy,
childhood, and young adulthood (Leffert et al.
1997; Mannes et al. 2003; Scales et al. 2004,
2010; VanderVen 2008). This work will be
addressed later in this essay.
The framework synthesizes research in a num-
ber of fields with the goal of selecting for inclusion
those developmental nutrients that: (a) have been
demonstrated to prevent high-risk behavior (e.g.,
substance use, violence, dropping out of school),
enhance thriving, or strengthen resilience; (b) have
evidence of generalizability across social location;
(c) contribute balance to the overall framework
(i.e., of ecological and individual-level factors);
(d) are within the capacity of communities to effect
their acquisition; and (e) are within the capacity of
youth to proactively procure.
Because the developmental assets framework
for adolescents ages 12–18 was designed not only
to inform theory and research, but also to have
practical significance for the mobilization of com-
munities, the 40 assets are placed in categories
that have conceptual integrity and can be
described easily to the residents of a community.
As seen in Tables 1 and 2, they are grouped into
20 external assets (i.e., environmental, contextual,
and relational features of socializing systems) and
20 internal assets (i.e., skills, competencies, and
values). The external assets comprise four catego-
ries: (a) support, (b) empowerment, (c) boundaries
and expectations, and (d) constructive use of time.
The internal assets are also placed into four cate-
gories: (a) commitment to learning, (b) positive
values, (c) social competencies, and (d) positive
identity. The scientific foundations for the eight
categories and each of the 40 assets are described
in more detail in Scales and Leffert (1999, 2004).
An exploratory factor analysis conducted with
150,000 6th–12th grade students showed that
14 scales emerged for middle-school students
and 16 for high-school students, all conceptually
reflecting the eight a priori asset categories; in
addition, a second-order factor analyses identified
two major superordinate scales, labeled Individ-
ual Assets and Ecological Assets, that mirrored
the a priori designation of assets into internal and
external classes (Theokas et al. 2005).
965
Although each element in the asset taxonomy
is grounded in research, the framework and its
measurement and reporting processes have four
applied purposes (Benson 2007). First, the frame-
work seeks to provide an understandable vocabu-
lary (for both lay and professional audiences) for
core elements of positive human development,
with emphasis on developmental processes, expe-
riences, and resources known to promote short- D
term and long-term well-being. Second, it is
intended to create a unified picture of positive
development capable of uniting citizens and mul-
tiple socializing systems around a shared vision.
In this way, it is an attempt to create a common
language that has the potential of contributing to a
public consensus on what “our” children and ado-
lescents need to succeed.
Third, it seeks to empower and mobilize resi-
dents (both adults and youth), families, neighbor-
hoods, youth organizations, religious institutions,
and other community sectors to take action.
Finally, through a survey and reporting process
that presents a portrait of developmental assets
among a community’s youth, the framework and
its local measurement serve as a kind of call to
action to strengthen developmental processes and
experiences for all youth within a community, not
just “at-risk” or particularly vulnerable youth.
The developmental asset framework is closely
aligned with the field of positive youth develop-
ment. As noted in a recent, systematic review of
the literature, the core concept in positive youth
development has to do with how the positive life
experiences that are embedded in relationships
and the culture of programs and institutions pro-
mote healthy development (Benson et al. 2006).
A rich vocabulary has developed to describe these
development-enhancing factors. Variously, those
have been called supports, protective factors, the
5C’s (caring, connection, etc.), opportunities,
promises, developmental resources, developmen-
tal strengths, and developmental assets.
Cutting across several models of positive youth
development (Lerner 2004; Roth and Brooks-
Gunn 2000; Pittman et al. 2000; Connell et al.
2001; Zeldin 1995) – including developmental
assets – is a considerable consensus on six theoret-
ical principles:
966 Developmental Assets

Developmental Assets, Table 1 The framework of developmental assets: external assets

Category External assets Definition
Support 1. Family support Family life provides high levels of love and support.
2. Positive family Young person and her or his parent(s) communicate positively, and young
Communication person is willing to seek advice and counsel from parents.
3. Other adult Young person receives support from three or more nonparent adults.
relationships
4. Caring Young person experiences caring neighbors.
neighborhood
5. Caring school School provides a caring, encouraging environment.
climate
6. Parent Parent(s) are actively involved in helping young person succeed in
involvement in school.
schooling
Empowerment 7. Community Young person perceives that adults in the community value youth.
values youth
8. Youth as resources Young people are given useful roles in the community.
9. Service to others Young person serves in the community 1 hour or more per week.
10. Safety Young person feels safe at home, school, and in the neighborhood.
Boundaries and 11. Family Family has clear rules and consequences and monitors the young person’s
expectations boundaries whereabouts.
12. School School provides clear rules and consequences.
boundaries
13. Neighborhood Neighbors take responsibility for monitoring young people’s behavior.
Boundaries
14. Adult role Parent(s) and other adults model positive, responsible behavior.
models
15. Positive peer Young person’s best friends model responsible behavior.
influence
16. High Both parent(s) and teachers encourage the young person to do well.
expectations
Constructive use 17. Creative Young person spends 3 or more hours per week in lessons or practice in
of time activities music, theater, or other arts.
18. Youth programs Young person spends 3 or more hours per week in sports, clubs, or
organizations at school and/or in community organizations.
19. Religious A young person spends 1 hour or more per week in activities in a religious
community institution.
20. Time at home Young person is out with friends “with nothing special to do” two or fewer
nights per week.
From Benson (2006), Copyright 2006 by John Wiley & Sons

1. All youth have the inherent capacity for posi-
tive growth and development.
2. A positive developmental trajectory is enabled
when youth are embedded in relationships,
contexts, and ecologies that nurture their
development.
3. The promotion of positive development is fur-
ther enabled when youth participate in multi-
ple, nutrient-rich relationships, contexts and
ecologies.
4. All youth benefit from these relationships, con-
texts, and ecologies. Support, empowerment,
and engagement are, for example, important
developmental assets for all youth, generaliz-
ing across race, ethnicity, gender, and family
income. However, the strategies and tactics for
promoting these developmental assets can vary
considerably as a function of social location.
5. Community is a viable and critical “delivery
system” for positive youth development.
Developmental Assets 967

Developmental Assets, Table 2 The framework of developmental assets: internal assets

Category Internal assets Definition
Commitment to 21. Achievement Young person is motivated to do well in school.
learning motivation
22. School engagement Young person is actively engaged in learning.
23. Homework Young person reports doing at least 1 hour of homework every school
day.
24. Bonding to school Young person cares about her or his school.
25. Reading for Young person reads for pleasure 3 or more hours per week. D
pleasure
Positive values 26. Caring Young person places high value on helping other people.
27. Equality and social Young person places high value on promoting equality and reducing
Justice hunger and poverty.
28. Integrity Young person acts on convictions and stands up for her or his beliefs.
29. Honesty Young person “tells the truth even when it is not easy.”
30. Responsibility Young person accepts and takes personal responsibility.
31. Restraint Young person believes it is important not to be sexually active or to use
alcohol or other drugs.
Social 32. Planning and Young person knows how to plan ahead and make choices.
competencies decision making
33. Interpersonal Young person has empathy, sensitivity, and friendship skills.
competence
34. Cultural Young person has knowledge of and comfort with people of different
competence cultural/racial/ethnic backgrounds.
35. Resistance skills Young person can resist negative peer pressure and dangerous
situations.
36. Peaceful conflict Young person seeks to resolve conflict nonviolently.
resolution
Positive identity 37. Personal power Young person feels he or she has control over “things that happen to
me.”
38. Self-esteem Young person reports having high self-esteem.
39. Sense of purpose Young person reports that “my life has a purpose.”
40. Positive view of Young person is optimistic about her or his personal future.
personal future
From Benson (2006), Copyright 2006 by John Wiley & Sons

6. Youth are major actors in their own develop-
ment and are significant (and underutilized)
resources for creating the kinds of relation-
ships, contexts, ecologies, and communities
that enable positive youth development.
Developmental Assets Among US Youth
Studies of developmental assets have blossomed
in a variety of venues, including universities,
national youth serving organizations, federally
funded initiatives, state departments of health
and education, county agencies, and public and
private schools. The primary research tool is a
156-item self-reporting instrument administered
anonymously in classroom or program settings,
the Search Institute Profiles of Student Life: Atti-
tudes and Behavior survey (and a companion
Search Institute survey for the upper elementary
grades called Me and My World). In the case of
schools and school districts, efforts usually are
made to conduct a complete census of all sixth
through twelfth grade students. Completed survey
forms are returned to Search Institute for analyses
with a comprehensive report prepared and sent
within weeks of the survey date.
More than 2,500 school districts in the USA
have commissioned this study of developmental
assets. In recent years, these include a balance of
968
urban, suburban, and rural districts. Urban dis-
tricts have included New York City, Seattle, Min-
neapolis, Albuquerque, Portland, San Jose, and
Dallas. Since that time, more than three million
students in grades 4–12 have participated.
School districts typically commission the
study at the request of community leaders for
the purposes of launching (or sustaining) a
community-wide asset-building initiative. The
survey is primarily used as a means of communi-
cating aggregate data on a community’s youth.
The developmental asset report often becomes a
widely shared document and is used both to frame
community-wide visioning and planning and to
serve as a focal point to mobilize around raising
healthy youth. A dichotomous form of reporting
the assets, whereby each asset is simplified into a
single percentage of youth who have, or do not
have, each asset, has become an effective method
for communicating the asset profile to diverse
community audiences. This allows for a simple
summation of the average number of assets youth
in any given community report having. (Binary,
dichotomous scoring is useful for simplifying
public communications about the assets, but of
course fails then to use all of the information
contained in the data. In its scholarly papers, the
Institute also uses continuous versions of the asset
variables for data analyses.) In addition to serving
as a research tool, the developmental asset survey
and its reporting process are intended to trigger
community-wide dialogue, reflection, and plan-
ning. In essence, a local asset study reframes
how a community knows and understands its
role in the development of children and adoles-
cents. The study of developmental assets at a local
level is intended to trigger several forms of
reframing. One, of course, is the reframing of
how a community of people and systems under-
stands the nature of successful development. The
goal here is to help communities expand their
shared understanding of healthy development
to encompass not only “problem free,” but also
“asset-rich.”
Another reframing has to do with a
community’s collective understanding of the pop-
ulation of children and adolescents to be targeted
by community interventions. Deficit reduction
Developmental Assets
approaches tend to bifurcate youth into two
camps, with the developmental “have nots”
labeled as at risk, vulnerable, high risk, or mar-
ginalized. The asset approach, supported by thou-
sands of community asset profiles, is to place
development on a continuum that runs from
“asset-depleted” on the one end (0–10 assets) to
“asset-rich” on the other (31–40 assets). By show-
ing communities that a majority of their 6th–12th
grade students experience half or fewer of the
40 assets, the report strategically and purposefully
creates a dissonance in the public’s understanding
of what the issue is. In more classic community
development verbiage, this is the process of
expanding citizen ownership of and engagement
in the issue of child and adolescent developments.
In language that resonates more with community
residents, local studies shift the understanding
from “some kids need more” to “all kids need
more.” This reframing to “all kids” is an essential
strategy for motivating multiple systems within
communities to pool their developmental
resources in a coherent, long-term, multisystem,
and citizen-engaged initiative to promote devel-
opmental assets. It also has other significant
advantages. Given the complex and long-term
dimensions of community change – as well as
the dearth of scientific knowledge about creating
developmentally attentive communities – the
work connects hundreds of communities in a
mutually supporting web of action and learning
directed toward the comprehensive transforma-
tion of community life. The “all kids” reframing,
and the underlying societal dimensions it presup-
poses, puts cities of many sizes and geographies
on a common playing field, seeking knowledge
and wisdom about similar issues (e.g., the expan-
sion of civic engagement, the creation of devel-
opmentally attentive schools, the building of
social trust within neighborhoods, and the recrea-
tion of intergenerational community). Positioned
this way, communities across the country discover
a commonality of interest and an eagerness to
connect, learn, and teach. And rather than
deflecting energy away from marginalized youth,
the “all kids” reframing reenergizes and
strengthens a community’s work with high-risk
youth.
Developmental Assets
Finally, embedded within the developmental
asset framework and the community report is a
comprehensive approach to the etiology of devel-
opmental strengths. The external assets directly
speak to the role of multiple developmental ecol-
ogies, including family, neighborhood, school,
youth organizations, congregations/synagogues/
mosques, and programs. The internal assets invite
inquiry and conversation about the multiple
sources of competencies, values, identity, com-
mitment, and purpose, and the degree to which
communities possess the harmony of voice and
deep and sustained relationships necessary for
these capacities to develop. As such, the taxon-
omy of developmental assets provides counter-
weight to approaches that are overdependent on
programs and professionalized services for their
implementation.
A number of research publications have been
based on analyses of three large aggregated data
sets (99,462 in school year 1996–1997, 217,277
in 1999–2000 and 148,189 in calendar 2003). All
were based on samples from more than 200 cities
spread across all regions of the country. (These
samples were large and reasonably diverse, but
they are not “national” samples. They were cre-
ated through district self-selection, and not by
drawing them from a probabilistic sampling
frame for the US youth population.) Based on
the 2003 sample, Benson (2006, 2009) provided
a demographic portrait of assets. Using the binary
form for each asset (so that an individual’s “score”
ranges from 0 to 40), six major findings are: (1) the
average number of assets was 18.6; (2) females
average 19.9 developmental assets versus 17.2 for
boys; (3) the average tends to decrease as grade
increases (from 23.0 in grade 6 to 17.8 in grade 12);
(4) the means for major categories of race and
ethnicity fall in a fairly narrow range, from 16.9
to 19.0; (5) youth in low-income families average
17.0 versus 19.8 in moderate-income or high-
income families; and (6) contrary to common pub-
lic perception, the average number of assets stays
quite constant across city-size categories (from
18.2 in small towns with a population under
2,500 to 18.6 in small cities with populations
between 10,000 and 50,000; the average in larger
cities of 250,000 or more is 18.2).
969
A concept of “levels of assets” is introduced
into each community study. These are defined
simply as the total number of 40 assets broken
into quartiles: 0–10, 11–20, 21–30, and 31–40.
Benson (2006) labeled these four as at-risk
(0–10), vulnerable (11–20), adequate (21–30),
and optimal development (31–40).
The percentages in each category by key
demographic variables are displayed in Table 3. D
Note that 59% of youth possess 20 or fewer of the
40 developmental assets.
Prediction and Explanation
A number of studies have consistently shown that
the developmental assets are additive or cumula-
tive in explaining both risk behaviors and indica-
tors of thriving (e.g., school success, prosocial
behavior, leadership). There are two versions of
this hypothesis. One is called the vertical pileup of
assets and points to the idea that the number of
assets at a single point in time is associated with
risk and thriving. The horizontal pile-up idea
implies contextual breadth. That is, outcomes
improve as a function of the number of asset-
rich contexts in which a person is embedded
(Benson et al. 2003). It also implies that assets
experienced earlier in life positively affect out-
comes later in life.
In their study of nearly 100,000 6th- to 12th-
grade students, Benson et al. (1999) reported that
consistently, across outcome variables, the higher
the number of assets students reported experienc-
ing, the less likely they were to report engaging in
a variety of patterns of high-risk behaviors. For
example, 53% of young people who reported
0–10 assets had used alcohol three or more times
in the past month or had gotten drunk at least once
in the last 2 weeks, but only 3% of students with
31–40 assets reported such problems alcohol use.
Even students with average levels of assets
(11–20) were ten times more likely (30%) to
have problems with alcohol use than were asset-
rich students. The same profoundly different
experiences with risk behaviors – with asset-rich
students many times less likely to engage in the
behaviors than even average-asset youth, much
970 Developmental Assets

Developmental Assets, Table 3 Percentage of youth: levels of assets

Level of developmental assets (in %)
0–10 11–20 21–30 31–40
Assets Assets Assets Assets
At-risk Vulnerable Adequate Optimal
Total 17 42 32 8
Male 22 45 28 6
Female 13 40 36 11
Grades 6–8 15 38 36 12
Grades 9–12 19 45 30 6
American Indian 23 42 27 8
Asian and Pacific Islander 15 46 31 8
Black and African American 13 47 34 6
Hispanic 23 45 27 5
White 17 40 33 10
Multiracial 18 46 30 7
Low family income 22 45 28 5
Moderate or high family income 14 40 35 11
Based on aggregate sample of 148,189 6th–12th grade students surveyed in 2003 from more than 200 US communities.
Percentages may not sum to 100 due to rounding

less asset-poor youth – were reported for all the
other risk patterns, including tobacco use, illicit
drug use, sexual intercourse, depression and/or
attempted suicide, antisocial behavior, violence,
school problems, driving and alcohol, and
gambling.
In a different study of the same sample, Leffert
et al. (1998) reported that clusters of developmen-
tal assets explained a considerable proportion of
the variance of those high-risk behavior patterns.
The 40 assets were allowed to enter stepwise
regressions as predictor variables after first enter-
ing gender, grade, racial/ethnic background, fam-
ily composition, and maternal education (as a
proxy for socioeconomic status). A predictor var-
iable was considered meaningful if it added at
least 1% to the variance of the risk behavior pat-
terns. Although slightly different clusters of assets
were meaningful in explaining different out-
comes, the total models (with demographic vari-
ables) accounted for 21–41% of the variance, and
the assets contributed 16–35%. Developmental
assets were most meaningful in predicting depres-
sion and/or suicide attempts, school problems,
violence, and alcohol use and had somewhat less
explanatory power for tobacco use, sexual inter-
course, and gambling. An overall risk index of
24 different risk behaviors also was created. The
total regression models (with demographics)
explained 66% of the variance of the risk index,
and assets explained 57%. Across the risk index
and various risk behavior patterns, the develop-
mental assets most often retained as meaningful
predictors were positive peer influence, the value
of restraint, peaceful conflict resolution, school
engagement, resistance skills, and time at home.
Achievement motivation was a unique predictor
of school problems, and a sense of purpose and
self-esteem uniquely explained depression and/or
suicide attempts.
The concept of thriving encompasses not only
the relative absence of pathology but also more
explicitly indicators of healthy and even optimal
development (Benson 2008). There is some con-
ceptual similarity between the notion of develop-
mental assets and that of thriving indicators, in
that both concepts focus on the presence of
strengths in young people’s lives. However, assets
are conceptualized as building blocks of success,
whereas thriving indicators are seen as signs or
markers of success. In explanatory terms, devel-
opmental assets are considered predictors of the
outcomes represented by thriving indicators.
Experiencing the assets defines conditions under
which the attainment of those thriving outcomes is
made more likely.
Developmental Assets
Benson et al. (1999) reported that developmen-
tal assets showed similar patterns of relations with
thriving indicators as with high-risk behavior pat-
terns. For all eight thriving indicators they stud-
ied, the proportion of students saying they
experienced them increased with each increase
in asset level. For example, only 7% of students
with 0–10 assets said they got mostly As at school,
whereas 53% of those with 31–40 assets reported
such thriving. Although the patterns typically
were not as dramatic as the relation of assets to
risk behaviors, the trends were all the same. There
were substantial differences between higher- and
lower-asset youth on all of these thriving indica-
tors: school success, helping others, valuing
diversity, maintaining physical health, exhibiting
leadership, resisting danger, delaying gratifica-
tion, and overcoming adversity.
Scales et al. (2000) allowed the 40 assets to
enter stepwise regressions after the demographic
variables had first been entered as a block and
retained as meaningful predictors those assets
that explained at least 1% of the variance in a
thriving indicator. They reported that clusters of
the assets explained 47–54% of a thriving index
(comprising all the indicators) across racial/ethnic
groups and 10–43% of seven specific thriving
outcomes across racial/ethnic groups, over and
above demographic variables. With demographic
variables included, the total models explained
48–57% of the variance of the thriving index and
11–48% of the individual thriving indicators. The
asset clusters best explained valuing diversity,
school success, physical health, helping others,
leadership, and delay of gratification and, likely
due to measurement issues, were less strong an
explanation (10–17%) for overcoming adversity.
Similarly, Scales and Benson (2005) created a
prosocial orientation measure by combining sev-
eral items tapping adolescents’ attitudes toward
helping others, and several items asking about
intentions to help those in need, working to
improve their school, or tutoring or coaching
younger children over the next year. They then
examined the concurrent relation to prosocial ori-
entation and the number of developmental assets
adolescents reported. In a racially/ethnically
diverse sample of more than 5,000 6th–12th
971
graders, they found that each increase in the quar-
tile level of the asset domains studied (0–2, 3–5,
6–8, or 9–12 assets) was associated with a signif-
icant increase in the mean score on prosocial
orientation. They also found that, controlling for
grade in school, race/ethnicity, and parental edu-
cation, both boys and girls with above average
levels of prosocial orientation were nearly four
times more likely to report actual volunteer ser- D
vice of at least 1 h per week in the past year.
Sesma and Roehlkepartain (2003) demon-
strated that the pileup of assets finding generalizes
to six racial ethnic groups: African American,
American Indian, Asian American, Latino/Latina,
White, and multiracial. In all six categories, the
pileup of assets substantially reduces risk behav-
ior and increases thriving.
Benson et al. (2004a) examined the role of
developmental assets in substance abuse preven-
tion, examining the odds that students report sub-
stance use if: (a) they live in a single-parent
family; (b) they are of low socioeconomic status,
or (c) if they have relatively few developmental
assets (0–10). The magnitude of the association
when comparing demographic “risk” factors with
asset depletion is substantial. For example, youth
from single-parent families are 1.3 times more
likely than those from two-parent families to
engage in problematic alcohol use. In comparison,
young people with a low asset level (0–10 assets)
are 5.5 times more likely to engage in problematic
alcohol use than those with an above-average
asset level (21–40 assets). Similarly, though low-
income youth are twice as likely as higher-income
youth to use illicit drugs, low-asset youth are 9.4
times more likely to use illicit drugs than those
with above-average asset levels. Similarly, Ben-
son and Scales (2009) found that every increase in
quartile level of assets was associated with a lower
probability of 6th–12th grade youth engaging in
antisocial behavior or violence. For example, 61%
of those with 0–10 assets reported engaging in
violent behaviors in the last year, versus just 6%
who had 31–40 assets. They also found that asset
level in middle school helped to predict violence
level 3 years later in high school, through its
relation to lower levels of concurrent violence.
Other lines of research have explored the
972
hypothesis that external and internal assets work
in harmony to promote developmental success.
The strong relationship between asset levels and
both risk behaviors and thriving indicators has
been documented in large sample studies in
major urban centers. These include New York
City, Seattle, Portland, Albuquerque and Minne-
apolis (Benson 2007). Scales et al. (2004) repli-
cated the “pileup” of assets having a positive
relationship with developmental outcomes, with
a sample of 1,294 10–12 year olds. As with 12–18
year olds, asset levels strongly predicted both risk
and thriving.
A longitudinal study in a small Midwestern
city in the USA suggests that levels of develop-
mental assets are strongly related to positive out-
comes both concurrently and 3 years later; levels
of developmental assets strongly predict academic
and behavioral measures embedded in students’
personal records; and developmental assets are
two to four times more powerful in predicting
academic achievement, risk behaviors, and thriv-
ing than are such demographic factors as race/
ethnicity and poverty (Roehlkepartain et al.
2003). This longitudinal study also shows, as
would be expected, that changes in a young per-
son’s developmental assets profile (with changes as
minimal as an increase or decrease in two or three
assets) have significant (and even dramatic) impact
on markers of developmental success (Scales and
Roehlkepartain 2003; Scales et al. 2006). A recent
line of inquiry spearheaded by Taylor and Lerner
provides supportive evidence that the link between
developmental assets and thriving documented in
many studies of youth can be seen also among
youth in particularly challenging social contexts
such as those surrounding youth in urban gangs
(Taylor et al. 2002).
Scales and Roehlkepartain (2004) introduced
the idea of certain assets functioning as “gateway”
assets. Focusing on the asset of service to others,
they suggest this action generates the experience
of other assets (e.g., adult role models, youth as
resources, personal power). In turn, service gen-
erates “positive outcomes, including school suc-
cess, because those service experiences are part of
an overall web of assets that provide a strong
foundation for healthy development” (p. 26).
Developmental Assets
Developmental Assets and
School Success
Scales and his colleagues (Scales and
Roehlkepartain 2003; Scales and Taccogna
2000; Starkman et al. 2006; Scales and Benson
2007) describe, based on many cross-sectional
studies of 6th–12th grade students, the robust
and consistent relationship between levels of
assets and self-reported school attendance and
grades. Similar patterns have been reported by
school districts in Michigan and California that
have conducted studies of the asset-to-
achievement link (see Scales and Roehlkepartain
2003) for a review of these studies.
Scales et al. (2006) extended this line of
research to a longitudinal investigation using
school records to measure achievement. In this
study, 370 students in the 7th–9th grades were
followed for 3 years (through the 10th–12th
grades). The greater the number of developmental
assets students reported in grades 7–9, the higher
their actual GPA 3 years later. Increases in devel-
opmental assets were significantly associated with
increases in GPA. Furthermore, the effect size of
assets on GPA was significantly larger than the
effect size typically found for documented school
reform efforts. As Walser (2006) noted in a review
of this work in the Harvard Education Letter
(2006), “achievement is as much about student
development as it is about rigor and curriculum”
(p. 2).
The Study of Asset-Building
Communities
Complementary to research on the role of devel-
opmental assets has been a stream of work on
conceptualizing how communities can be orga-
nized and mobilized to promote the assets. The
dynamics and processes by which communities
mobilize their developmental capacity constitute a
relatively unexplored line of inquiry, both theo-
retically and empirically (Blyth and Leffert 1995).
An initial framework for understanding the asset-
building capacity of communities provides a set of
core principles and strategies, grounded in the
Developmental Assets
literatures of community development, social
marketing, and organizational change (Benson
2003b). Among these are the principles of devel-
opmental redundancy (the exposure to asset-
building people and environments within multiple
contexts), developmental reach (a focus on nur-
turing most or all assets in children and adoles-
cents), and developmental breadth (extending, by
purpose and design, the reach of asset-building
energy to all children and adolescents).
In activating these core principles, five sources
of asset-building potential are hypothesized to
exist within all communities, each of which can
be marshaled by means of a multiplicity of com-
munity mobilization strategies. These sources of
potential asset-building influence include:
• Sustained relationships with adults, both
within and beyond family
• Peer group influence (when peers choose to
activate their asset-building capacity)
• Socializing systems, including families, neigh-
borhoods, schools, playgrounds, congregations,
youth organizations, and places of employment
• Community-level social norms, ceremony, rit-
ual, policy, and resource allocation
• Programs, including school-based and
community-based efforts to nurture and build
skills and competencies
In brief, asset-building communities are
distinguished as relational and intergenerational
ecologies, with a critical mass of citizens and
socializing institutions (e.g., families, schools,
neighborhoods, youth organizations, religious
communities) choosing to attend to the develop-
mental needs of all children and adolescents.
Developmental assets become a language of the
common good, uniting sectors, citizens, and pol-
icy in the pursuit of shared goals for all children
and adolescents. The commitment of a commu-
nity and its people, institutions, and organizations
is both long term and inclusive.
Ultimately, rebuilding and strengthening the
developmental infrastructure in a community are
conceived less as a program implemented and
managed by professionals and more as a mobili-
zation of public will and capacity. A major target
973
for this level of community engagement is the
creation of a normative culture in which all resi-
dents are expected, by virtue of their membership
in the community, to promote the positive devel-
opment of children and adolescents. For example,
only 15% of young people are “rich” in the
12 assets particularly linked to relationships with
adults outside their own families, i.e., report
experiencing 9–12 of those assets; yet, a national D
study of US adults found that those who experi-
ence a normative sense of social expectation to get
involved with youth are more likely to consider
that involvement important, and to be in networks
of adults who connect positively with other peo-
ple’s kids (Scales et al. 2003).
While the developmental assets framework –
and the reframing principles on which it is based –
is designed to create a readiness for new commu-
nity action, models of asset-rich developmental
ecologies are needed to give this energy focus
and direction. Drawing on a range of sources,
including reviews of system change research,
field studies, and interviews with practitioners, a
series of publications paint conceptual pictures of
asset-building contexts and concrete examples
of how the principles are applied in a wide variety
of settings. These include, for example, schools
(Starkman et al. 2006), neighborhoods (Saito et al.
2000), congregations (Roehlkepartain 1998),
and whole communities (Benson 2006). Research
on strategies for creating and sustaining asset-
building community initiatives are reviewed
in Benson et al. (2006) and Enfield and
Owens (2009).
Lifespan Extensions
The developmental assets framework originated
as an approach for understanding and promoting
positive development in adolescence, or roughly
grades 6–12. Theoretical and empirical work also
have been conducted to extend the framework, in
developmentally appropriate accents, to younger
children from birth-grade 5, as well as to young
adults, roughly ages 18–25.
The initial formulation of developmental assets
for young children was published in 1997 (Leffert
974
et al. 1997), and was a straightforward extension
of the concepts from adolescence to younger chil-
dren from birth onward. For the first time, the
conceptual utility of the framework throughout
the first two decades of life could be seen, as
versions of the 40 assets were articulated for
infants and toddlers (ages 0–2), preschoolers
(3–5), elementary-age children (6–11), and ado-
lescents (12–18). This work grew out of asking
the question, what are the earlier roots of the
40 assets in adolescence? An extensive review of
the literature, and the insights of both local and
national practitioners and researchers, contributed
to the development of these frameworks for youn-
ger children.
More recently, Search Institute focused on
elaborating the conceptualization of the assets
framework in early childhood, undertaking an
even more extensive review and consultation ini-
tiative around the first decade of life. The resulting
Early Childhood Developmental Assets Frame-
work is thus grounded in the original assets frame-
work for adolescents, but also well aligned with
influential scientific, theoretical, and practice-
oriented approaches such as the National
Research Council’s From Neurons to Neighbor-
hoods report, Brazleton and Greenspan’s seminal
Irreducible Needs of Children, and the Head Start
program’s outcomes framework. In accenting the
areas that are most developmentally important for
early childhood, the framework notes that the
pairing of support and social competencies, and
constructive use of time and commitment to learn-
ing, are “primary” assets – conceptually fusing
these pairs of internal and external asset
categories – that are “fundamental in develop-
ment” (VanderVen 2008, p. 159).
The theoretical, conceptual, and practice-based
contributions of the early childhood assets frame-
work are considerable. However, the Institute has
yet to embark on a major program of measurement
of the assets in early childhood, in large part
because the rather lengthy self-report survey
needed to study assets in adolescence is less fea-
sible to use with younger children. A Search Insti-
tute collaboration with the YMCA of the USA has
enabled initial development and testing of a brief
survey of parents of children in grades K-5 on a
Developmental Assets
small number of assets, and a reformulation of the
Institute’s Developmental Assets Profile (see
below) for parents of younger children has been
drafted. But this effort is at a very early stage of
development, and so the measurement of the
developmental assets in early childhood remains
an area needing considerable work.
An extensive review of more than 600 studies
confirms that the developmental assets concepts
originally developed to describe adolescence are
well-suited to describing healthy development in
middle childhood (Scales et al. 2004). Middle
childhood is defined mostly as grades 4–5, with
a swing year of grade 6 for many children. It is
during these years that children approach the cusp
of early adolescence. In many respects, children
have one foot firmly planted in childhood, and
with the other are gingerly reaching toward the
vastly different world of adolescence.
As a result, there is both similarity and differ-
ence between the assets frameworks for adoles-
cence and middle childhood. There is great
continuity, not only in the underlying structure
of the assets (e.g., the family-support asset con-
notes high levels of love and support, regardless
of developmental level), but also in how the assets
are operationalized (e.g., one of the criteria for
family support is how well the child and parent
get along).
Beyond these simple continuities, however, lie
a number of differences corresponding to the
varying capacities and skills of children in those
developmental periods. For example, sense of
purpose is a developmental asset for both middle
childhood and adolescence, but younger children
are not expected to have as much insight into the
purpose and meaning of their lives as adolescents.
Another example is “school” engagement in the
adolescent framework. In the middle childhood
framework, this asset is called “learning” engage-
ment to emphasize the importance of children at
this age both being engaged at school and devel-
oping an interest in learning regardless of where
that learning occurs.
Both the more than 600 middle childhood stud-
ies reviewed in Scales et al. (2004) and data from
the Search Institute assets survey for 4th–6th
graders, Me and My World, strongly suggest that
Developmental Assets
the same relation of assets to outcomes exten-
sively documented for adolescents pertain to
children in middle childhood. The more develop-
mental assets they experience, the better their
odds of not just “doing okay” in their present
and future but of thriving, of being the very best
unique persons they can be.
For example, in a sample of nearly 5,000
4th–6th graders from the 2003–2004 school
year, one analysis found that asset-depleted chil-
dren (0–10 assets) are much more likely than
children with even as few as 11–20 assets to
engage in antisocial behavior (22% vs 8%), and
children with 11–20 assets are more likely than
asset-rich children to engage in this risk pattern
(8% versus 2%). Similarly, 72% of asset-rich
4th–6th graders say they have good coping skills,
compared with 47% of children with 21–30
assets, 25% of students with only 11–20 assets,
and just 16% of asset-depleted students (Scales
et al. 2005). Thus, the developmental assets
framework seems validly to describe a broad
array of relationships, opportunities, values, and
skills that promote a healthy middle childhood
and increase the odds of a successful adolescence.
Search Institute is now expanding the territory
of developmental assets into the arena of young
adulthood. Different authors use different terms –
usually either emerging adult or young adult – for
the same period of young adulthood, which is also
variously defined in terms of age range, but which
may be defined as approximately ages 18–25. An
extensive research review conducted for the Gates
Foundation (Benson et al. 2004b) amply demon-
strates that although the transition to new roles
characterizes the essence of young adulthood, the
social and psychological processes at work are
much the same as in the first two decades of life.
Other efforts have addressed pathways to success-
ful young adult development, and define what
successful young adulthood entails (Schorr and
Marchand 2007), but are essentially about what
adolescents need subsequently to have a success-
ful young adulthood, much as the assets frame-
work is about what adolescents need while they
are adolescents. The new assets framework for
young adulthood, however, describes what
young adults need during those years from 18 to
975
25 in order to enjoy current well-being and suc-
cessful transition to later life.
As early as 1997, Benson (1997, 2006) artic-
ulated an initial description of adult assets. In
2004, in a report to the Bill and Melinda Gates
Foundation, Search Institute and the Social
Development Research Group at the University
of Washington collaborated to make more
explicit a statement of successful development D
in the next developmental period beyond adoles-
cence, that of emerging or young adulthood
(Benson et al. 2004b).
Subsequent to the Gates Foundation project,
from 2004 to 2006, Search Institute worked with
Child Trends and the America’s Promise Alliance
to articulate and develop measurement tools to
assess whether America’s children and youth
were experiencing five “promises” (based on the
developmental assets framework) that are known
to be linked to positive developmental outcomes
(the promises are: caring adults, safe places and
constructive use of time, a healthy start, effective
education, and opportunities to make a difference;
see Scales et al. 2008; America’s Promise
Alliance 2007). Although the eventual measure-
ment focused on school-age children and youth,
the authors generated indicators of positive devel-
opmental experiences for each of the age group-
ings of 0–5, 6–11, 12–17, and, most relevant for
this discussion, ages 18–21. That conceptual work
informed the evolving framework of assets for
young adults.
Similarly, from 2006 to 2008, under a grant
from the John Templeton Foundation, Institute
researchers collaborated with a global group of
more than 100 advisors and research partners in
North America, South America, Europe, Africa,
Asia, and Oceania to develop a new theory of
spiritual development among childhood and
youth, and to begin to measure salient dimensions
of spiritual development with new measurement
tools (Roehlkepartain et al. 2008). Because of the
global nature of the work, and the tendency for
much of the world outside the USA to define
“youth” as including older ages than is common
in US definitions, the focus spanned the ages from
about 12–25. Much of this work around theory
and measures of spiritual development involved a
976
focus on naming the positive developmental expe-
riences of emerging or young adults.
The result of all this conceptual and empirical
work is an initial description of the developmental
assets framework for young adults (Scales et al.
2010). Most of the asset names used for adoles-
cents can validly be used as well in the young
adult period, although the definition must change
somewhat to reflect developmental realities.
Some asset names must change. For example, a
number of assets refer to the context of the school,
which for young adults must broaden to include
not only post-secondary school settings, but
workplace settings and the military as well. Dif-
ferent young adults will of course have differing
constellations of relationships too, with some
being married, some being parents, some with
partners and some not, etc., but the conceptuali-
zation and measurement of assets in this period
must be broad enough to adequately reflect that
diversity of life trajectories. In collaboration with
students and faculty at several universities, Search
Institute began pilot testing of a new survey of
assets for young adulthood in 2010, with the
intention to have, within several years, psycho-
metrically sound surveys that can be used with
young adults in college, workplace/community,
and military settings.
The Developmental Assets Profile (DAP)
The Search Institute Profiles of Student Life: Atti-
tudes and Behavior survey (the A&B survey),
along with its other surveys, has been adminis-
tered to more than three million young people in
thousands of communities over the last 20 years.
The strength of the A&B survey is providing an
aggregate portrait of the 40 developmental assets
experienced by young people, with the data cata-
lyzing and mobilizing communities into taking
action to promote positive youth development.
However, it was not designed for assessing
change over time at either the aggregate or indi-
vidual level.
The Developmental Assets Profile (DAP) was
designed in 2005 to capture the developmental
experience of young people in grades 6–12 in a
Developmental Assets
survey that was more sensitive to detecting
changes over time, and of a high enough psycho-
metric quality to be used at an individual level.
The DAP also is much briefer than the A&B
survey. The trade-off for the value-adds of the
DAP is that it does not provide scores for each
of the 40 individual assets, but rather for the eight
asset categories (Support, Positive Values, etc.).
An added feature, however, is that it also provides
scores by environmental context, so it can be
readily seen how youth are experiencing assets
in the family, school, community, social, and per-
sonal contexts (details in Search Institute 2005).
The DAP has been used in more than
200 research and program evaluation applications
since 2005. Most have been with relatively small
samples of less than 100, and often fewer than
50 youth. However, several dozen studies have
been done with sample sizes of at least 400 for
one-time cross-sectional surveys, and at least
200 for pre/post-program evaluation studies. In
2010, the Institute began collecting the databases
from those relatively large studies, as a prelude to
conducting a meta-analysis of DAP research that
has occurred over the survey’s first 5 years.
A particularly intriguing study was conducted
in Binghamton, New York. Selected DAP items
were regrouped into prosociality, social support,
and neighborhood social capital scales, and scores
linked to spatial mapping of middle- and high-
school students’ (N = 1,840) residential locations
and other Census data (Wilson et al. 2009).
Results showed that individual prosociality scores
were strongly linked to social support, and that it
took multiple sources of social support (e.g.,
extracurricular activities, neighborhood, school,
religion) to incrementally add up to explaining a
substantial percentage (52%) of the variance in
prosociality. Moreover, students’ perceptions of
their neighborhood quality, based on DAP items
such as “I have neighbors who help watch out for
me,” were strongly linked to whether pedestrians
picked up a planted, “lost letter” and mailed it,
impressive evidence of the validity of their DAP
responses. In turn, the students’ DAP perceptions
of neighborhood quality were also confirmed by
crime statistics, school delinquency notices, and
even the extent of holiday decorations observed in
Developmental Assets
the neighborhoods between Halloween and
Christmas. The DAP measures of neighborhood
quality also were more important than neighbor-
hood median income in predicting prosociality.
Among the program evaluation studies, the
DAP was used as one of the tools in a study of
the Gates-funded Community Access to Technol-
ogy program. Ten organizations and nearly
900 youth aged 10–21 in Washington state partic-
ipated. The researchers found that participation in
the program – which increases access to digital
technology through after-school programs – was
linked to significant gains in developmental
assets: 62% of those in the “low” asset level of
DAP scores moved to either the “fair” or “good”
levels after the program, and one-third moved
from the fair or good levels to “excellent” (MGS
Consulting 2008).
One of the most ambitious DAP-related pro-
jects is being undertaken by Search Institute and
Vision Training Associates in collaboration with
the RAND Corporation, the University of South-
ern Maine, and the Communities for Children and
Youth initiative of the Governor’s Children’s Cab-
inet. Assets-Getting-to-Outcomes for Maine
(AGTO4ME) is a 5-year project funded by the
National Institute of Drug Abuse, using a quasi-
experimental design to assess the success of a
youth program improvement model (http://
maineassets.org, see also National Institute on
Drug Abuse 2008). Twelve community coalitions
comprising scores of organizations serving Maine
youth are participating. Six were randomly
assigned to be trained in the developmental assets
framework, and the AGTO process (Fisher et al.
2006). AGTO is a ten-step process that blends
asset building as an improvement strategy, with
critical elements of program planning, implemen-
tation, and outcome measurement. Those coali-
tions are being compared with six community
coalitions not receiving the assets and AGTO
training and technical assistance. Data are being
collected from organizations’ staff on how the
steps in the AGTO process are being carried out,
and from youth participants in the 12 coalitions’
programs, using the DAP to determine whether
changes in the youths’ experiences of develop-
mental assets can be linked to program activities,
977
and whether youth in the experimental programs
enjoy greater improvements than youth in the
comparison communities. Initial results are
expected in 2012.
Perhaps the most significant DAP-related
development of the last few years is the explo-
sive growth in use of the survey internationally.
Developmental asset surveys have been used in a
number of other countries for many years, par- D
ticularly in Canada and Australia, but since the
introduction of the DAP, it has become the most
common developmental assets survey used glob-
ally, with users now in nearly 60 countries world-
wide. Among other languages, the DAP has
been, or is being translated, into Albanian, Ara-
bic, Armenian, Chinese, French, Japanese,
Nepali, Portuguese, Spanish, and Tagalog. An
extensive and well-documented local language
versioning process carried out in the Philippines
in a collaboration between Search Institute and
Education Development Center (EDC) provided
the model for this process (James-Wilson and
Sesma 2007).
Working with a variety of local experts and
practitioners, as well as with colleagues from
international consultation and relief organizations
such as EDC, World Vision International
(Albania, Armenia, Mexico), and Save the Chil-
dren (Bangladesh, Egypt, Gaza, Lebanon,
Morocco, Yemen), Search Institute provides train-
ing on the developmental assets framework,
administration and scoring of the DAP, and assists
the indigenous teams to ensure that translated
versions retain fidelity to the original English
intent of the questions, while still being modified
enough to be culturally meaningful.
An intensive local language versioning process
of training, consultation, and pilot and field testing
carried out over 4 months in Albania is illustra-
tive. A field test sample of 259 youth in grades
4–12 took the translated DAP in 2009. Most of the
scales achieved acceptable reliability, both inter-
nal consistency and stability, but some did not,
showing the need for further revisions before they
could be used for program evaluation and
improvement purposes. About 40% of the
58 items required several rounds of translation-
back translation-revision to capture the English
978
meanings adequately, and a number of different
administration strategies had to be tested. Nev-
ertheless, the majority of the scales did reach
acceptable levels of comprehension, reliability,
and validity (through moderate to high correla-
tions with validation measures) that those could
be recommended for use in Albania (Scales
2009).
The use of the DAP in Bangladesh is also
provocative. It is the most rigorous evaluation
design Save the Children staff have observed. It
involves a Random Control Trial (RCT) based on
a village randomization approach, with pre- and
post-tests done 6-months apart, and includes a
panel data set of 11,000 girls, four different
types of interventions, and measures for contam-
ination and spill-over affect for the control group
of girls, as well as contamination and level of
involvement measurement for the intervention
girls (email from Larry Dershem to Peter Scales,
October 6, 2009). In another case, an Arabic ver-
sion of the DAP was used in Yemen by Save the
Children as part of the evaluation of a youth
empowerment project funded by USAID. About
600 youth ages 12–24 were surveyed. Among
many interesting findings, older Yemeni youth
aged 19–24 tended to have lower DAP scores
than adolescents ages 12–18 (Bakeer et al.
2009). This corresponds to what Search Institute
has found in younger US samples, both cross-
sectional as was the Yemen study, and longitudi-
nal, when one follows the same group of youth
over several years: Middle-school youth tend to
have more assets than high-school youth,
suggesting the need for even more intentional
asset-building efforts for older youth. This sug-
gests that, despite the substantial cultural differ-
ences between Yemen and the US, the DAP
survey has validity in both settings.
These examples confirm that, although the
technical challenges to cross-cultural use of the
DAP are not insignificant, the mounting experi-
ence Search Institute has gained with its global
partners makes it clear that the challenges can be
met. The content of the survey is seen as broadly
relevant to positive youth development, it can be
successfully adapted with acceptable scientific
strength in differing cultural contexts, and it
Developmental Assets
resonates to local experts as a uniquely useful
tool for stimulating positive youth development
efforts around the world.
Conclusion
In the little more than 20 years since its introduc-
tion, the developmental assets approach has
become acknowledged as one of the most wide-
spread and influential frameworks for understand-
ing and strengthening positive youth development
(Eccles and Gootman 2002; Small and Memmo
2004). Google Scholar shows that the develop-
mental assets approach and/or Search Institute has
been referenced in more than 17,000 peer-
reviewed journal articles. In 2009 alone, more
than 10,000 schools and youth programs were
using Search Institute resources, and in the last
15 years, more than 20 million of the Institute’s
books and other resources have been disseminated
worldwide. In the last decade, more than 300,000
leaders in education, health, social services, reli-
gion, youth development, and other fields have
been trained in the assets framework, and more
than five million people have visited the Institute’s
web site. More than 60 countries across the globe
are actually using the assets approach, and people
from three times that number of countries have
been exposed to these ideas through visiting the
Search Institute web site. The expansion of the
assets framework to younger children and young
adults and emergence of new surveys such as the
DAP seem likely to fuel a continued increase in
both scholarship around the assets and the grow-
ing application of this strength-based approach to
policies, programs, and practice intended to ben-
efit young people around the world.
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Developmental Contextualism
Rhonda A. Richardson
Human Development and Family Studies, Kent
State University, Kent, OH, USA
Overview
Developmental contextualism is a perspective that
views human development as inextricably and
reciprocally linked to the multiple contexts of
individuals’ lives (Lerner 1991, 1995). While the
perspective is applicable to human development
across the life span, the focus of this essay is on its
relevance for understanding and facilitating posi-
tive adolescent development. Essentially, devel-
opmental contextualism implies that adolescent
981
development cannot be examined independent of
the people and places that comprise an adoles-
cent’s life space (i.e., contexts). Key contexts for
adolescents include family, peers, school, and
community (Hill 1983). Moreover, there is a
reciprocal relationship between adolescents and
these contexts such that not only do contexts and
the individuals comprising them influence adoles-
cents, but adolescents also shape the contexts D
(Lerner 1991, 1995). The interplay between per-
son and context is dynamic and developmental.
This means that families, peers, schools, and com-
munities respond to the maturational changes of
an adolescent and their responses in turn further
influence the development of the adolescent.
More simply put, adolescents “grow up” not
only because of developmental, maturational pro-
cesses but also as a result of their interactions
with other people and in a variety of settings.
Furthermore, these individuals and settings are
simultaneously changing. The positive youth
development (PYD) orientation (Lerner et al.
2003) is based on principles of developmental
contextualism.
Specific Principles of Development in
Context
In articulating developmental contextualism,
Richard Lerner (1991, 1995) explained the per-
spective as one that views “fused and changing
relations among biological, psychological, and
social contextual levels” (Lerner 1995, p. 15) as
comprising the process of developmental change.
That is, a developmental contextual perspective
views the essential process of human develop-
ment as being composed of changing, reciprocal
relations between individuals and the multiple
contexts within which they live (Richardson
2005). Therefore, understanding adolescent
development requires attention to the interaction
between the continuously changing adolescent
and the social contexts within which the adoles-
cent spends time.
There are three key themes within develop-
mental contextualism: (1) Children actively influ-
ence their own development; (2) Development is a
982
life span phenomenon; and (3) Human develop-
ment is embedded within social contexts (Lerner
1995). The remainder of this essay explains each
of these themes in detail. In addition, the applica-
bility of these three principles to understanding
positive adolescent development is illustrated by
focusing on their relevance to parent–adolescent
connectedness. The latter has been identified as a
critical factor facilitating positive development in
adolescence (Lezin et al. 2004). Finally, the newly
emerged positive youth development (PYD) per-
spective (Lerner et al. 2003) is summarized to
demonstrate the applicability of a developmental
contextual perspective for understanding and
facilitating positive adolescent development.
Adolescents’ influences on their own develop-
ment. According to this principle, every adoles-
cent brings unique personal characteristics to his
or her encounters with others. While some of
these characteristics, such as gender and temper-
ament, can be considered “fixed” or stable, many
of them are changeable, particularly during ado-
lescence. For instance, maturational changes in
physical characteristics include both hormonal
processes and outward (somatic) changes such
as dramatic increases in height and weight and
changes in body shape. Recent research has iden-
tified adolescence as a significant period of brain
growth with consequences for cognitive and
behavioral characteristics of the age group such
as limited impulse control, increased emotional-
ity, and an inclination toward risk-taking (Straugh
2004). A number of psychological changes also
typically occur during adolescence, such as iden-
tity development and individuation (Steinberg
2008). All of these changes within an individual
are referred to as intraindividual change. Of
course, no two individuals change in exactly the
same way; that is, there are interindividual differ-
ences in intraindividual change.
An understanding of adolescent development
begins with an awareness of distinctive personal
characteristics and intraindividual change. How-
ever, developmental contextualism further
emphasizes that as a consequence of their individ-
uality different adolescents present unique stimu-
lation to the people in their lives who in return
respond to the adolescent based on this
Developmental Contextualism
distinctiveness (Lerner 1995; Muuss 1996).
Thus, by affecting the other people that are
influencing him or her, the adolescent is shaping
a source of his or her own development (Lerner
1995). According to developmental
contextualism, adolescent development is partly
a function of this influence of the adolescent on
the individuals occupying the contexts that com-
prise his or her life. The primary contexts for
adolescents are family, school, peers, and commu-
nity (Hill 1983).
An illustration of this principle was provided
by Richardson (2005), who identified aspects of
intraindividual change that are particularly salient
and may influence the family context during the
early years of adolescence. Specifically, she noted
that increases in height, the emergence of second-
ary sex characteristics such as breast development
in girls, and heightened moodiness stemming
from hormonal fluctuations and altered levels of
limbic system neurotransmitters may influence a
parent’s behaviors toward his or her adolescent.
Extrapolating from the limited body of empirical
research examining such effects, Richardson
suggested, for example, that “moody children
may be harder for parents to like and enjoy, lead-
ing to fewer shared activities and less time spent
together” (p. 30) and “the larger physical size
and emerging adult physique of children in
early adolescence may prompt parents to begin
granting more autonomy (p. 30).” In this way,
intraindividual changes may partially account for
the decrease in parent–child closeness or connect-
edness that typically occurs in adolescence. Par-
ents report that during adolescence their children
become harder to communicate with, more argu-
mentative, and more moody due to the physical,
cognitive, and emotional changes taking place
(Shearer et al. 2005; Steinberg and Silk 2002).
The adolescent’s fixed trait of gender is also of
significance as illustrated by the finding that
mothers are closer to sons than to daughters
(Shanahan et al. 2007).
Development is a life span phenomenon.
A second theme of developmental contextualism
is the principle that development is a life span
phenomenon (Lerner 1995). This implies that
adults, as well as children and adolescents,
Developmental Contextualism
develop as distinct individuals over time. Those
who occupy an adolescent’s life contexts possess
their own unique individuality, part of which is
stable and part of which is fluid. These distinctive
qualities will influence their responses to the ado-
lescent. That is, adolescents receive different
responses from different people (Lerner 1995;
Muuss 1996). To understand adolescent develop-
ment, then, one must consider how the character-
istics of each individual comprising an
adolescent’s family, peer group, school, and com-
munity interact with the unique qualities of each
adolescent. The result is a very complex mosaic of
adolescent development.
The concept of reciprocal interaction captures
this complexity. Reciprocal interaction refers to
the process by which both the adolescent and the
members of his or her life contexts mutually influ-
ence and respond to the behavior of one another in
a circular fashion. Specifically, as a consequence
of the different stimulation received from each
adolescent, and in relation to their own character-
istics of individuality, each family member, peer,
teacher, and community member will have a
unique relationship with each adolescent they
encounter and vice versa. This exchange of influ-
ence in turn contributes to further change in each
individual. For example, a moody adolescent may
stimulate frustration in a parent who has a reactive
temperament, and the resultant irritable response
from the parent may exacerbate the adolescent’s
moodiness, which in turn would increase the par-
ent’s frustration. The result might be a reduction in
connectedness between parent and adolescent.
Conversely, the same moody adolescent may
stimulate an empathic response from his or her
more easygoing other parent. This may result in a
more regulated emotional response from the ado-
lescent and reduce the likelihood of future emo-
tional outbursts toward that parent, thus
preserving connectedness between the two.
Richardson (2005) suggested a number of par-
ent characteristics that may have a bearing on
parental connectedness to their adolescents, such
as gender, beliefs about adolescence, and prior
experience. Adolescents generally spend more
time with and feel closer to mothers than to fathers
(Steinberg 2008). With regard to beliefs and
983
experience, Richardson noted that inexperienced
parents are more likely than experienced parents
to expect that they and their children will become
closer in adolescence, and suggested that this
expectation of increased closeness might lead par-
ents to be more intentional about spending time
together or expressing acceptance of the adoles-
cent. Recent research illustrates the interplay of
parent gender and experience in relation to D
parent–adolescent connectedness (Shanahan
et al. 2007). Declines in paternal warmth over
the course of adolescence were found to be less
pronounced for second-borns than for firstborns,
suggesting that fathers learn from experience,
whereas maternal warmth decreased for both
first- and second-born siblings.
Positive development depends on the goodness
of fit between the person and the context (Lerner
1995). This refers to the idea that when there is a
good match between the characteristics and
behaviors of the adolescent and those occupying
his or her life contexts, positive development will
ensue. Eccles et al. (1993) illustrated this principle
in an analysis of young adolescents’ experiences
in schools and families. These authors argued that
declines in academic motivation and performance
during middle school are largely attributable to a
mismatch between developmental characteristics
of young adolescents (e.g., desire for indepen-
dence and autonomy) and educators’ teaching
approaches (e.g., limited opportunities for student
decision-making). Similarly, conflict in the
parent–adolescent relationship is largely a func-
tion of a poor fit between the adolescent desire for
autonomy and parent tendency toward
maintaining control (Eccles et al. 1993). Con-
versely, Richardson (2004) suggested that when
adults understand the multiple characteristics and
processes of adolescence they are better suited to
support and guide adolescents through the
changes and decisions they face.
From a developmental contextual perspective,
then, to facilitate positive adolescent develop-
ment, it is important that contexts are developmen-
tally responsive. This means that the contexts and
individuals have an understanding of the develop-
mental nature and needs of adolescents and pos-
sess qualities that complement those. This
984
principle is the basis for the National Middle
School Association’s (NMSA) position that a suc-
cessful middle school is one in which the organi-
zation, curriculum, pedagogy, and programs are
based on the developmental readiness, needs, and
interests of young adolescents (NMSA 2003).
Specifically, among the characteristics of the
school context that are associated with higher
levels of student achievement and overall devel-
opment are educators who understand the devel-
opmental uniqueness of the age group; teaching
approaches that accommodate the diverse skills,
abilities, and prior knowledge of adolescents; and
specialized professionals who are readily avail-
able to offer the assistance many students need
in negotiating their lives both in and out of school
(NMSA 2003).
Richardson (2004) proposed that a develop-
mentally responsive family context for adolescent
development is one in which parents are willing to
engage in meaningful, open communication with
their children. Indeed, positive family communi-
cation contributes to connectedness and has been
found to be a strong predictor of adolescents’
acquisition of positive values (Hillaker et al.
2008). To be effective communicators, parents
need to be attuned to what the adolescent believes
is appropriate for them to discuss, yet the topics
adolescents would like to talk about with parents
encompass a wider range of concerns than what
parents may assume (Richardson 2004). In other
words, there appears to be a limited goodness of fit
between parents and adolescents regarding their
preferred important topics of communication.
While adults may assume that the important topics
for parent–adolescent discussion are sensitive
subjects such as alcohol and drug use and sexual-
ity, adolescents themselves want to discuss under-
standing and handling conflict with their parents,
expressing love and support, building and
maintaining trust, discovering and appreciating
individual qualities, and learning about their par-
ents’ past (Richardson 2004). Richardson and
Pevec (2007) developed a guidebook to assist
parents and young adolescents in using movies
to start meaningful conversations about these and
additional topics that kids want to discuss. Strate-
gies such as this may contribute to a
Developmental Contextualism
developmentally responsive family context that
will enhance positive adolescent development.
Human development is embedded within social
contexts. Developmental contextualism recog-
nizes that humans are inherently social beings,
and in fact it is through interactions with other
human beings that an individual’s personal char-
acteristics come to have meaning and that change
occurs (Lerner 1995). From this perspective, then,
adolescent development does not occur in a social
vacuum but rather depends upon contacts and
exchanges with those who constitute the primary
social contexts of adolescence: family members,
peers, school personnel, and community mem-
bers. Drawing upon ecological systems theory
(Bronfenbrenner 1979), developmental
contextualism recognizes the significance of prox-
imal microsystems (e.g., family, friends, teachers)
as well as the more distal macrosystem (e.g.,
culture, society). With regard to the latter, for
example, it is conceivable that new communica-
tion technologies such as text messaging and
social networking web sites could have implica-
tions for connectedness between adolescents and
their parents. On the one hand, the technologies
enable quicker, more accessible contact, but on
the other hand they may depersonalize that con-
tact and ultimately diminish the feelings of con-
nectedness that are correlated with positive
adolescent development. In this way, the broader
macrosystem has implications for adolescent
development via its influence on the family
microsystem.
Interconnections between the various micro-
systems of an adolescent are also recognized
as significant from a developmental contextual
perspective. Referred to as mesosystems
(Bronfenbrenner 1979), these linkages between
contexts can be thought of as creating a “safety
net” or “web” that surrounds the adolescent and
bolsters positive development. As one example,
the National Middle School Association empha-
sizes the importance of school-initiated family
and community partnerships (NMSA 2003). For
instance, teachers can establish good channels of
communication with students’ parents by distrib-
uting weekly written or electronic newsletters that
may prompt parent involvement. In turn, parent
Developmental Contextualism
participation such as helping with homework,
attending school conferences, and discussing
school assignments, contributes to greater aca-
demic success for youth (Pena 2000; Steinberg
2008). Notably, consistent with the developmen-
tal contextual perspective, some parents may feel
better equipped than others for involvement with
their child’s school based on personal factors such
as self-efficacy, prior educational experiences,
and language-speaking ability (Pena).
Ultimately, the adolescent is part of a larger,
enmeshed system of fused relations among
multiple social contexts. This principle of
embeddedness underlies the positive youth devel-
opment (PYD) approach that has emerged over
the past decade (Lerner et al. 2003; Silbereisen
and Lerner 2007). PYD is a perspective that views
youth as resources to be developed rather than
problems to be fixed. It draws on principles of
developmental contextualism to consider the
strengths, competencies, and contributions that
youth can make and ways to align these with
resources and supports in the environment to max-
imize healthy development (Silbereisen and
Lerner 2007). From this viewpoint, every adoles-
cent has the capacity for positive development
(Lerner et al. 2003). Fulfilling that capacity
depends on the goodness of fit between individual
strengths of adolescents and resources for healthy
development existing across the key contexts of
adolescents’ lives (i.e., families, peer groups,
schools, communities). In other words, the devel-
oping adolescent contributes positively to self,
family, peer groups, school, and community and
those contexts simultaneously support the devel-
opment of the adolescent. Lerner et al. have used
the term “thriving” to describe adolescents who
are involved in mutually beneficial interactions
with their multilevel contexts.
Conceptually, PYD demonstrates the relevance
of a developmental contextual perspective for
understanding and facilitating positive adolescent
development. There is emerging empirical sup-
port for this applicability. The Search Institute
has identified 40 developmental assets that con-
tribute to positive adolescent development
(Leffert et al. 1998). This list of assets is divided
into two sets: internal and external. Internal assets
985
are personal characteristics of an adolescent asso-
ciated with positive behavioral outcomes and
comprise four categories: commitment to learn-
ing, positive values, social competencies, and
positive identity. External assets are provided by
the family, peer, school, and community contexts,
and encompass support, empowerment, bound-
aries and expectations, and constructive use of
time (Leffert et al. 1998). Thus, both individual D
and contextual factors are recognized as important
for positive adolescent development.
Recent research has demonstrated that internal
and ecological assets commingle to promote pos-
itive development (Theokas et al. 2005). For
example, a measure of positive identity capturing
youths’ feelings about themselves and their future
is statistically intertwined with measure of youths’
connections to family, school, and community.
This implies that adolescents’ individual identities
are inherently linked with their experiences in the
contexts that define their lives. Multiple such link-
ages between individual and ecological assets
exist and are predictive of a composite of “thriv-
ing” behaviors such as school success, leadership,
and helping others (Theokas et al. 2005). The
research of Theokas and colleagues demonstrates
the empirical soundness of adopting a develop-
mental contextual perspective for considering
processes of positive youth development.
Informed by developmental contextualism, the
positive youth development perspective recog-
nizes the importance of interindividual differ-
ences in intraindividual change, reciprocal
interaction, goodness of fit, developmentally
responsive contexts, and contextual embeddedness
for understanding and facilitating optimal develop-
ment in adolescence.
References
Bronfenbrenner, U. (1979). The ecology of human devel-
opment. Cambridge: Harvard University Press.
Eccles, J. S., Midgley, C., Wigfield, A., Buchanan, C. M.,
Reuman, D., Flanagan, C., et al. (1993). Development
during adolescence: The impact of stage-environment
fit on young adolescents’ experiences in schools
and in families. The American Psychologist, 48(2),
90–101.
986
Hill, J. (1983). Early adolescence: A framework. Journal
of Early Adolescence, 3, 1–21.
Hillaker, B. D., Brophy-Herb, H. E., Villarruel, F. A., &
Haas, B. E. (2008). The contributions of parenting to
social competencies and positive values in middle
school youth: Positive family communication,
maintaining standards, and supportive family relation-
ships. Family Relations, 57, 591–601.
Leffert, N., Benson, P. L., Scales, P. C., Sharma, A. R.,
Drake, D. R., & Blyth, D. A. (1998). Developmental
assets: Measurement and prediction of risk behaviors
among adolescents. Applied Developmental Science,
2(4), 209–230.
Lerner, R. M. (1991). Changing organism-context relations
as the basic process of development: A developmental-
contextual perspective. Developmental Psychology, 27,
27–32.
Lerner, R. M. (1995). America’s youth in crisis. Thousand
Oaks: Sage.
Lerner, R. M., Dowling, E. M., & Anderson, P. M. (2003).
Positive youth development: Thriving as the basis of
personhood and civil society. Applied Developmental
Science, 7(3), 172–180.
Lezin, N., Rolleri, L., Bean, S., & Taylor, J. (2004). Parent-
child connectedness: Implications for research, inter-
ventions, and positive impacts on adolescent health.
Scotts Valley: ETR Associates.
Muuss, R. E. (1996). Theories of adolescence. New York:
McGraw-Hill.
NMSA. (2003). This we believe: Successful middle schools
for young adolescents. Columbus: National Middle
School Association.
Pena, D. C. (2000). Parent involvement: Influencing fac-
tors and implications. Journal of Educational
Research, 94, 42–54.
Richardson, R. A. (2004). Early adolescence talking
points: Questions that middle school students want to
ask their parents. Family Relations, 53, 87–94.
Richardson, R. A. (2005). Developmental contextual con-
siderations of parent-child attachment in the later mid-
dle childhood years. In K. A. Kerns & R. A. Richardson
(Eds.), Attachment in middle childhood (pp. 24–45).
New York: Guilford.
Richardson, R. A., & Pevec, A. M. (2007). What kids
REALLY want to ask: Using movies to start meaningful
conversations (A guidebook for parents and children
ages 10–14). Acton: VanderWyk & Burnham.
Shanahan, L., McHale, S. M., Crouter, A. C., & Osgood,
D. W. (2007). Warmth with mothers and fathers from
middle childhood to late adolescence: Within- and
between-families comparisons. Developmental Psy-
chology, 43(3), 551–563.
Shearer, C. L., Crouter, A. C., & McHale, S. M. (2005).
Parents’ perceptions of changes in mother-child and
father-child relationships during adolescence. Journal
of Adolescent Research, 20(6), 662–684.
Silbereisen, R. K., & Lerner, R. M. (2007). Approaches to
positive youth development: Aview of the issues. In R. K.
Silbereisen & R. M. Lerner (Eds.), Approaches to positive
youth development (pp. 3–30). Thousand Oaks: Sage.
Developmental Periods
Steinberg, L. (2008). Adolescence (8th ed.). New York:
McGraw-Hill.
Steinberg, L., & Silk, J. S. (2002). Parenting adolescents.
In M. Bornstein (Ed.), Handbook of parenting
(Children and parenting, 2nd ed., Vol. 1,
pp. 103–133). Mahwah: Lawrence Erlbaum
Associates.
Straugh, B. (2004). The primal teen. New York:
Doubleday.
Theokas, C., Almerigi, J. B., Lerner, R. M., Dowling,
E. M., Benson, P. L., Scales, P. C., et al. (2005). Con-
ceptualizing and modeling individual and ecological
asset components of thriving in early adolescence.
Journal of Early Adolescence, 25(1), 113–143.
Developmental Periods
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Developmental periods reference the human life
cycle, which in modern times has been deemed as
comprising the following periods: the neonatal
period (0–1 month), infancy (birth to 1 year),
middle childhood (ages 6–10), preadolescence
(ages 10–12), adolescence (ages 12–21), adult-
hood (ages 21–65), and old age (age 65 and
older). More recently, researchers have conceptu-
alized the adolescent period itself as including
three periods: early adolescents (ages 11–13),
middle (ages 14–16), and late (ages 17–19) (see
Clark-Lempers et al. 1991). That increasingly
accepted delineation has been subjected to further
elaboration by the concept of emerging adulthood
(ages 18–30) (see Arnett 2000). These different
developmental periods are known for being
impacted by “multiple, integrated levels of orga-
nization” (Lerner and Galambos 1998, p. 415), or,
a myriad of dimensions including the biological,
individual-psychological, social-interpersonal,
institutional, cultural, and historical. During ado-
lescence, each individual undergoes distinctive
shifts in each of these areas, and a person’s devel-
opmental trajectory also consists of the relation-
ships between and among all these factors, as no
single component acts alone to produce the sum
total of a person’s adult persona.
Deviancy
References
Arnett, J. J. (2000). Emerging adulthood: A theory of
development from the late teens through the twenties.
American Psychologist, 55, 469–480.
Clark-Lempers, D. S., Lempers, J. D., & Ho, C. (1991).
Early, middle, and late adolescents' perceptions of their
relationships with significant others. Journal of Adoles-
cent Research, 6, 296–315.
Lerner, R. M., & Galambos, N. L. (1998). Adolescent
development: Challenges and opportunities for
research, programs, and policies. Annual Review of
Psychology, 49, 413–446.
Deviancy
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
The term deviancy describes characteristics,
behaviors, or thought patterns that significantly
differ from that of the rest of the population.
Deviance can be fixed or variable over both time
and contexts. Additionally, deviance can be
thought of in terms of not only too much of an
undesirable behavior but also too little of a desired
behavior, and it can occur as extremely intense
and isolated events such as mental illness. Devi-
ance tends to be determined by considering what
is not deviant, given that the norms of a popula-
tion generally dictate what that population deems
deviant.
Researchers studying deviancy tend to use one
of two common approaches to defining it. The first
common way to determine whether thoughts or
actions are deviant is to use statistical approaches
to create definitive categories for what is consid-
ered deviant by determining what thoughts or
behaviors statistically differ from the rest of the
population. The second common approach places
more emphasis on dysfunctional and undesirable
behaviors and thoughts that are significantly dif-
ferent from the rest of the population. Importantly,
regardless of the approach, categories of deviancy
still need to involve important judgment calls
since views of behaviors may not necessarily be
absolute and may require a relativistic approach
987
given that they depend on the nature and attitudes
of dominant groups.
The more flexible approach to deviancy partic-
ularly applies to adolescents, and those who study
the period of adolescence typically must consider
additional factors. When examined in the context
of the adolescent period, deviance can mean more
than different from the norm or more than unde-
sirable behavior. When relating to youth, deviant D
behavior also includes behaviors that are a source
of concern or behaviors that are deemed inappro-
priate by adult authority as well as behaviors that
typically elicit some kind of social control
response (see Jessor and Jessor 1977). Adoles-
cents’ different position in society, then, translates
into different ways of considering them as poten-
tially deviant and as exerting control over them to
suppress their deviancy.
Different kinds of deviant behaviors have been
deemed particularly pronounced among adoles-
cents. Those behaviors range from potentially
minor deviances such as lying to parents or
teachers and shoplifting to potentially more seri-
ous ones like alcohol and drug abuse and physical
violence. Importantly, some argue that these
behaviors tend to constitute a single entity called
general deviance or problem behavior (see
Donovan et al. 1988). Other researchers view the
behaviors as distinct forms of deviance and cham-
pion the need to differentiate them given, for
example, that they differently depend on adoles-
cents’ developmental phases (see McGee and
Newcomb 1992; Osgood et al. 1988). Regardless
of the approach taken to understanding youth’s
deviancy, it is clear that society marks it as impor-
tant to respond to as it even has created entire
justice systems devoted to adolescent deviance
(i.e., the juvenile justice system) and to address
types of deviance in this period of human devel-
opment that are ignored in others (e.g., through
the creation of status offenses).
Although controversy surrounds whether there
is such a phenomenon as a problem behavior syn-
drome, researchers continue to give considerable
attention to the concept of deviant lifestyles.
Indeed, the concept of deviant lifestyles increas-
ingly contributes to productive ways of viewing
adolescents’ troubling and troubled behavior and
988
actions. Most notably, researchers have shown
important links between deviant lifestyles and
problem behavior, and research now also links
deviant lifestyles to victimization (see Chen et al.
2007). For example, studies report how adoles-
cents’ deviant lifestyles, such as involvement in
delinquent behavior, association with deviant
peers, and unsupervised activities, directly increase
the risk of personal victimization (see Lauritsen
et al. 1991; Sampson and Lauritsen 1990). This
research builds on well established sets of findings
highlighting how associations with deviant peers
serve as risk factors for victimization.
Efforts to understand links between deviant
lifestyles, peer influences, and deviant behavior
(including victimization) constitute one of the key
areas of research in this area. Researchers suggest
several mechanisms that can help to explain the
links. Notably, the social influence hypothesis
suggests that adolescents engage in deviant
behavior due to the influence of their deviant
peers. For example, adolescents who are more
heavily embedded in contexts of deviant peer
groups likely have more peer role models, encour-
agement, access, and rewards for deviant behav-
ior, such as substance use (see Hussong 2002).
The process by which adolescents influence one
another likely is both directional and
bi-directional (see Farrell 1994). That is,
according to the well established selection
hypothesis of peer influences, adolescents who
initiate deviant behavior may actively select
friends who closely match their behaviors and
attitudes. According to the bi-directionality thesis
of peer influences, selection processes are at work
during the formation of friendship but that selec-
tion eventually contributes to the development of
social processes that reinforce the maintenance,
escalation, or even desistance of deviance in the
context of these friendships. The understanding of
these factors has been well developed by propo-
nents of social learning theory (e.g., Akers and
Lee 1999) who have identified processes, such as
differential association, vicarious learning, and
differential reinforcement within peer contexts,
as playing important roles in the development of
deviant behavior. The factors also have been well
developed by proponents of interactional theories
Deviancy
that focus on the mechanisms through which peers
influence the initiation and maintenance of devi-
ancy (see, e.g., Thornberry and Krohn 2001).
Although this very rich tradition of research con-
tinues to explore the relative weight to be given to
different factors, few doubt the importance of
peers in the development and maintenance of
deviancy.
Although the study of adolescent deviancy
tends to focus on peers, it is important to highlight
that deviancy also may be due to individual or
broad structural factors and that those factors
likely influence not only individual behaviors
but also behaviors while in peer contexts. These
factors may be of significance in that they may
well make spurious the links between particular
adolescents’ deviant behaviors and those of their
peers. For example, some adolescents simply may
be prone to antisocial behavior and have difficult
temperaments that also make them prone to devi-
ancy (see Dishion and Owen 2002). It also may be
that some adolescents have a tolerance of devi-
ance and a general tendency toward non-
conformity or rebelliousness (Curran et al. 1997;
Wills and Cleary 1999). On another very different
level of analysis, it may well be that social struc-
tural differences create barriers and privileges for
groups of youth, resulting in some finding oppor-
tunities in society and others feeling alienated, as
reflected in research highlighting sex differences
in delinquent behavior and even in what consti-
tutes delinquent behavior in that society is much
less tolerant of girls’ deviancy (see Feld 2009)
(e.g., running away tends to be seen as more
deviant for girls than for boys; see Kempf-
Leonard and Johansson 2007). These potentially
important factors help to reinforce the need for
researchers to proceed cautiously as they identify
factors that seem to influence adolescents’ deviant
behavior.
The above lines of research certainly have
made important progress in shaping the under-
standing of adolescent deviance, but they are not
without their limitations. Perhaps the strongest
limitation in this area of research is the lack of
focus on discerning what constitutes deviancy.
As a result, measures tend to focus on behaviors
and the focus on deviant behaviors varies
Deviancy
considerably. Some adopt a general approach that
is synonymous with problem behavior, as assessed
by the frequency of involvement in nine problem
behaviors (e.g., lying, cheating, stealing, and
aggression) during a certain time period, typically
within the past 6 month or year (see, e.g., Donovan
et al. 1991). Other approaches simply index con-
duct problems, such as questions that would be
answered by teachers who rate youth on their ten-
dency to engage in antisocial and rule-breaking
behavior, including destroying property (see
Kamphaus et al. 1997). Researchers tend to borrow
measures from projects that were not aimed at
understanding deviance but at exploring, for exam-
ple, delinquency. When coupled with differences in
who rates youth (self-reports, teacher or parent
reports, or investigator observations), what consti-
tutes deviancy becomes even more important to
consider.
The study of deviancy has a long history, as does
the focus on adolescents’ deviancy. That history has
led to important research detailing the nature,
causes, and consequences of deviancy among
youth and has led to important developments in
the study of deviance itself. Research has particu-
larly addressed how the causes of deviancy vary
from internal, to structural, to both, to social. Still,
research in this area remains limited in important
ways. Despite those limitations, the study of ado-
lescents’ deviancy, like the period of adolescence
itself, provides researchers with important opportu-
nities to understand the nature of deviance.
Cross-References
▶ Delinquency
▶ Deviancy Training
References
Akers, R. L., & Lee, G. (1999). Age, social learning, and
social bonding in adolescent substance use. Deviant
Behavior, 19, 1–25.
Chen, X., Thrane, L., Whitbeck, L., Hoyt, D., & Johnson, K.
(2007). Onset of conduct disorder, use of delinquent
subsistence strategies, and street victimization among
homeless and runaway adolescents in the Midwest.
Journal of Interpersonal Violence, 22, 1156–1183.
989
Curran, P. J., Stice, E., & Chassin, L. (1997). The relation
between adolescent alcohol use and peer alcohol use:
A longitudinal random coefficients model. Journal of
Consulting and Clinical Psychology, 65, 130–140.
Dishion, T. J., & Owen, L. D. (2002). A longitudinal anal-
ysis of friendships and substance use: Bidirectional
influence from adolescence to adulthood. Developmen-
tal Psychology, 38, 480–491.
Donovan, J. E., Jessor, R., & Costa, F. M. (1988). Syn-
drome of problem behavior in adolescence:
A replication. Journal of Consulting and Clinical Psy- D
chology, 56, 762–765.
Donovan, J. E., Jessor, R., & Costa, F. M. (1991). Adoles-
cent health behavior and conventionality-
unconventionality: An extension of problem behavior
theory. Health Psychology, 10, 52–61.
Farrell, A. D. (1994). Structural equation modeling with
longitudinal data: Strategies for examining group dif-
ferences and reciprocal relationships. Journal of Con-
sulting and Clinical Psychology, 62, 477–487.
Feld, B. C. (2009). Violent girls or relabeled status
offenders? An alternative interpretation of the data.
Crime & Delinquency, 55, 241–265.
Hussong, A. M. (2002). Differentiating peer contexts and
risk for adolescent substance use. Journal of Youth and
Adolescence, 31, 207–220.
Jessor, R., & Jessor, S. L. (1977). Problem behavior and
psychosocial development – A longitudinal study of
youth. New York: Academic Press.
Kamphaus, R. W., Huberty, C. J., DiStefano, C., &
Petosky, M. D. (1997). A typology of teacher-rated
child behavior for a national U.S. Sample. Journal of
Abnormal Child Psychology, 25, 453–463.
Kempf-Leonard, K., & Johansson, P. (2007). Gender and
runaways: Risk factors, delinquency, and juvenile jus-
tice experiences. Youth Violence and Juvenile Justice,
5, 308–327.
Lauritsen, J., Sampson, R., & Laub, J. (1991). The link
between offending and victimization among adoles-
cents. Criminology, 29, 265–291.
McGee, L., & Newcomb, M. D. (1992). General deviance
syndrome: Expanded hierarchical evaluations at four
ages from early adolescence to adulthood. Journal of
Consulting and Clinical Psychology, 60, 766–776.
Osgood, D. W., Johnston, L. D., O’Malley, P. M., &
Bachman, J. G. (1988). The generality of deviance in
late adolescence and early adulthood. American Socio-
logical Review, 53, 81–93.
Sampson, R., & Lauritsen, J. (1990). Deviant lifestyles,
proximity to crime, and the offender-victim link in
personal violence. Journal of Research in Crime and
Delinquency, 27, 110–139.
Thornberry, T. P., & Krohn, M. D. (2001). The develop-
ment of delinquency: An interactional perspective. In
S. O. White (Ed.), Handbook of youth and justice
(pp. 289–305). New York: Plenum.
Wills, T. A., & Cleary, S. D. (1999). Peer and adolescent
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990
Deviancy Training
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
One of the most important findings to emerge from
deviancy prevention programs is that some of them
actually provide environments that increase the
outcomes that the programs sought to prevent.
The concept of “deviancy training” has been used
to explain, in part, why some prevention interven-
tions that were assumed to be helpful actually harm
participants by fostering delinquent dispositions
(see Dishion et al. 1999). The term “deviancy
training” was derived from social learning research
that had described the process and effects of
youths’ discussions that positively respond to rule
breaking, types of discussions that researchers first
identified as occurring among some groups of boys
and their friends. Dishion and others had identified
deviancy training as occurring when youth spent
time in groups with peers, when their interactions
had reinforced rule breaking, and their norm-
violating talk had increased future problem behav-
iors (Dishion et al. 1996; Patterson et al. 2000;
Snyder et al. 2005). This process now has been
well documented.
Researchers have found a positive association
between delinquent behavior and both unstruc-
tured and unsupervised activities (Osgood et al.
1996). Unstructured activities tend to increase
adolescents’ involvement in delinquent behav-
iors, even though structured, but unsupervised,
activities do not. Delinquent behavior at individ-
ual and school levels also has been reported to
increase with higher unsupervised, unstructured
activity (Osgood and Anderson 2004). Even with
nondeviant peers, unstructured time correlates
with increased deviance. Researchers have noted
that the combination of reduced social control and
increased social rewards for deviance may be the
cause of the deviancy training phenomenon
(Osgood et al. 1996). Peers long have been
found to influence deviant behavior (see, e.g.,
Patterson et al. 2000). The relationship between
early involvement with delinquent peers and
Deviancy Training
increase in delinquency has been shown to be
mediated by the rate of reinforcement and level
of peer delinquency. High or increased levels of
reinforcement of and exposure to deviance also
have been shown to increase levels of conduct
problems at home, at school, and on the play-
ground (Snyder et al. 2005). Peer affiliations also
have been demonstrated to be a critical determi-
nant of violent perpetration, especially for some
minority groups (Haynie and Payne 2006) and for
early adolescents (Pardini et al. 2005; Matjasko
et al. 2010). This line of research suggests that
adolescents are more likely than adults to assign
higher status, attention, and approval to deviant
peers, and they are more likely to act on those
views (Osgood et al. 1996).
Taken together, research on deviancy training
produced important findings. This line of research
points to the importance of structured activities in
after-school programs in reducing the promotion
of delinquent behavior by peers. While after-
school programs and other youth-oriented pro-
grams can promote the acquisition of prosocial
skills and values, the structure of these programs
also may decrease delinquent behaviors in adoles-
cents when the programs carefully monitor activ-
ities and decrease the extent to which they are
unstructured. Importantly, although these findings
have been found in interventions and other pro-
grams designed to provide activities for youth, it
is notable that youth already otherwise spend con-
siderable time in unstructured activities that
appear to be normative to their development.
Cross-References
▶ Delinquency
▶ Deviancy
▶ Peer Influences
References
Dishion, T. J., Spracklen, K. M., Andrews, D. W., &
Patterson, G. R. (1996). Deviancy training in male
adolescent friendships. Behavior Therapy, 27, 373–390.
Dishion, T. J., McCord, J., & Poulin, F. (1999). When
interventions harm: Peer groups and problem behavior.
The American Psychologist, 54, 755–764.
Diary Methods
Haynie, D. L., & Payne, D. C. (2006). Race, friendship
networks, and violent delinquency. Criminology, 44,
775–805.
Matjasko, J. L., Needham, B. L., Grunden, L. N., & Farb,
A. F. (2010). Violent victimization and perpetration
during adolescence: Developmental stage dependent
ecological models. Journal of Youth and Adolescence,
39, 1053–1066.
Osgood, D. W., & Anderson, A. L. (2004). Unstructured
socializing and rates of delinquency. Criminology, 42,
519–549.
Osgood, D. W., Wilson, J. K., O’Malley, P. M., Bachman,
J. G., & Johnston, L. D. (1996). Routine activities and
individual deviant behavior. American Sociological
Review, 61, 635–655.
Pardini, D. A., Loeber, R., & Stouthamer-Loeber,
M. (2005). Developmental shifts in parent and peer
influences on boys’ beliefs about delinquent behavior.
Journal of Research on Adolescence, 15, 299–323.
Patterson, G. R., Dishion, T. J., & Yoerger, K. (2000).
Adolescent growth in new forms of problem behavior:
Macro- and micro-peer dynamics. Prevention Science,
1, 3–13.
Snyder, J., Schrepferman, L., Oeser, J., Patterson, G.,
Stoolmiller, M., Johnson, K., & Snyder, A. (2005).
Deviancy training and association with deviant peers
on young children: Occurrence and contribution to
early onset conduct problems. Development and Psy-
chopathology, 17, 397–413.
Diary Methods
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
One of the most effective ways to obtain data
relating to individuals’ experiences is to ask
them to report their moods, behaviors, situations,
thoughts, or other information as they experience
the phenomenon under study. This approach gen-
erally is known as the diary method, which was
devised to have participants record their experi-
ences as soon as they could after it was experi-
enced (and sometimes during it). This approach
provides unique data and has become part of an
increasingly popular method that takes advantage
of emerging technologies as well as new statistical
methods that allow researchers to understand bet-
ter the “lived experiences” of phenomena (see
Bolger et al. 2003; Laurenceau and Bolger 2005).
991
Although researchers adopting diary methods
can use the method in a variety of ways, this
approach can be grouped in two major categories:
time-based and event-based. Event-based diary
entries depend on when the phenomenon occurs
and are particularly useful for rare, specialized, or
unpredictable phenomena. Time-based
approaches involve entries collected at regular or
randomized time intervals chosen by researchers D
and are slightly more common given that they
provide a greater sense of consistency across par-
ticipants. Both approaches are useful for aggre-
gating, generalizing, and reporting frequencies.
To know when to record observations, partici-
pants often wear wristwatches, pagers, or phones
that indicate when to enter data into the collection
medium. The medium may be a journal, electronic
device, or Internet. And what they report also can
vary considerably; researchers can use event
checklists, checklists used with Experience Sam-
pling Method (ESM) assessments, and open-
ended responses that are categorized after they
have been recorded (see Stone et al. 1991).
Thus, the diary method can address questions
that center on the need to aggregate experiences
over time, examine temporal patterns of experi-
ences, and understand factors affecting changes in
these experiences. As with any other method, the
research questions determine which approach will
secure the most useful data.
Diary methods have important strengths that
highlight the benefits that can accrue from efforts
that are self-reported and center on ongoing expe-
riences within everyday situations. Recording
data using the diary method seeks to minimize
retrospection and idealized beliefs about the self;
it instead seeks to capture transient states as they
are lived. Doing so is of significance given that the
length of time between the phenomenon and
reporting affects the generation of responses. In
this regard, the diary method is particularly robust
compared to other methods in that attempting to
report over an aggregated time period usually
overemphasizes certain moments and may be
either less reliable or less valid. In addition, diaries
capture contextual effects on the phenomenon and
help researchers understand the development of
the phenomenon. The method allows for clearly
992
identifying antecedents, concomitants, and conse-
quences. Diaries also are able to demonstrate indi-
vidual differences in the phenomenon, which may
or may not be generalizable to some groups of
people. Diary methods, then, have substantial
strengths that provide researchers with important
opportunities to create highly useful data.
While the diary method can result in the col-
lection of highly useful data, it also can have
drawbacks. Diaries can be burdensome to partic-
ipants, and those burdens can result in compli-
ance issues. The technique also is not well
understood in terms of the effects of special atten-
tion given to the phenomenon under study; stud-
ies have demonstrated that the observer effect
may change the behavior of research participants
who know that they are under observation, a
concern exacerbated by reliance on self-reports
(see Schwartz 1999). While observer effects in
the context of self-reports have not been the sub-
ject of much focus (perhaps because of a lack of
research interest in it), it remains a concern that
could be applicable to this method. The diary
method, then, evinces limitations peculiar to the
method itself as well as some shared with others
that rely on self-reports.
Despite notable limitations, the diary method
has been developed in new ways that increase its
promise as a highly useful research tool. These
efforts have centered on increasing the robustness
of data obtained from participants and on using
statistical techniques that permit highly sophisti-
cated use of the gathered data (see Snijders and
Bosker 1999; Reis and Gable 2000). For example,
researchers now may use diary methods along
with other methods of data collection to increase
the depth of data. Researchers also may combine
diaries with collateral data collected from other
environmental or interpersonal sources. They also
may include reminders or instructions for partici-
pants. Also important to note is the extent to
which the diary method produces inherently
multilevel data, which has important implications
relating to cutting-edge statistical techniques.
Techniques to analyze multilevel data have devel-
oped rapidly and increase in popularity as they
include multilevel modeling, general mixed
models, random regression, and hierarchal linear
Diary Methods
modeling. The methods can help account for sta-
tistical interdependence between repeated mea-
sures, unbalanced data from categories of
participants, and the incorporation of within- and
between-personal predictors. Diary-based studies,
then, can provide information about the average
person, between-person variability, and predictors
and determinants of this variability. These devel-
opments highlight how both technical as well as
more practical developments have sharpened the
effectiveness and general utility of diary methods.
The diary method has allowed researchers to
study phenomena outside of the laboratory,
increasing the robustness of the findings. Diaries
capture transient states not easily elicited in labo-
ratory settings, as well as behaviors that are diffi-
cult to replicate in a laboratory. As this method of
data collection increases in popularity, more
research needs to address the effects of this
method on participants’ behaviors, thoughts, feel-
ings, and other experiences.
Cross-References
▶ Qualitative Methods
▶ Quantitative Methods
▶ Self-Report
References
Bolger, N., Davis, A., & Rafaeli, E. (2003). Diary methods:
Capturing life as it is lived. Annual Review of Psychol-
ogy, 54, 579–616.
Laurenceau, J.-P., & Bolger, N. (2005). Using diary
methods to study marital and family processes. Journal
of Family Psychology, 19, 86–97.
Reis, H. T., & Gable, S. L. (2000). Event sampling and
other methods for studying daily experience. In H. T.
Reis & C. M. Judd (Eds.), Handbook of research
methods in social and personality psychology
(pp. 190–222). New York: Cambridge University Press.
Schwartz, N. (1999). Self-reports: How the questions
shape the answers. The American Psychologist, 54,
93–105.
Snijders, T. A. B., & Bosker, R. (1999). Multilevel analy-
sis: An introduction to basic and advanced multilevel
modeling. London: Sage.
Stone, A. A., Kessler, R. C., & Haythornthwaite, J. A.
(1991). Measuring daily events and experiences: Deci-
sions for the researcher. Journal of Personality, 59,
575–607.
Dietary Patterns
Dietary Patterns
Gretchen J. Cutler, Andrew Flood and
Dianne Neumark-Sztainer
Division of Epidemiology and Community
Health, School of Public Health, University of
Minnesota, Minneapolis, MN, USA
Overview
The use of dietary patterns to describe an individ-
ual’s or a population’s overall dietary intake and to
relate that intake to health outcomes has increased
greatly in the last few decades. Traditional methods
in nutritional epidemiology typically examine sin-
gle foods or nutrients, which informs our under-
standing of associations between specific measures
of dietary intake and health outcomes. But people
eat a variety of foods every single day; thus the
study of dietary patterns can offer a different per-
spective. The increased emphasis on the examina-
tion of dietary patterns within the field of
nutritional epidemiology has been a direct result
of the issues that arise when the combinations of
foods that are included in an individual’s usual diet
are overlooked. Examining the contributions of
single foods and nutrients to one’s overall dietary
intake and health outcomes will always be impor-
tant, but foods and nutrients work together, thus, if
we want to truly understand the impact of usual diet
on health it is important to examine them together.
This essay will examine what dietary pattern anal-
ysis is, why it has emerged as an important alter-
native to traditional methods used in nutritional
epidemiology, and how its use may further our
knowledge on the relationship between diet and
health. The essay will specifically focus on how
dietary patterns have been examined in adolescents
to date, and future directions for research using this
new method.
Introduction
Dietary pattern analysis has been used success-
fully in adult populations for some time, and in the
993
past decade, research using this method in adoles-
cent populations has emerged. There are multiple
reasons to expand our knowledge on dietary
intake in adolescents. The prevalence of over-
weight and obesity has increased dramatically in
adolescents, and many health problems previ-
ously associated only with adult obesity are now
being seen in adolescents. In addition, overweight
adolescents tend to become overweight adults, D
leading to further consequences for their future
health. Even with abundant research on single
foods, nutrients, and food groups, we know little
about the role that dietary intake plays in the
development of overweight or obesity in adoles-
cents. It will also be crucial to learn more about
the characteristics associated with high consump-
tion of healthy versus unhealthy dietary patterns.
Knowing the characteristics of adolescents con-
suming the least healthful diets will help identify
subgroups most at-risk for future health problems.
This knowledge will be important for improving
the efficiency, and better targeting, of interven-
tions aimed at improving dietary intake. Research
using the single food/nutrient/food group
approach to examine dietary intake in adolescent
populations has without a doubt provided impor-
tant information and should continue. With this in
mind, there are very few studies that have exam-
ined dietary patterns in adolescents, but these
methods may be especially informative. At a
time when the number of adolescents meeting
current dietary recommendations is extremely
low, and the number of health issues they face is
increasing, the use of promising new methods to
study their overall diet is especially warranted.
Defining Dietary Patterns
A dietary pattern can be defined as the distribution
of foods by frequency and/or amount in an indi-
vidual’s habitual diet (Togo et al. 2001). Dietary
patterns are mainly examined to assess overall
dietary intake, and to relate that overall dietary
intake to health outcomes or other factors
(Moeller et al. 2007). The examination of dietary
patterns has increased in popularity over the past
few decades for several reasons. Traditionally,
994
research examining dietary intake has focused on
intake of single foods or nutrients, but this
approach has many limitations. As mentioned
above, people eat a variety of foods every single
day. By not taking the complexity of the human
diet into account, traditional methods are ignoring
the fact that foods and nutrients work together. By
examining only a single food or nutrient, we are
missing out on any interactive and synergistic
effects between it and the other foods or nutrients
in the diet (Michels and Schulze 2005; Moeller
et al. 2007; Togo et al. 2001). In addition, we
cannot measure every substance in our usual
diet, and these unknown substances may also
impact our health. Examining the whole diet
through dietary patterns is an attempt to address
these limitations, and although not without
issue, dietary pattern analysis has emerged as an
important alternative method in nutritional
epidemiology.
Dietary patterns have usually been defined in
two ways. They have been defined a priori using
a score-based approach, and they have been
defined a posteriori using a data-driven approach
(Michels and Schulze 2005; Togo et al. 2001). In
a score-based approach, dietary patterns are
defined through a diet index in which foods or
nutrients are grouped according to predefined
criteria of a healthy diet. In a data-driven
approach, dietary patterns are defined through
statistical methods that identify patterns of die-
tary intake from data collected on a specific
research population. Neither of these methods is
considered more useful than the other, and both
are considered to have multiple benefits and lim-
itations (Moeller et al. 2007). Both are described
in more detail below.
It is also noteworthy that a third approach to
dietary pattern analysis has recently emerged.
This approach is called reduced rank regression
(RRR), and it combines characteristics of the a
priori and a posteriori methods described above
(Michels and Schulze 2005). As there have been
no studies using RRR in an adolescent population
to date, the bulk of this essay will focus on the
most commonly used dietary pattern analysis
methods, and RRR will be briefly described later
in the essay.
Dietary Patterns
Dietary Pattern Analysis: Score-Based
Approaches
In a score-based approach, dietary patterns are
defined theoretically according to criteria of a
healthy diet that have been determined a priori
based on current nutrition knowledge and dietary
recommendations (Michels and Schulze 2005).
The Healthy Eating Index (HEI) is a well known
diet index in which subjects are ranked by their
score to determine the healthfulness of their diet
(Moeller et al. 2007). The original HEI was
released in 1995, and was recently revised to
reflect the 2005 dietary guidelines represented in
My Pyramid and was renamed the HEI-2005
(Guenther et al. 2008). Scores on the HEI-2005
can range from 0 to 100, with higher scores indi-
cating higher diet quality. Individuals are scored
on multiple dietary components including total
fruit, whole fruit, total vegetables, dark green
and orange vegetables and legumes, total grains,
whole grains, milk, meat and beans, oils, saturated
fat, sodium, calories from solid fats, alcoholic
beverages, and added sugars (Guenther
et al. 2008).
To show an example of how a diet index is used
and how scoring criteria is applied, a simplified
diet index has been created and is presented in
Table 1. This simplified diet index has a scoring
range of 0–12 points, with a higher score indicat-
ing a healthier diet. Each study subject would
receive a score for each diet index component,
and the scores would be summed to create a total
diet index score. To receive the maximum score in
this simplified diet index, a study subject would
have to report that they consume three or more
servings per day of vegetables, fruits, and whole
grains, 0 servings of snack foods or sweetened
beverages, and they would also have to report
that they consume breakfast four or more times a
week. The dietary data used to create a diet index
score such as this one could be collected in a
variety of ways, including food frequency ques-
tionnaires (FFQ), 24-h recalls, a diet history, or a
dietary interview. Benefits of a diet index include
the fact that they are usually simple to compute,
they are easily reproducible in other populations,
and it is easy to compare the results found in one
Dietary Patterns
Dietary Patterns, Table 1 Simplified diet index example: components and scoring criteria (score range = 0–12)
Minimum score
Diet index component Servingsa Score
Vegetables 0 (0)
Fruits 0 (0)
Whole grains 0 (0)
Snack foods 3 (0)
Sweetened beverages 3 (0)
Timesa Score
Eat breakfast 0 (0)
a
Servings per day, Times per week
population to another (Moeller et al. 2007).
Although several studies have had success using
the diet index approach to examine relationships
between dietary intake and health behaviors and
outcomes, this approach has rarely been taken in
research on adolescent populations.
Two diet indices have recently been developed
for use in adolescent populations, and in contrast
to the majority of studies using the data-driven
dietary pattern approach, they have added mea-
sures of healthy behaviors in addition to the usual
measures of dietary intake. In 2004, the HEI was
adapted for use in children and adolescents
(Hurley et al. 2009). This adaption, the Youth
HEI (YHEI), was developed to rate diet quality
while also addressing eating behaviors critical to
healthy childhood and adolescent growth and
development (Hurley et al. 2009). These behav-
iors include eating breakfast, attending family
dinners, and avoiding snack foods and soft drinks
(Hurley et al. 2009). In regards to dietary intake,
the YHEI measures intake of vegetables, fruits,
whole grains, low-fat and full-fat dairy products,
lean proteins and higher fat meats, visible fat on
meat, butter and margarine, snack foods high in
salt or sugar, and sweetened beverage intake
(Hurley et al. 2009). Total scores for the YHEI
can range from 0 to 100, and similar to the HEI,
higher scores indicate better diet quality (Hurley
et al. 2009). Data from a food frequency question-
naire (FFQ) served as the basis for calculating the
YHEI (Hurley et al. 2009). Specifically, the
Youth/Adolescent Food Frequency Questionnaire
was used, which, in addition to questions on die-
tary intake, also assesses eating behaviors such as
frequency of eating breakfast (Hurley et al. 2009).
995
Maximum score
Servings Score Servings Score
1–2 (1) 3 (2)
1–2 (1) 3 (2)
1–2 (1) 3 (2)
1–2 (1) 0 (2)
1–2 (1) 0 (2)
Times Score Times Score D
1–3 (1) 4 (2)
The YHEI was found to be useful at assessing diet
quality in low-income African American adoles-
cents, but was not associated with body composi-
tion in this study (Hurley et al. 2009).
In 2009, Kosti et al. published a paper describ-
ing a diet index that was developed to incorporate
various dietary and lifestyle behaviors associated
with adolescent overweight/obese status (Kosti
et al. 2009). Lifestyle behaviors assessed included
hours of extracurricular sports/activities a week,
hours of TV/electronic game use a week, fre-
quency of eating breakfast, eating breakfast
cereals, and eating foods not prepared at home,
number of eating episodes per day, and obesity
status of parents (Kosti et al. 2009). In regards to
diet, the Diet-Lifestyle Index measures intake of
vegetables, fruits, whole grains, type of dairy
products consumed (low fat vs. full fat), visible
fat on meat, and sweets and added sugars (Kosti
et al. 2009). Scores for the Diet-Lifestyle Index
can range from 11 to 57, with higher scores indi-
cating greater adherence to recommended eating
and lifestyle behaviors that may protect against
obesity (Kosti et al. 2009). Similar to the YHEI,
dietary data was used from an FFQ to create the
Diet-Lifestyle Index score (Kosti et al. 2009). For
non-dietary intake data, information from a study
questionnaire was used (Kosti et al. 2009). The
Diet-Lifestyle Index was inversely associated
with the odds of being overweight/obese in a
population of Greek adolescents (Kosti
et al. 2009).
The YHEI and the Diet-Lifestyle Index mea-
sure slightly different healthy behaviors, which
may be due in part to the fact that the Diet-
Lifestyle Index was specifically developed to
996 Dietary Patterns

measure eating and lifestyle behaviors that are
associated with overweight/obesity in adoles-
cents. The inclusion of healthy eating and lifestyle
behaviors in these diet indexes may be a useful
way to assess important factors above and beyond
dietary intake in this population. More research
using these diet indices developed for adolescent
populations is needed.
Dietary Pattern Analysis: Data-Driven
Approaches
In data-driven approaches, often called data-
driven dietary pattern analysis, dietary patterns
are defined through statistical methods that iden-
tify patterns of dietary intake from data collected
on a specific research population (Moeller et al.
2007). Empirically defined patterns have the
advantage of not being defined a priori, and thus
they do not depend on the investigator’s idea of a
healthful eating pattern. Using this method also
allows researchers to use the dietary data from
their specific studies, and thus can provide insight
into the diet behavior of the study participants.
Empirically defined patterns can also provide
important information on distinct diet behavior
in many different populations. In addition, this
method can lead to the identification of new die-
tary patterns, and thus, the development of new
hypotheses on the relationship between diet and
health. Factor and cluster analysis are the methods
most commonly used to identify data-driven die-
tary patterns in nutritional epidemiology.
Factor analysis reduces the dietary data col-
lected from participants into factors (i.e., dietary
patterns) based on the intercorrelations between
dietary items. It is a data reduction technique
that constructs new variables (i.e., dietary pat-
terns) from the original dietary variables. Prin-
cipal components analysis is the most common
type of factor analysis used in nutritional epide-
miology (Moeller et al. 2007). As with a diet
index, dietary data can be collected through
food frequency questionnaires (FFQ), 24-h
recalls, diet history, or dietary interview
(Moeller et al. 2007). Identified dietary patterns
are usually given qualitative names that describe
the types of foods in that pattern with regard to
their nutritional quality (e.g., healthy,
unhealthy), cultural or geographic description
(e.g., traditional, western, southern), or the com-
bination of foods seen in the pattern (e.g., junk
food, snack food). After dietary patterns are
identified, each participant is given a score for
each dietary pattern, which indicates the agree-
ment between the participant’s diet and that spe-
cific pattern (Togo et al. 2001). These scores can
then be used in further analyses to examine the
relationship between adherence to certain die-
tary patterns and health outcomes or other char-
acteristics (Togo et al. 2001).
An example of dietary patterns identified
through principal components factor analysis in
an adolescent cohort is given in Table 2. In this
study, dietary patterns were identified among a
cohort of 4,746 middle and high school boys and
girls who participated in Project EAT (Eating

Dietary Patterns, Table 2 Dietary patterns identified over a 5-year period using factor analysis in adolescent boys and
girls (n = 4,761 at baseline) by Cutler et al. (2009)
Dietary pattern Description of dietary pattern
Vegetable Mixed vegetables, broccoli, zucchini/squash/eggplant, green/red peppers, tofu, spinach,
cooked carrots, raw carrots, corn, celery, beets
Fruit Pears, grapes, peaches/plums/apricots, oranges/grapefruit, strawberries, cantaloupe/melons,
bananas, apples and apple sauce
Starchy foods Crackers, lasagna, pretzels, English muffins/bagels, mashed potatoes, grilled cheese,
macaroni and cheese, pancakes, spaghetti with sauce
Sweet and salty snack Brownies, cake, cookies, sweet rolls, snack cakes, ice cream, donuts, corn chips, nachos,
foods potato chips, candy with chocolate, popsicles, fruit roll-ups
Fast fooda Hamburgers, cheeseburgers, non-diet soda, French fries, fried food not at home, fried food at
home
a
Identified only at 5-year follow-up
Dietary Patterns 997

Among Teens) (Cutler et al. 2009). Dietary pat-
terns were identified at baseline, and were identi-
fied again 5 years later in the same cohort who had
now transitioned from middle school to high
school and from high school to post-high school
(Cutler et al. 2009). The following qualitative
names were given to the dietary patterns identified
at baseline after examining the foods that contrib-
uted to each pattern: “vegetable,” “fruit,” “starchy
food,” and “sweet and salty snack food” (Cutler
et al. 2009). Factor analysis has often been used to
describe dietary patterns in a population and
examine their stability over time. In the Project
EAT cohort, when dietary patterns were identified
again 5 years later, relatively similar patterns were
found (Cutler et al. 2009). Interestingly, a new
pattern labeled “fast food” was identified in the
Project EAT cohort at the 5-year follow-up, indi-
cating a slight change in the usual diet of adoles-
cents as they age (Cutler et al. 2009). This may be
due to the independence in food choices that are
gained as adolescents grow older, coupled with
taste preferences for fast food and a limited ability
or desire to cook for themselves (Cutler et al.
2009).
Cluster analysis is similar to factor analysis,
but instead of reducing the dietary data into die-
tary patterns consisting of specific foods, the die-
tary data are used to categorize study subjects into
separate groups of individuals based upon differ-
ences in their dietary intake (Michels and Schulze
2005; Moeller et al. 2007). In cluster analysis,
individuals are placed into groups on the basis of
shared dietary intake, and each group shares a
similar dietary pattern (Togo et al. 2001). In con-
trast to factor analysis, where subjects receive a
score for each identified dietary pattern, in cluster
analysis, subjects belong to only one dietary pat-
tern group (i.e., cluster). There are no scores
involved in cluster analysis. The only output for D
each subject is the fact that he or she belongs to a
specific dietary pattern group, and does not belong
to the other dietary pattern groups identified. Fur-
ther analyses then often examine the relationship
between dietary pattern group membership and
health outcomes or other characteristics (Togo
et al. 2001). Ritchie et al. (2007) used cluster
analysis to examine how dietary patterns in ado-
lescence are related to adiposity in young adult
black and white females (Ritchie et al. 2007).
A description of the dietary patterns identified by
Ritchie et al. is given in Table 3. They found that a
“healthy” pattern, followed by 12% of the white
girls, was related to more favorable nutrient
intakes and a smaller increase in waist circumfer-
ence over time (Ritchie et al. 2007). None of the
dietary patterns identified in the black girls were
related to adiposity in young adulthood (Ritchie
et al. 2007).
Another recent study in adolescents used
cluster analysis in a group of adolescents,
but, in contrast to Ritchie et al., they created

Dietary Patterns, Table 3 Dietary patterns identified using cluster analysis in adolescent girls by Ritchie et al. (2007)
Dietary pattern n Description of dietary pattern
Black Girls
Customary 643 General intake of many food groups
Snack-type foods 276 High intake of diet drinks, coffee/tea, yogurt, crackers pretzels
Meal-type foods 269 High intake of plain breads and grains, other breakfast grains, most types of sandwiches
and protein sources
Sweets and cheese 23 High intake of sweets, flavored milk and cheese, and low intake of other food groups
White Girls
Convenience 521 High intakes of pizza, fried fish and poultry, and ramen
Sweets and snack- 380 High intake of sweetened and diet drinks, juice, candy, crackers, pretzels, nuts/popcorn
type
Fast food 118 High intake of flavored milk, burger sandwiches, fried potatoes, red meat, processed
meats/sandwiches
Healthy 141 Low intake of sweetened drinks, baked desserts, chips, red meat, burgers, pizza, and fried
potatoes
998
clusters of diet, activity, and other obesity-
related behaviors (Boone-Heinonen et al.
2008). Similar to the YHEI and the Diet-
Lifestyle Index, Boone-Heinonen et al. wanted
to take health behaviors/obesity-related behav-
iors into account along with dietary intake
(Boone-Heinonen et al. 2008). Through cluster
analysis, several obesogenic behavior patterns
were identified, many of which were related to
obesity in adolescent females (Boone-Heinonen
et al. 2008).
Although often used in adult populations, the
use of data-driven dietary pattern analysis is a
relatively new method in adolescent populations.
Until recently, most research on dietary intake in
this population has focused on single foods,
nutrients, and food groups. Only a handful of
studies have examined dietary patterns in adoles-
cent populations. The majority of these studies
have been published in the last 3 years, indicat-
ing the increased interest in this new method.
Adolescent dietary pattern studies have taken
place in multiple countries and have focused on
varied research questions, but they are unified in
their desire to examine the whole diet in this
important age group. The majority of studies in
adolescent populations have used factor analysis,
and a few have used cluster analysis. The number
of dietary patterns identified and their chosen
label vary, but similar to studies done with adult
populations, a version of a “healthy” pattern and
an “unhealthy” or “Western” pattern are usually
found. Many studies in adolescents have also
found a pattern characterized by snack-type
foods that is high in fat and sugar, possibly due
to the high level of snacking done by this age
population. A “traditional” pattern has also been
commonly found, specifically in countries
experiencing a nutritional transition. While the
dietary pattern approach has thus far been used in
adolescent populations to examine multiple
research questions, most research has focused
on a few major issues including stability
of dietary intake over time, associations
between dietary patterns and adiposity, and
associations between dietary patterns and
socio-demographic, socioeconomic, and/or
lifestyle factors.
Dietary Patterns
Dietary Pattern Analysis: Reduced Rank
Regression
Reduced Rank Regression (RRR) is an approach
to dietary pattern analysis that has recently
emerged as an alternative to the use of factor or
cluster analysis or the use of a diet index. RRR is
unique in that it combines the use of a data-driven
approach, similar to factor or cluster analysis, with
the use of prior knowledge, as is done when
developing a diet index (Michels and Schulze
2005). In short, RRR uses dietary data to develop
dietary patterns that predict intermediate out-
comes of a specific disease, and these intermediate
outcomes are chosen using prior knowledge of
risk factors for that disease (Michels and Schulze
2005). Ultimately, the relationship between the
identified dietary patterns and the disease of inter-
est are examined (Michels and Schulze 2005). For
example, McNaughton et al. recently used RRR to
identify a dietary pattern that was associated with
insulin resistance in a cohort of men and women
(35–55 years of age) (McNaughton et al. 2008).
Insulin resistance was chosen as the intermediate
outcome because of prior knowledge indicating
that insulin resistance is closely associated with
the development of type 2 diabetes (McNaughton
et al. 2008). The identified dietary pattern was
characterized by high consumption of low-calo-
rie/diet soft drinks, onions, sugar sweetened bev-
erages, burgers and sausages, potato chips and
other snacks, and white bread, and a low con-
sumption of medium to high-fiber breakfast
cereals, jam, French dressing/vinaigrette, and
wholegrain bread (McNaughton et al. 2008).
McNaughton et al. then examined whether the
identified dietary pattern was prospectively asso-
ciated with type 2 diabetes, and found that the
pattern was significantly associated with risk of
type 2 diabetes (McNaughton et al. 2008). Other
outcomes examined using RRR have included
obesity, cardiovascular disease, and all-cause
mortality (McNaughton et al. 2008). Very few
studies have used the RRR approach in adult
studies (Michels and Schulze 2005), and to date,
this approach has not been used in adolescent
populations. Results from studies using this
approach in adult populations have been
Dietary Patterns
promising, and thus, future research using this
method in adolescent populations is warranted
(Michels and Schulze 2005).
Controversies/Limitations
The use of theoretically defined dietary patterns
such as diet indexes have raised some concerns.
Since they are defined a priori they must be based
on subjective evaluation of the existing literature
on the relationships among many aspects of diet
and multiple health outcomes (Michels and
Schulze 2005). And with many different individ-
uals and groups devising what they view as an
ideal diet, there can be many different definitions
of a healthful eating pattern (Michels and Schulze
2005). Furthermore, although it is possible to
devise an index that describes an idealized dietary
pattern, this does not mean that any significant
number of people actually follow this pattern, or
that there is any evidence that following this pat-
tern per se results in any real health benefits.
Caution is needed in interpreting a single sum-
mary score. If various components of an index are
not related to each other, then they do not collec-
tively represent a single underlying construct
(Moeller et al. 2007). Also, a summary score is
only instructive when it is very high or very low
(Moeller et al. 2007). Subtleties in midrange can
be lost, which is important since most do not have
a very good or very poor diet (Moeller et al. 2007).
Finally, studies in adolescents are extremely lim-
ited, making it difficult to assess the usefulness of
this method in this population.
Data-driven methods such as factor or cluster
analysis also have several limitations, including
the fact that dietary patterns derived in one popu-
lation may not be reproducible in another popula-
tion due to differences in dietary habits/traditions,
or due to differences in decisions made in the
analytic process (Moeller et al. 2007). Throughout
the process of dietary pattern analysis there are
subjective decisions made on the dietary intake
variables to include, energy adjustment, number
of patterns derived, number of patterns reported,
and the number analyzed (Moeller et al. 2007).
Even the naming process involves subjectivity.
999
Although patterns will never be exactly the same
across studies and populations, both factor and
cluster analysis show reasonable reproducibility
of several major patterns in adult studies (Moeller
et al. 2007). The same has been true in adolescents
studies thus far, with the majority identifying sim-
ilar dietary patterns even though they have taken
place in various countries.
A further caution in using factor analysis is that D
investigators must remember that an individual’s
overall dieting pattern is a combination of all the
identified patterns. That is to say, in a population in
which a few major dietary patterns have been iden-
tified, an individual study subject can score high
(or low) on all of them, none of them, or a combi-
nation of some but not others. Finally, the ultimate
goal is often to examine the relationship between
dietary patterns and health outcomes, but factor and
cluster analysis are not designed to derive dietary
patterns that are predictive of these outcomes
(Moeller et al. 2007). The dietary pattern that is
most predictive of a specific disease or health out-
come cannot be easily answered with these
methods alone (Michels and Schulze 2005). For
this reason the use of alternative methods such as
reduced rank regression (RRR) has been proposed
(Moeller et al. 2007). None of the approaches
currently used to examine the diet-disease relation-
ship are perfect, and the use of multiple methods
will likely provide the most insight.
Future Directions
Although research is limited, dietary pattern anal-
ysis has proven to be a useful approach to sum-
marize dietary intake in adolescent populations, to
relate that intake to health or other outcomes, and
to examine what influences dietary intake. There
are limited data on reproducibility and validity of
dietary pattern analysis methods in adolescent and
adult populations, and future research should pay
more attention to these and other methodological
issues (Moeller et al. 2007). In addition, most
studies have been cross-sectional, and more lon-
gitudinal studies are needed. Important questions
for future research using dietary pattern analysis
in adolescent populations include the following:
1000
• What dietary patterns are shown by different
adolescent populations?
• Are these patterns stable as adolescents transition
into young adulthood and then into adulthood?
• Do the identified patterns relate to health out-
comes (e.g., overweight/obesity, type 2 diabe-
tes, etc.)?
• Which patterns are most predictive of these
health outcomes?
• What factors influence adherence to healthy or
unhealthy dietary patterns?
• How do other factors (lifestyle, behavioral,
environmental) interact with dietary patterns?
• Can dietary patterns do a better job at pre-
dicting weight status in adolescents than ana-
lyses using single foods/nutrients?
• How can these findings be used to better plan
and target interventions focused on improving
dietary intake and decreasing overweight/obe-
sity in youth?
Finally, future research using dietary pattern
analysis in adolescent populations should not be
limited to using the same methods and asking the
same questions only with different data sets, as
this will restrict the field of dietary pattern
research (Moeller et al. 2007). Investigators need
to continue to ask new questions, and to be inquis-
itive enough to try new methods when current
ones do not provide the answers.
Summary
The use of dietary pattern analysis methods to
explain dietary intake and relate that intake to
health outcomes has greatly increased in adult
populations over the last few decades. Results
from the handful of studies using dietary pattern
analysis in adolescent populations have given
support to the usefulness of this approach in this
age group as a complement to the traditional
methods of examining single foods and nutrients
in nutritional epidemiology. Adolescence is a cru-
cial time period, and we need more information on
adolescent’s overall dietary intake, how this
intake changes over time, how diet is associated
with health outcomes such as obesity and type
2 diabetes, and what influences their dietary
Dietary Patterns
intake. Dietary pattern analysis can provide valu-
able new insights into these relationships.
Although not free of limitations, dietary pattern
analysis provides an opportunity to examine ado-
lescent dietary intake in new ways. Ultimately, the
goal should be to use results from studies using
dietary pattern analysis to inform interventions
and guidelines focused on improving the health
of our youth. For this reason, much attention must
be paid to quality of the methods used and to the
thoughtful interpretation of the results.
Cross-References
▶ Obesity and Overweight
References
Boone-Heinonen, J., Gordon-Larsen, P., & Adair, L. S.
(2008). Obesogenic clusters: Multidimensional adoles-
cent obesity-related behaviors in the U.S. Annals of
Behavioral Medicine: A Publication of the Society of
Behavioral Medicine, 36(3), 217–230.
Cutler, G. J., Flood, A., Hannan, P., & Neumark-Sztainer,
D. (2009). Major patterns of dietary intake in adoles-
cents and their stability over time. The Journal of
Nutrition, 139(2), 323–328.
Guenther, P. M., Reedy, J., & Krebs-Smith, S. M. (2008).
Development of the Healthy Eating Index-2005. Jour-
nal of the American Dietetic Association, 108(11),
1896–1901.
Hurley, K. M., Oberlander, S. E., Merry, B. C., Wrobleski,
M. M., Klassen, A. C., & Black, M. M. (2009). The
Healthy Eating Index and Youth Healthy Eating Index
are unique, non-redundant measures of diet quality
among low-income, African American adolescents.
The Journal of Nutrition, 139(2), 359–364.
Kosti, R. I., Panagiotakos, D. B., Mariolis, A., Zampelas,
A., Athanasopoulos, P., & Tountas, Y. (2009). The
Diet-Lifestyle Index evaluating the quality of eating
and lifestyle behaviours in relation to the prevalence
of overweight/obesity in adolescents. International
Journal of Food Sciences and Nutrition, 60(Suppl 3),
34–47.
McNaughton, S. A., Mishra, G. D., & Brunner, E. J.
(2008). Dietary patterns, insulin resistance, and inci-
dence of type 2 diabetes in the Whitehall II study.
Diabetes Care, 31(7), 1343–1348.
Michels, K. B., & Schulze, M. B. (2005). Can dietary
patterns help us detect diet-disease associations? Nutri-
tion Research Reviews, 18(2), 241–248.
Moeller, S. M., Reedy, J., Millen, A. E., Dixon, L. B.,
Newby, P. K., Tucker, K. L., et al. (2007). Dietary
patterns: Challenges and opportunities in dietary
Digital Divides
patterns research an experimental biology workshop,
April 1, 2006. Journal of the American Dietetic Asso-
ciation, 107(7), 1233–1239.
Ritchie, L. D., Spector, P., Stevens, M. J., Schmidt, M. M.,
Schreiber, G. B., Striegel-Moore, R. H., et al. (2007).
Dietary patterns in adolescence are related to adiposity
in young adulthood in black and white females. The
Journal of Nutrition, 137(2), 399–406.
Togo, P., Osler, M., Sorensen, T. I., & Heitmann, B. L.
(2001). Food intake patterns and body mass index in
observational studies. International Journal of Obesity
and Related Metabolic Disorders: Journal of the Inter-
national Association for the Study of Obesity, 25(12),
1741–1751.
Digital Divides
Linda A. Jackson
Michigan State University, East Lansing,
MI, USA
This essay examines the nature of the digital
divides, which are known as the divides between
individuals and groups who have access to infor-
mation technology (IT) and can use it effectively
and those who lack access and/or lack the critical
skills needed to use information technology effec-
tively. To do so, this essay has six objectives.
First, it provides evidence that there is a digital
divides in Internet access in the USA that is based
on race, income, and education; second, that there
are digital divides in the USA in the intensity and
nature of Internet use that is based not only on
race, income, and education, but also on gender;
and third, that the intensity and nature of the
Internet “use” divides have consequences as far
reaching as the initial Internet “access” divides.
The existence of digital divides, broadly defined
to include access, intensity, and nature of Internet
use indicate that vital information about health,
government, jobs, education, and commerce, all
of which are migrating relentlessly to the Internet,
will become increasingly less available to those
who need this information the most – members of
underserved groups. The fourth objective is to
demonstrate that efforts to reduce the digital
divides in the USA and elsewhere through public
1001
access are unlikely to result in digital equality.
Rather, direct interventions from both the public
and private sectors are needed to reduce and ulti-
mately eliminate the digital divides. This is a
critical point that will be returned to later in this
discussion.
The last two objectives relate directly to youth.
The fifth objective is to demonstrate that the digital
divides is almost as pervasive among youth in the D
USA as they are among adults. The so called “Net
Generation” is not the entire generation but rather
an exclusive subset of it. (The Net Generation
consists of individuals who have grown up with
computer technology and the Internet as a com-
monplace. The distinguishing mark of this genera-
tion is that its members spent their formative years
during the rise of the World Wide Web; they usu-
ally have no memory of [or nostalgia for] pre-
Internet history; and most were born after 1993.)
The youth digital divides have more negative
implications than the adult digital divides, widen-
ing the gap between the “haves” and “have-nots”
on a variety of dimensions, including academic
performance, career choices, and social and politi-
cal integration into mainstream society. The sixth
and final objective of this essay is to demonstrate
that digital equality has the potential to “level the
playing field” by providing underserved youth and
adults with the same opportunities for cognitive,
social, and psychological development as their
more affluent peers. In today’s world, being
“connected” is essential for achieving the educa-
tional and occupational outcomes needed for suc-
cess in the twenty-first century. Research from the
authors’ HomeNetToo Project is used to describe
the changing nature of the digital divides in the
USA, the potential benefits of IT use to the aca-
demic performance of underserved youth, and gen-
der differences in select dimensions of academic
performance and information technology (IT) use
among children in the USA and China. By IT we
mean the use of electronic computers and computer
software to convert, store, protect, process, trans-
mit, and securely retrieve information as well as,
more broadly, the ability to use effectively such
devices as cell phones and videogames. The dis-
cussion leads ultimately to policy recommenda-
tions aimed at reducing the digital divides to
1002
achieve social, economic, and political parity for all
subgroups in the USA.
Since the Internet first entered the public con-
sciousness (circa 1995) there have been countless
discussions about the digital divides, including
debates about the extent of their existence and
likely that their persistence (Drori 2005; van
Dijk 2005; Jackson 2008; Pew Internet and Amer-
ican Life Project 2000a, 2002a, 2003a, 2005a,
2006a, b); NTIA (1999, 2000). Initially, the term
“digital divides” was used to refer to the gap
between those who had access to digital technol-
ogies, especially the Internet, and those who did
not (NTIA 1999, 2000). More recently, the term
has been used to refer to the gap between those
who have regular, “effective” access to digital
technologies and those who do not. Thus, discus-
sions have shifted away from physical access and
toward the digital skills and literacy needed for
success in the twenty-first century global work-
force (Digital Inclusion Panel 2005; Drori 2005;
Livingstone 2003; Van Dijk 2005).
Are there a digital divides? As the discussion to
follow demonstrates, the answer to this question
depends on how are digital divides defined (Chen
and Wellman 2003; Drori 2005; Driori et al. 2006;
Livingstone 2003; Pew Internet and American
Life Project 2000a, 2002a, 2003a, 2005a, 2006a,
b; Van Dijk 2005). If the multidimensional nature
of the digital divides is acknowledged, then solu-
tions will require a multiple levels approach.
Access to the Internet, especially limited access
in public places (e.g., schools, libraries), will not
be enough to achieve Internet equity. A multiple
levels approach would include training activities
designed to achieve Internet skills and technology
literacy while emphasizing the crucial role that
technology plays not only in the twenty-first cen-
tury global workforce but also in everyday life, as
computers become more and more integrated into
the tools of daily life (e.g., cars, TVs).
The First Digital Divide: Access to
Information Technology (IT)
For over a decade, national survey research
conducted by the Pew, NTIA and independent
Digital Divides
researchers has documented the existence and
persistence of a racial digital divide with respect
to physical access to the Internet (e.g., Hoffman
et al. 2001; Pew 2000a, 2003a, 2005a, 2006a, b;
NTIA 1999, 2000). In most of this research,
“access” is defined as whether or not the respon-
dent has gone online within a designated period of
time (e.g., the last 6 months). In 2000, 50% of
Caucasian Americans had Internet access, com-
pared to 36% of African-Americans (Pew 2000a).
Six years later, this racial digital divide in Internet
access persisted. In 2006, 73% of Caucasian
Americans compared to 61% of African-
Americans had Internet access. The racial digital
access divide is most pronounced among the
lower and higher income groups. About 25% of
African-Americans compared to 32% of Cauca-
sian Americans with incomes below $20,000 (net
annual household) had access to the Internet; 65%
of African Americans compared to 82% of
Caucasian Americans with incomes greater than
$50,000 had access. At incomes between $20,000
and $49,999, similar percentages of African-
Americans (55%) and Caucasian Americans
(57%) had Internet access. African-Americans
have consistently lagged about 10 percentage
points behind Caucasian Americans in physical
access to the Internet (Pew 2006a).
Since the landmark reports by the NTIA, titled
“Falling thru the net: Defining the digital divides”
(1999) and “Digital Inclusion” (2000), evidence
of an income-based digital divide in access to the
Internet has been unequivocal. Quite simply, as
income increases so too does the likelihood of
having Internet access. Data obtained by the Pew
Internet and American Life Project indicated that
44%, 69%, 81%, and 89% of Americans earning
less than $30,000, $30,000 to $49,999, $50,000 to
$74,999, and greater than $75,000, respectively,
had access to the Internet (Pew 2006a).
Overall, the survey research just discussed sug-
gests the following conclusions: (1) A racial digital
divide exists with respect to Internet access that
cannot be explained by income or education. Cau-
casian Americans are more likely to have access to
the Internet than are African-Americans, a differ-
ence that has existed and persisted since the earliest
days of the Internet; (2) The racial digital divide
Digital Divides
cannot be explained for by race differences in
income or education. Even within similar levels of
these characteristics African-Americans are less
likely than Caucasian Americans to have access to
the Internet (Hoffman et al. 2001); (3) Given access
to the Internet, African-Americans use the Internet
less intensely and for different purposes than do
Caucasian Americans (Jackson et al. 2004; Pew
2000a, 2003b, 2005a, 2006a, b, c).
Since the early days of the Internet (circa 1995)
efforts have been made in the USA and elsewhere
to eliminate the digital divide based on access to
the Internet. To some extent, these efforts have
been successful (e.g., Pew 2003a, 2006a; NTIA
2000). Physical access to the Internet has become
more commonplace for African-Americans and
low-income Americans of all races/ethnicities in
part because the cost of technology (e.g., com-
puters) has decreased and in part because public
access has increased (e.g., access in schools,
libraries, and other public spaces). However,
new digital divides are developing just as the
access divides decline. Solutions to these new
digital divide in the USA will require more than
equity in physical access to technology.
The Second Digital Divide: Broadband
Versus Dial-Up Access
Recent evidence indicates that a second digital
divide is developing based on broadband access
(i.e., high speed, high bandwidth access) to the
Internet at home (Pew 2002a, 2005a, 2006d). In
2000, less than 5% of home Internet users had
broadband access (Pew 2006a, b, d). In March
2006, 42% had broadband access. The new broad-
band access divide is based primarily on income
(Pew 2006d). Here too, as income increases so
does the likelihood of having broadband Internet
access at home. In October 2005, Internet users
living in the highest-income households ($75,000
and up) were not only the most likely to have
Internet access (93%), but were also the most
likely to have broadband access (71%). African-
Americans are less likely to have broadband
access at home, again lagging behind by about
10 percentage points compared to Caucasian
1003
Americans in the same income bracket. However,
on an encouraging note, the rate of increase in
broadband access between 2003 and 2006 was
much higher for African-Americans (and the mid-
dle class) than for Caucasian Americans (and the
upper and lower classes; Pew 2006d).
Researchers, educators, and policy makers are
concerned that the new digital divide based on
broadband access will have implications as far D
reaching as the original physical access divide
(Children’s Partnership Foundation 2007; Drori
2005; van Dijk 2005). They argue that broadband
access changes the users’ relationship with the
Internet entirely, including how often they go
online, how long they stay online, and what they
do online. Whereas dial-up access is disruptive,
broadband access is seamless, a distinction that
may result in deepening social and economic
divides (Livingstone 2003; van Dijk 2005).
Because these disparities are based primarily on
income, their overall effect is likely to be that “the
rich get richer and the poor get poorer” as existing
disparities in digital skills and literacy are exacer-
bated with the addition of the broadband divide
(Norris 2001). Research has already demonstrated
that broadband users spend more time online,
engage in more activities (7/day for broadband
users versus 3/day for dial-up users), and engage
in a greater variety of activities than do dial-up
users (Pew 2006d). Broadband users are more
likely to turn to the Internet first when they have
a health question (versus calling a health profes-
sional). Broadband users are more confident about
their Internet search abilities. They use the Inter-
net to save time and money, and to get the best
information available for themselves and their
families. Broadband users are more likely than
dial-up users to create content online (e.g., blogs
or web pages) and to share online self-created
content (e.g., stories, artwork, or videos; Chil-
dren’s Partnership Foundation 2007; Pew 2006d).
The Third Digital Divide: Intensity and
Nature of Internet Use
As physical access to the Internet in the USA
becomes commonplace, whether connection is
1004
by broadband or dial up, attention has shifted to a
“third digital divide” pertaining to the intensity
and nature of Internet use. It is quite obvious,
especially to educators, that some uses of the
Internet contribute more to cognitive, social and
psychological development, and technology skills
and literacy than do other uses (Annenberg Digital
Future Project 2004, 2006; Jackson et al. 2004,
2006a, b; Driori et al. 2006; Livingstone 2003).
Research thus far suggests that individuals are
more likely to use the Internet in intense and
“engaging” ways when they have broadband
access at home. But beyond this finding are deeper
issues about the nature of Internet use, particularly
with regard to what kinds of uses contribute to
technology skills and literacy, and who is likely to
use the Internet in these ways.
For example, since the primary vehicle for
delivering the Internet is the computer, there is
concern that people lacking computer skills and
confidence will use the Internet less intensely and
in less engaging ways than those with more com-
puter skills and confidence. Because the primary
reason for going online is to communicate with
others, there is concern that people who lack com-
munication partners online will use the Internet
less intensely and in less engaging ways than
those who use it to connect with family and
friends. Technology skills and use are strongly
influenced by peer group support. Therefore,
there is concern that people lacking peer group
support for technology use will use the Internet
less intensely and in less engaging ways than do
those who have peer support. Thus, having access
to the Internet, even home access, and even broad-
band access, does not guarantee that the user will
develop the technology skills and literacy needed
to participate in the twenty-first century – eco-
nomically, politically, and socially.
A racial digital divide is evident in the intensity
of Internet use when access is no longer an issue.
In a 2000 survey by Pew (2000a) a greater pro-
portion of Caucasian Americans than African-
Americans who had access to the Internet went
online on a typical day (56% versus 36%), or sent
or received e-mail (49% versus 27%). Moreover,
growth in the online African-American popula-
tion has been driven primarily by females,
Digital Divides
resulting in a gender gap in Internet use among
African-Americans that no longer exists among
Caucasian Americans. The HomeNetToo project
also found that African-Americans used the Inter-
net less often than did their Caucasian American
peers.
Not only the intensity but also the nature of
Internet use differs for African-Americans and
Caucasian Americans who have Internet access.
In a Pew (2000b) online survey, African-
Americans were proportionally more likely than
online Caucasian Americans to search for infor-
mation about major life issues, such as finding a
job or a place to live. African-Americans were
more likely than Caucasian Americans to seek
entertainment online through music, video, and
audio clips. They were also more likely to search
for religious or spiritual information than were
online Caucasian Americans (Pew 2006a, b, c, d;
Jackson et al. 2001a).
Race differences in the intensity and nature of
Internet use, when access is not an issue, are as
pronounced in later surveys as they were in the
2000 Pew Survey. In 2006, compared to other
racial/ethnic groups, online African-Americans
used the Internet less frequently (Pew 2000a).
They were less likely than online Caucasian
Americans to use the Internet to connect to family
and friends or to engage in other social network-
ing activities (e.g., chat; Pew 2007). They were
less likely than online Caucasian Americans to
contribute content to the Internet (web pages,
blogs; Livingstone 2003; Pew 2005b, c). More-
over, these race differences in the intensity and
nature of Internet use held across all income and
age levels (see also Hoffman et al. 2001).
The HomeNetToo Project, funded by the
National Science Foundation (http://www.msu.
edu/user/jackso67/homenettoo/), recorded the
Internet activity of 90 families, 117 adults, and
143 children, who resided in a medium-size urban
community in the Midwestern United States. Inter-
net activity was automatically and continuously
recorded between January 2001 and June 2002
(Jackson et al. 2004; Jackson et al. 2006a, b).
Most of the children in the project were African-
American (83%), male (58%), and living in single-
parent households (75%) where the median annual
Digital Divides
income was $15,000 (USD). Most of the adults
were African-American (67%) and female (80%).
The majority reported having some college educa-
tion or earning a college degree (62%), making the
sample better educated than the typical low-income
sample (e.g., Annenberg Digital Future Project
2004; Pew 2000a). Average age was 38 years old
for adult participants and 13 years old for child
participants.
Analyses focused on four measures of Internet
use: time online (minutes per day), number of
sessions (logins per day), number of domains
visited (per day), and number of e-mails sent
(per day). Findings indicated that African-
American adults initially used the Internet less
than did Caucasian American adults, in terms of
both number of sessions and number of domains
visited. Race differences in adults’ Internet use
became more pronounced as the project pro-
gressed. African-Americans spent less and less
time online, participated in fewer Internet ses-
sions, and visited fewer domains than did Cauca-
sian Americans (Jackson et al. 2004). However,
there was no race difference in e-mail use,
which was relatively infrequent throughout the
16-month project. Two explanations were offered
for the low level of e-mail use. First, the study was
conducted in 2001, a time when home Internet
access was less common than it is today, particu-
larly among low-income families. Second, and
relatedly, low-income families were unlikely
to have family and friends to communicate with
online. Moreover, few had jobs that required
e-mail communication from home. Additional
evidence obtained in ethnographic interviews of
a sample of adult participants indicated that com-
municating with strangers online was viewed as
inappropriate, unnecessary, and potentially dan-
gerous, a view that was held more tenaciously by
African-American than Caucasian American
adults.
Other findings from the HomeNetToo adults
indicated that older participants (age 38 and
above) engaged in fewer Internet sessions and
visited fewer domains than did younger partici-
pants. These differences became more pro-
nounced as the project progressed. On the other
hand, there were no gender or income differences
1005
in Internet use among adult participants. How-
ever, there was some evidence that education
influenced adult Internet use later in the project.
Adults with more education were using the Inter-
net more after 1 year of home Internet access than
were adults who had less education (Jackson
et al. 2004).
Gender differences in access to the Internet
worldwide and in the nature and intensity of Inter- D
net use in the USA have been well documented
since the Internet first entered the public con-
sciousness (circa 1995; Jackson et al. 2001b). In
the USA, males and females are equally likely to
access the Internet (Pew 2005a), but a gender gap
persists worldwide, with men more likely to have
Internet access than women (Bradbrook and
Fisher 2004; Chen and Wellman 2003; Norris
2001; van Dijk 2005). Even within the USA,
gender gaps exist with respect to the nature and
intensity of Internet use (Pew 2003b, 2005a,
2006a, b, c, d; Van Dijk 2005). Men are also
more likely than are women to use the Internet
for commercial transactions and know more about
Internet technology than do women. Women are
more likely than men to use the Internet to com-
municate with friends and family (Boneva et al.
2006; Jackson et al. 2001b; Pew 2006a, b, c, d).
The Digital Divides in the “Net”
Generation
Are there a digital divides in Internet access,
intensity, or nature of use among today’s “Net
Generation” (Tapscott 1998)? The answer to this
question again depends on how you define the
digital divide (Pew 2003a; Drori 2005; Jackson
et al. 2001a; Hoffman et al. 2001; Van Dijk 2005).
In the USA, access to the Internet from school is
nearly universal, with about 99% of schools hav-
ing Internet access (Children’s Partnership
2005a). Thus, if the digital divides is defined in
terms of having access to the Internet from any-
where, then there are no divides among the Net
Generation in the USA. However, there is a digital
divide among youth worldwide (e.g., Norris
2001), especially with respect to home Internet
access, how homes are connected to the Internet
1006
(broadband or dial-up), and how the Internet is
used once access is obtained (Boneva et al. 2006;
Jackson 2008; Pew 2007, 2005a, 2006a, b).
Among the 88% of youth who report using the
Internet in the USA, home access is higher for
those whose parents have more education and
income, for Caucasian American, Hispanic Amer-
ican, and Asian American children than for
African-American children, and for urban and
suburban children than for rural children,
although the latter gap is quickly narrowing. As
was the case for adults, a digital divide exists
between youth who have broadband access at
home and youth who have dial-up access. The
broadband divide are based primarily on parental
income and, to a lesser extent, race (Pew 2002b,
2006d).
Researchers of the Net Generation have
suggested that there is also a growing digital
divide between youth who use the Internet as a
rich, diverse, engaging, and stimulating resource
and those who use it as a narrow, unengaging, if
occasionally useful resource (Jackson 2008;
Livingstone 2003). Like the access and broadband
divides, these Net Generation’s digital use divide
are structured primarily along racial/ethnic and
socioeconomic background (Pew 2001, 2002a,
2003b; Driori et al. 2006; Van Dijk 2005). The
percentages of youth on each side of these new
divides are difficult to estimate. But it is clear from
the following statistics that large numbers of
youth are not using the Internet in intense and
engaging ways, but rather are using it as routine
and mundane extensions of offline activities.
According to a report by the Pew, titled “Teens
and the Internet” (Pew 2006e), only a minority of
teens are using the Internet in ways that may be
described as engaging or stimulating. For exam-
ple, only 19% of online youth say they have
created a web page or blog, although a larger
percentage, 32%, have created or worked on a
web page for school, a friend, or an organization.
Only 33% of online youth have shared original
content on the Internet, such as artwork, photos,
stories, or videos. Only 19% have remixed content
they found online to make something new. Race
and parental income appear to distinguish
between youth who use the Internet in engaging
Digital Divides
ways from those who use it in more mundane
ways. These differences in Internet use may have
implications for participation in the twenty-first
century knowledge economy, implications as pro-
found as the initial Internet access divide of the
twentieth century.
Findings from the HomeNetToo project indi-
cated that African-American children and youn-
ger children used the Internet less than did
Caucasian American children and older children,
respectively, even though all groups had equal
access to the Internet at home (Jackson et al.
2006a). African-American children spent less
time online, participated in fewer Internet ses-
sions, visited fewer domains, and sent fewer
e-mails than did Caucasian American children.
However, race differences in Internet use
decreased as the project progressed. E-mail activ-
ity was low and varied considerably over the
16-month trial, as it did for adults, probably
because these low-income families had few com-
munication partners online.
In the NSF-funded research, the Children and
Technology Project (http://www.msu.edu/user/
jackso67/CT/children/) evidence indicated a
“new” racial digital divide in IT use among
12-year-old children (Jackson et al. 2010a, b).
The sample consisted of 515 children,
172 African-Americans, and 343 Caucasian
Americans, whose average age was 12 years. Par-
ents also participated in the project. All partici-
pants completed mailed surveys requesting a wide
variety of information, including information
about the frequency of their computer and Internet
use, the frequency with which they used the Inter-
net for communication purposes (e-mail and
instant messaging), how often they played video
games, and how often they used cell phones.
African-American boys were the least intense
users of computers and the Internet and African-
American girls were the most intense users. Boys,
regardless of race, played video games far more
than did girls, whereas girls, but especially
African-American girls, used cell phones more
than did boys of either race.
An extension of the Children and Technology
Project compared the IT use of the sample of USA
children to their same-age peers in China (Jackson
Digital Divides
et al. 2010a, b). This study focused on three basic
questions. First, are there differences between Chi-
nese and USA children in their computer and Inter-
net use? Second, are there differences between
Chinese and USA children in their use of other
technologies, namely, video games and cell
phones? Third, does gender moderate the influence
of culture – Chinese or USA, on the use of com-
puters, the Internet, and other technologies?
Based on samples of 600 Chinese and
600 USA children, the study found cultural and
gender differences in technology use as well as
interactions between culture and gender. USA
children used computers and the Internet more
intensely than did Chinese children, with Chinese
females being the least intense users. Males
played video games more intensely than did
females, with USA males playing more intensely
than did Chinese males. USA females lead all
other groups in cell phone use whereas Chinese
females were the least likely to use cell phones.
The Truly Disconnected
In 2005, 22% of USA adults said they never used
the Internet or e-mail and that they do not live in
Internet-connected households (Pew 2005b).
Interestingly, the percentage of the USA adult
population in this category, labeled the “Truly
Disconnected,” has remained unchanged since
2002, despite a 10-point increase in the percent-
age of all adults who go online. In addition to race
and income, age and education are strong predic-
tors of being truly disconnected. Members of the
truly disconnected group are overwhelmingly
above the age of 70, and have less than a high
school education. In both 2002 and 2005, the truly
disconnected said the primary reason they do not
go online is because they do not want or need the
Internet (Pew 2002a, 2005b). Other reasons
included cost, lack of support for use, and being
too busy to learn and use the new technology.
In the USA, 13% of adolescents do not use the
Internet at all (Pew 2006b). About half (47%) of
these nonusers had been online but dropped off for
a variety of reasons, including bad experiences,
parental restrictions, or not feeling safe online.
1007
Adolescents who never used the Internet say that
lack of interest, time, and access were the major
reasons for not using it.
Implications of the Digital Divides:
Adults
Most discussions of the implications of the digital D
divides have focused on adults. The assumption,
often implicit, is that there are no digital divides
among the NetGeneration or, if there are, they are
small and will disappear as technology diffusion
continues (Pew 2006c; Drori 2005; Van Dijk
2005). In contrast, this discussion acknowledges
the existence of digital divides among both youth
and adults and addresses the implications of these
divides for both age groups.
What are the implications of the digital divides
in Internet access and use among adults in the
USA today? Five broad implications have been
identified (Harris 2003).
First, the digital divides have implications for
social equality, primarily through access to infor-
mation. The argument here is that those who lack
access to the Internet are disadvantaged because
they lack access to information needed to main-
tain and enhance the quality of their lives. For
example, research indicates that adults use the
Internet to find information about health, jobs,
and housing. In a March 2005 survey, 12% of
online adults (17 million people) said the Internet
played a crucial or important role in their ability to
help another person cope with a major illness.
Another 7 million said it played a crucial or
important role in helping them to cope with their
own major illness (Pew 2006c). Information about
social services unrelated to health, such as com-
munity and day care services, bus schedules, and
law enforcement services are available on the
Internet 24/7 and at little or no cost. The
Internet also provides a plethora of entertainment
resources, such as music, videos, games, sports,
and celebrity Web sites, all of which may contrib-
ute to the quality of life and, more generally, to
social equality (Pew 2006d).
Relevant to the implications of the digital
divides for social equality, as well as implications
1008
for economic equality and social mobility,
discussed next, is the near limitless capacity of
the Internet to support social networking. Internet
users can create and maintain social networks
online that are difficult to imagine offline. Those
on the “have-not” side of the divides may be
disadvantaged because they are less socially
connected than the “haves.” A March 2005 survey
indicated that being able to stay in touch with
family and friends, both within and beyond one’s
geographic community, was a major reason for
using the Internet (Pew 2006e). Moreover, much
of the evidence indicates that online social con-
nections and resources do not detract from offline
connections and resources. Instead, online social
activity supplements rather than replaces offline
social activity (Jackson 2008; Kraut et al. 2001).
For example, Internet users report that having
social support on the Internet has helped them to
get through “major life moments,” such as chang-
ing jobs, dealing with a serious illness, and finding
a new place to live.
The adult digital divides have implications for
economic equality. Educational and occupational
opportunities are migrating relentlessly to the
online world, leaving people without access at a
considerable disadvantage. For example, almost
half of young adult Internet users who chose a
college during the preceding 2 years said the
Internet played a crucial or important role
(Digital Inclusion Panel 2005; Pew 2003b,
2006b). These opportunities are available 24/7
and in the comfort of one’s home, making them
particularly attractive to parents and caregivers for
whom inflexible working hours and travel are
major barriers to continuing education and
employment. Information about housing and
products is also available 24/7 on the Internet, as
is the ability to purchase products and have them
delivered conveniently to one’s doorstep.
Related to issues of social and economic equal-
ity raised by the digital divides is the issue of
social mobility. Without access to the Internet
and the social and economic equality facilitated
by it, adults on the “have-not” side of the divides
are likely to remain on that side. But the implied
causal relationship between Internet access and
social mobility may be a bit overstated. In light
Digital Divides
of the confounding “offline” factors that also limit
social mobility and economic progress it may be
more helpful to posit a relationship mediated by
both online and offline factors, rather than a causal
link. Movement out of lower socioeconomic
groups will become increasingly difficult for the
disconnected as social and economic opportuni-
ties move to the online world. Thus, failure to
close the digital divides may exacerbate existing
social class differences, resulting in the rich get-
ting richer and the poor getting poorer (Drori
2005).
The digital divides have even broader implica-
tions for sustaining democracy. The participation
of all citizens is fundamental to a democratic
society. Access to information about government,
political issues and politicians, and national and
local issues is essential to having an informed
citizenry motivated to participate in its own gov-
ernance. Participation in the political system
already has a substantial online component.
There exists today a plethora of Web sites, blogs,
and chat rooms devoted to government, politics,
and political candidates, and issues of conse-
quence for sustaining a democratic society and
an involved citizenry. Although voting has yet to
move to the online world, largely for reasons of
security, efforts are underway to make online vot-
ing an option in the not-so-distant future.
A fifth reason to close the adult digital divides
is that the economic growth and competitiveness
of society may well depend on closing it. The
development of an information infrastructure and
its active use by all citizens is inextricably linked
to economic growth and competitiveness.
Advances in digital technologies are associated
with increased productivity in most if not all sec-
tors of today’s economy, as is the development of
new “cutting-edge” technologies. Thus, eliminat-
ing the digital divides makes good economic
sense.
Another way to view the implications of the
digital divides for adults is to consider how adults
on the “have” side of the divides use the Internet.
Findings from the Pew Internet and American
Life Project with respect to adults Internet use
are summarized in Table 1. As can be seen in the
table, the primary reasons adults go online are for
Digital Divides 1009

Digital Divides, Table 1 Adult Internet activities It is by now clear that eliminating digital
Activity Percent divides will require more than just increasing
E-mail 90 access to the Internet, although increasing access
Instant messaging 46 is a necessary first step. In a recent discussion of
Chat 26 the digital divides in the UK, the Digital Inclusion
Information: specific question 83 Panel Report (2005) elaborated “5 Cs” of digital
Information: product 83 inclusion that apply equally well to the USA.
Information: health/specific 80 They are connectivity, capability, content, confi-
Information: hobby/interest 77 dence, and continuity. D
News 71 Connectivity refers to the way people access
Information: health/general 66 the Internet. Connectivity at home is generally
Browse for fun 65
considered the ultimate goal of digital inclusion
Purchase product 61
because home access has numerous benefits,
Government Web site 56
including 24/7 availability, privacy, and the ability
Information: school/training 53
to tailor the technology to personal needs. How-
Information: work-related 52
Information: sports 44
ever, community-based access also has its advan-
Information: financial 42 tages. Community-based access, as in technology
Listen to music 38 centers and libraries, can provide needed expertise
Play games 37 while focusing on community projects, needs, and
Download music 32 concerns (e.g., safety, car-pooling, day care).
Information: religious/spiritual 30 Community-based access also has the potential
Banking 30 to provide the continuity (discussed later) needed
Auction 22 to develop technology skills and literacy.
Create content 19 Capability, the second “C” of digital inclusion,
Stocks: buy and sell 12 refers to the development of technology skills and
Note: Data are from the Pew Internet and American Life literacy that improve the quality of life and
Project (2006b). Internet evolution, Internet penetration increase employability. Developing these skills
and impact. Retrieved January 6, 2008, from http://www.
pewinternet.org/pdfs/PIP_Internet_Impact.pdf
in low-income adults is particularly challenging
because many no longer have access to traditional
educational channels, nor do they have the time
and resources needed for additional job training.
communication and information. Most adults use The private and flexible nature of e-learning is
e-mail and most go online to search for informa- particularly helpful for members of this group,
tion. An overwhelming majority search for infor- provided that some minimal level of technology
mation to address a specific health issue. More skills is already present, and provided there is the
than half have purchased a product or made travel technical and social support needed for successful
reservations online. Many go online to get news. e-learning.
More than half have visited government Web The third “C” of digital inclusion is content.
sites, looked for school or training information, There is still a shortage of relevant content on the
or conducted work-related searches. Almost half Internet – content that will motivate members of
of these adults have used the Internet to get finan- disadvantaged groups to go online. A study by
cial information, and almost one third have The Children’s Partnership (2005a, b, 2007) iden-
engaged in online banking. About one third have tified some of these content-related barriers.
downloaded music files, listened to music, or Among 1,000 relevant Web sites sampled, only
played games online. Almost two thirds say they 6% had local information that users needed and
go online to browse just for the fun of it. Only one wanted. Only 1% was developed for adults with
fifth have created content online, such as a Web limited literacy. Only 1% was created in a cultur-
site or a posting to a bulletin board. ally relevant manner. Only 2% had information
1010
available in several languages. As the Web con-
tinues to develop issues of content relevance may
disappear, but not without concerted effort and a
supportive public policy. Research has shown that
the key to relevant content is that it be created by
and for the community. Thus, to the extent that
corporations, government, educators, and the
entertainment industry are the content providers
online, relevance may continue to be an issue for
members of disadvantaged groups.
The fourth “C” of digital inclusion is confi-
dence. Lack of confidence is one of the most
frequently cited barriers to adult Internet use
(39%), after “don’t want to/no need” (57%) and
“no Internet access” (44%), and ahead of cost
concerns (15%).Instilling confidence about tech-
nology use among the less-educated and low-
income groups is a challenging task that will
require a multifaceted approach. But research is
already available to guide the development of
techniques that will enhance confidence in tech-
nology use. For example, one method known to
increase learner confidence is to provide success-
ful experiences with the technology. Another is to
provide social support for learning, especially
support from family and friends.
The final “C” of digital inclusion is continuity.
Too often efforts to increase technology use in
low-income communities are one-shot interven-
tions that leave participants adrift after the inter-
vention is over. Community-based interventions,
especially those that address a pressing commu-
nity need, allow for greater continuity in both
technical and social support. Continuity increases
the likelihood that the technology skills and con-
fidence needed for social inclusion and occupa-
tional attainment and advancement will develop
and continue to flourish.
Implications of the Digital Divides:
Youth
What are the implications of the youth digital
divides in Internet access and use in the USA? An
optimistic perspective would argue that there would
be fewer implications for youth than for adults.
After all, youth can access the Internet from school,
Digital Divides
an alternative not typically available to adults. How-
ever, although 99% of USA public schools have
Internet access, it is not clear how school access
translates into individual student use. In many
schools, Internet access is available in only one
location, typically the library or media center. The
number of computers in these locations is limited,
and sometimes extremely so, with ten or fewer
connected computers to serve hundreds of students.
Hours of computer availability are also limited, as
are hours of student availability for technology use.
The types of activities that students are permitted to
engage in at school are also limited.
The implications of the youth digital divides
become abundantly clear when one considers
what youth do when they go online. Table 2 lists
specific Internet activities by youth. The over-
whelming majority of youth use e-mail and instant
messaging, visit entertainment Web sites, play
games, and get news. More than half of the online
youth visit social networking Web sites, down-
load music or video files, and search for informa-
tion about college or politics. Fewer youth make
purchases online. About one third search for infor-
mation about health, dieting and physical fitness,
jobs or religious/spiritual information. About one
Digital Divides, Table 2 Youth Internet activities
Activity Percent
E-mail 89
Entertainment sites 84
Play games 81
News 76
Instant messaging 75
Download music 51
Information: college/education 57
Social networking Web sites 55
Information: politics 55
Purchase product 43
Download videos 31
Information: health/diet/fitness 31
Information: jobs 30
Information: religious/spiritual 26
Information: health-related (sex, drugs) 22
Note: Data are from the Pew Internet and American Family
Life Project (2005d). Teens and technology: Youth are lead-
ing the transition to a fully wired and mobile nation.
Retrieved January 8, 2008, from http://www.pewinternet.
org/pdfs/PIP_Teens_Tech_July2005web.pdf
Digital Divides
fifth search for information about health topics
that are difficult for them to talk about in “real
life” (e.g., drug and sex-related health issues;
Children’s Partnership Foundation 2005a, b,
2007; Pew 2006a, b).
Youth report that they use social networking
Web sites to help manage their real-world friend-
ships: 91% say they use these sites to stay in touch
with friends they see frequently in real life; 82% use
them to stay in touch with friends they rarely see in
person. Almost three fourths (72%) use social net-
working Web sites to make plans with friends.
Almost half (49%) use them to make new friends,
typically peers they are already acquainted with in
real life. They view online communication and
friendships as supplements to, rather than substitutes
for real-life social communication and friendships
(Bargh and McKenna 2004; Boneva et al. 2006;
Gross 2004; Pew 2001, 2003b; Roberts et al.
2005; Subrahmanyam et al. 2001; Wellman and
Haythornwaite 2002). Other research, discussed
next, has examined the effects of Internet use on
youth, although “effects” research is nascent and the
findings are far from conclusive (Jackson 2008).
Gender differences in youth’s Internet use have
been found, although similarities are more com-
mon than differences. Girls lead the way in using
the Internet’s communication tools, such as
e-mail, instant messaging, blogging, and visiting
social networking Web sites. Boys lead the way in
playing games, downloading files, and file shar-
ing. Both sexes use the Internet as a social
communication tool.
Consistent with findings just discussed, the
most popular Web sites for youth are social net-
working Web sites (e.g., MySpace, FaceBook)
and Web sites that support social networking
(PLyrics, Snapvine). Also consistent with the pre-
ceding discussion, other popular Web sites are
those that supplement real-life activities. Thus,
fashion magazine Web sites are popular among
adolescent girls (e.g., http://www.teenmag.com/).
Both sexes frequent the MTV Web site (http://
www.mtv.com/), teen news Web sites (e.g.,
http://www.teenspeaknews.com/), teen chat sites
(http://www.teenchat.com/), teen culture sites
(http://www.spankmag.com/), and music sites
(http://www.teenmusic.com/).
1011
The effects of Internet use on youth have been
a topic of much public concern and academic
debate, but little systematic research (Jackson
2008). On the one hand is the “utopian perspec-
tive,” which argues that the Internet provides
youth with unprecedented opportunities for
self-expression, creativity, and active learning
while simultaneously facilitating the develop-
ment of technology skills – skills that are critical D
to educational and occupational attainment and
advancement as adults. On the other hand is the
“dystopian perspective,” which argues that Inter-
net use has negative effects, particularly for
youth, because it provides inaccurate and
unreliable information and exposes users to
potentially harmful content (e.g., pornography)
and experiences (e.g., bullying). Moreover, from
the dystopian perspective, time online is time
taken away from family, friends, and other
healthy pursuits, such as reading books, doing
school work, and participating in sports and rec-
reational activities.
Research on the consequences of Internet use
for youth, though nascent, is more supportive of
the utopian perspective and the dystopian per-
spective. As discussed earlier, youth use the Inter-
net to manage their social lives rather than replace
them, and many consider the Internet indispens-
able for doing so. As is true for adults, youth’s
online social activities appear to have no negative
consequences for their offline social lives. On
the contrary, research supports the “the rich get
richer” hypothesis; youth who already have rich
social networks in real life enrich them further
with online activities.
Also supporting the utopian perspective, youth
say that the Internet is as important to their school
work as it is to their social lives. More than half
(60%) of online youth regard the Internet as the
most useful tool for finding information for
homework – more useful than books (21%), par-
ents (11%), CDs (3%), friends (2%), or TV (1%).
For the majority of families, education is the most
important reason for purchasing a home computer
and connecting to the Internet (Pew 2006a). The
home computer has become one of the indispens-
able “symbolic goods” of contemporary parent-
ing. Enthusiasm about the Internet is driven not
1012
only by its ability to deliver content but also by its
potential to provide individualized, interactive,
autonomous, and learner-centered learning oppor-
tunities, although how often this occurs is unclear
(Jackson 2008; Livingstone 2003).
In the HomeNetToo project, discussed earlier,
home Internet use by low-income youth was
found to increase academic performance (Jackson
et al. 2006b). In this longitudinal study, which
occurred between January 2001 and June 2002,
the Internet use of 140 youth (average age
13 years old) was continuously recorded for
16 months. Most of the youth were African-
American (83%), male (58%), and living in
single-parent households (75%) in which the
median annual income was $15,000 or less
(USA dollars). Findings indicated that youth
who used the Internet more subsequently had
higher scores on standardized tests of reading
achievement and higher grade point averages
6 months, 1 year, and 16 months later than did
youth who used it less.
The Children and Technology Project, also
discussed earlier, also found benefits to Internet
use for youth (average age was 12 years). Youth
who used the Internet more, either to search for
information or to communicate with others (i.e.,
instant messaging and e-mail) performed better on
a standardized test of reading skills than did youth
who used it less (Jackson et al. 2010a, b). More-
over, IT use predicted youth’s academic perfor-
mance. The longer the time the youth had been
using computers and the Internet the better was his
or her academic performance.
Any discussion of the effects of youth’s IT
use on their development would be incomplete
without some discussion of the most popular IT
activity of youth, videogame playing. Research on
the effects of videogame playing has produced
remarkably strong and consistent results.
Supporting the utopian perspective, there is strong
evidence from both correlational and experimental
research that videogame playing improves visual-
spatial skills, which relate to the ability to think
and learn through visual processes. This form of
nonverbal learning is viewed as important in learn-
ing science, technology, engineering, and mathe-
matics (known as the STEM areas; Green and
Digital Divides
Bavelier 2003, 2006, 2007). However, supporting
the dystopian perspective, there is also strong evi-
dence, including evidence from the authors’
research (Jackson et al., in press), that videogame
playing undermines academic performance (GPA)
and, that playing violent videogames increases
aggressive cognition and behavior, both immedi-
ately and in the long run (Anderson et al. 2007).
Equally unequivocal is that boys are more likely to
play videogames than are girls.
Future Trends
Research reviewed here indicates that digital
divides in Internet access and use exist for both
youth and adults and have important implications
for both groups. For adults, the digital divides have
implications for the development of the technology
skills and literacy needed to participate fully in the
twenty-first century, especially in the workforce.
Social and economic equality and social mobility
depend on the acquisition of IT skills and literacy.
Sustaining a democratic society and maintaining a
competitive economic edge require a citizenry that
is fully participating in an information-based econ-
omy. Systematic, concerted efforts are needed to
turn the “have-nots” in today’s adult population
into the “haves,” for their own sake and that of
their children and the society.
For youth, the digital divides have even more
pressing implications. Although Internet effects
research is still in its early stages, the evidence
suggests that social connectedness, academic per-
formance, and ultimately occupational attainment
and advancement may depend on youth’s partici-
pation in the digital world. Being disconnected
from new technology is fast becoming tantamount
to being disconnected from social and profes-
sional resources that may contribute to personal,
social, and professional development. The likely
link between Internet use and academic perfor-
mance for youth is an even more compelling
reason to eliminate digital divides. Those on the
“have-not” side of the divides may be at an ever
increasing disadvantage in developing the tech-
nology skills and literacy needed to participate in
the twenty-first century global economy.
Digital Divides
Understanding the digital divides and their
implications will require additional research
aimed at establishing cause–effect relationships
between technology use and a variety of positive
and negative outcomes. A more fine-tuned analy-
sis of what it means to “use” IT, such as the
Internet, will also shed light on how and when
positive or negative outcomes might be expected.
For example, using the Internet to search for
health information is likely to produce different
cognitive outcomes and academic performance
outcomes than is using the Internet to discuss
inappropriate behavior in chat rooms. The next
generation of research on technology use and its
effects must focus on specific uses, specific
effects, and on establishing a causal link between
the two.
Conclusions
Digital divides are multidimensional and are best
conceptualized as a number of divides in technol-
ogy access and use. Those on the “have” side of
the divides have 24/7 access to the Internet at
home with a broadband connection so that Inter-
net activities fit seamlessly into the activities of
everyday life. The “haves” use the Internet
intensely and for multiple purposes, such as
acquiring information about products, politics,
and purchases. Youth on the “have” side of the
digital divides use the Internet to facilitate social
connectedness and to gain information that bene-
fits their academic performance. In contrast, the
“have-nots” lack the social, academic, and profes-
sional benefits enjoyed by the “haves.”
Because the digital divides are multi-
dimensional, eliminating them will require a
multidimensional approach. From a policy per-
spective, universal broadband access is a neces-
sary first step toward eliminating digital divides.
Internet Service Providers may need government
incentives to reduce the recurring cost of broad-
band connection for low-income subscribers.
Internet content developers may need to expand
their design capabilities to appeal to a more
diverse set of users (Buckingham and Scanlon
2006). Furthermore, the technologies themselves
1013
must be introduced early in development, just as
soon as the cognitive structures needed to support
them have developed.
Cross-References
▶ Media Literacy and Health Promotion
D
Acknowledgments We wish to thank the National Science
Foundation for funding the HomeNetToo Project (NSF-ITR,
December 1, 2005–November 30, 2009) and the Children
and Technology Project (NSF-HSD, September 1,
2000–August 31, 2005).
Thanks go to the 15 graduate and 30 undergraduate
students who have assisted in data collects for these
projects.
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Disability
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
The term disability generally refers to limitations
of functions that are secondary to the disorder of a
specific system. The word can be differentiated
from the label of handicapped, which instead ref-
erences the obstacles encountered by individuals
who pursue goals as a result of their disability.
Handicap frequently represents a degree of emo-
tional, economic, social, or physical dependence
that a person can experience as the result of a
disability. A person’s “handicap” reflects an inter-
action between a disability and the person who is
disabled, concerning the way the individual
behaves in a broader context and environment
which itself consists of social, attitudinal, archi-
tectural, and legal dimensions (Walker and
Greene 1991). Globally, almost 180 million
1016
people between the ages of 10 and 24 operate with
some type of an identifiable disability (Groce
2004). Disabilities during adolescence are impor-
tant to consider given that all adolescents face
physical, cognitive, and social changes and that
those changes may be experienced differently by
adolescents with disabilities.
Cross-References
▶ Delinquent Youth with Disabilities
References
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16(1), 39–58.
Disciplining
Emily P. Garai1, Laura G. McKee2,
Virginia Peisch3 and Rex Forehand3
1
Atlanta Psychological Services, Atlanta,
GA, USA
2
Georgia State University, Atlanta, GA, USA
3
Department of Psychological Science, Dewey
Hall, University of Vermont, Burlington,
VT, USA
Broadly, the purpose of discipline is to mold, cor-
rect, train, and modulate behavior. Appropriate
discipline is particularly important during adoles-
cence given both the new demands placed on youth
because of increased independence as well as the
potential for conflictual relationships with parents
as peers and romantic partners become more
important (e.g., Eisenberg et al. 2008). Parents of
adolescents utilize various disciplinary strategies to
socialize their teenager’s behavior to be in accor-
dance with rules of conduct deemed safe, accept-
able, and appropriate according to established
Disciplining
individual, family, societal, and cultural norms
and expectations. Traditionally, the term discipline
has been synonymous with punishment and has
been characterized by use of an aversive or
unpleasant consequence (Forehand and McKinney
1993); however, as will be evident from the
research reviewed here, a more comprehensive
conceptualization situates the construct of disci-
pline in a much broader framework, including the
expectations parents set forth for their adolescents,
the consequences they use, and how they monitor
behaviors. What initially appeared to be a straight-
forward and simple construct has proven to be a
complex and multifaceted phenomenon – for both
parents and researchers – and boasts a long history
of change across the past 400 years in the United
States (see Forehand and McKinney 1993).
In order to understand the role of discipline in
healthy adolescent development, one must
acknowledge both the wide array of strategies
embodied by the term as well as its place within
the larger context of parenting. Generally speak-
ing, authoritative parenting has emerged from
over 40 years of research as a style of parenting
most clearly associated with positive child out-
comes. An authoritative approach, which com-
bines disciplinary strategies with warmth and
positive regard, is appropriate for use with all
ages of children; however, specific adaptations
for teenagers are necessary because of the
unique biological, cognitive, social, and environ-
mental changes that occur during adolescence
(Holmbeck et al. 1995, 2010). The following dis-
cussion provides an overview of the development
of authoritative parenting as a framework within
which to examine discipline, an argument for why
this type of parenting is important, a discussion of
specific discipline strategies that are effective with
adolescents, and a review of the literature
suggesting the importance of considering disci-
pline within the context of other parenting behav-
iors (i.e., warmth), the family, and culture.
Authoritative Parenting
Two frameworks for studying parenting have
evolved since the mid-1960s, and research
Disciplining
camps have either focused on individual parenting
dimensions or broad typologies of parenting (for
reviews see McKee et al. 2008, 2013). The first
framework, based on work by Schaefer (1965),
identified three behavioral dimensions – warmth,
hostility, and behavioral control – as important
elements of parenting. Researchers have contin-
ued to explore the effects of these three salient
parenting concepts on child and adolescent psy-
chopathology and healthy adaptation. The second
framework, based on work by Baumrind (1966,
1967), advanced the field by focusing not on
individual behaviors in isolation but rather on
three constellations of parenting behaviors
consisting of various combinations of warmth
and control labeled authoritative, authoritarian,
and permissive. While Baumrind’s approach to
studying parenting was novel in that she catego-
rized parents according to their behaviors regard-
ing both control and warmth, the parenting
concepts she highlighted were remarkably similar
to the warmth and behavior control dimensions
(e.g., parental expectations, consequences, and
monitoring) being studied by Schaefer and others.
Maccoby and Martin (1983) then modified and
expanded Baumrind’s original system into a
schema in which parenting could be classified
into four constellations, again based on different
combinations of warmth and behavioral control
(i.e., discipline): authoritarian-autocratic (i.e., low
levels of warmth and high levels of control),
indulgent-permissive (i.e., high levels of warmth
and low levels of control), indifferent-uninvolved
(i.e., low levels of both warmth and control), and
authoritative-reciprocal (i.e., high levels of both
warmth and control). Both the dimensional
approach and the typological approach to the
study of parenting have yielded research germane
to healthy child and adolescent development and
psychopathology. For example, each of the four
parenting styles has been associated with different
developmental outcomes for teens. Most notable,
Steinberg’s (2001) review of 25 years of research
on parenting adolescents and a recent update by
Baumrind and colleagues (2010) both conclude
that an authoritative parenting style is associated
with positive outcomes for adolescents, including
academic success, social skillfulness, and lower
1017
levels of anxiety and depression (Steinberg
and Silk 2002). Alternatively, other parenting
behaviors and constellations (e.g., harsh or critical
parenting behaviors, indulgent-permissive typol-
ogies) have been linked with both internalizing
(e.g., anxiety, depression) and externalizing (e.g.,
aggression) problems (for a review see McKee
et al. 2013).
Although individual parenting dimensions D
(e.g., behavioral control) and constellations of
behavior (e.g., authoritative) are associated with
positive child outcomes, the form of these behav-
iors and their delivery must vary to match the
developmental age and stage of the child
(Forehand and Wierson 1993). During the adoles-
cent years, children have the capacity to question
authority and seek psychological autonomy. As a
consequence, authoritative parenting includes
verbal give-and-take between the parent and
teen, delineation of clear expectations, enforce-
ment of rules when appropriate, and the encour-
agement of independence (Holmbeck et al. 1995;
also see Holmbeck et al. 2010). In essence,
authoritative parenting for teenagers provides the
child with direction but allows considerable free-
dom within broad limits.
Discipline Procedures with Adolescents
Background and overview. Drawing from the par-
ent training literature, several specific parenting
skills identified as components of an authoritative
parenting style have become part of clinical inter-
ventions for adolescents struggling with behavior
problems (e.g., Barkley and Robin 2014; Forgatch
and Patterson 1998; Patterson and Forgatch 2005;
Wells et al. 2008). Successful programs promote
positive parenting skills (i.e., warmth, sensitivity,
realistic rules that are monitored), including effec-
tive discipline strategies, while also attempting to
eliminate negative parenting skills (e.g., harsh
criticism, guilt induction, physical discipline).
The intervention literature provides evidence
regarding which parenting skills and behaviors
constitute effective discipline; as we will note
below, experimental manipulation of parenting
behavior in intervention programs is a particularly
1018
powerful tool when attempting to determine
which disciplinary tactics promote adolescent
development.
The parent behavior management literature,
which addresses skills for parents of children
ranging from early childhood (e.g., McMahon
and Forehand 2003) through middle childhood
(e.g., Kazdin 2008) and adolescence (Patterson
and Forgatch 2005), delineates three components
of discipline that are typically implemented in
stages. First, clearly defined rules must be devel-
oped. Parents who provide clear rules and expec-
tations for their teens give them the opportunity to
succeed: When adolescents know the expecta-
tions of their parents (e.g., telling their parents
where they will be going for the evening), they
are more likely to meet that expectation. Also,
having clear expectations allows for psychologi-
cal autonomy to develop as parents can provide
increasingly more freedom (e.g., the teen can
choose where to go as long as the parents are
informed). Clear and appropriate expectations
are related to increased self-esteem, academic
functioning, and behavioral compliance (e.g.,
Patterson and Forgatch 2005; also see Holmbeck
et al. 1995, for a review).
The second component of discipline involves
consequences, which are tied to the adherence and
violation of the rules established by parents. Allo-
wing a teenager to earn rewards for appropriate
behavior and/or experience negative conse-
quences for inappropriate behavior increases pos-
itive behaviors while reducing negative ones (e.g.,
Wells et al. 2008). There is a long history of
research to support the role of parental positive
and negative consequences in promoting child
and adolescent positive outcomes and decreasing
problem behaviors (e.g., see McMahon et al. 2006,
for a review of child conduct problems).
The final component of discipline is monitor-
ing an adolescent’s behavior. Monitoring is nec-
essary to ensure that rules are being followed and
allows parents the opportunity to provide conse-
quences for the child’s behavior. Research has
shown monitoring to be related to higher levels
of self-esteem, lower levels of delinquent behav-
ior, and lower rates of susceptibility to peer
pressure (for reviews, see Crouter and Head
Disciplining
2002; Dishion and McMahon 1998; Holmbeck
et al. 1995).
Before turning to a more in-depth consider-
ation of each of the three components of disci-
pline, a recent review of parenting behaviors that
have been identified as mediators in parenting
programs is worthy of note. Among other parent-
ing behaviors, Forehand et al. (2014a) examined
constructs they labeled as discipline (e.g., lax,
consistent versus inconsistent), which would be
consequences in our framework, and monitoring
(e.g., awareness of activity and location of youth).
These authors found that the construct of disci-
pline (i.e., consequences for inappropriate behav-
ior) had the most support as a mediator (i.e.,
accounted for youth behavior change as a result
of parent participation in a parenting program),
whereas monitoring alone received the least sup-
port. These findings suggest that parental conse-
quences are a key component to effective
discipline; nevertheless, we would advocate that
clearly defined rules and expectations as well as
monitoring are necessary components for disci-
pline to be most effective with adolescents.
We now turn to an examination of each of the
components of discipline. We first examine how
each of these components changes as a function of
the child’s age and then focus on the adolescent
years.
Rules and Expectations. Regardless of devel-
opmental age or stage, the three components of
discipline – clearly defined rules and expectations,
contingencies for complying with or breaking the
rules, and sufficient parental monitoring – have
been shown to decrease negative behaviors and
promote positive behaviors of children. However,
the implementation of effective discipline changes
as children progress through various developmen-
tal stages; as a result, sensitivity and thoughtful-
ness regarding the delivery of discipline is integral
to successful positive parenting. Consider house
rules as an example of parental expectations. As
with younger children, having a limited number of
clearly articulated rules is important for teenagers:
A child’s opportunities for success are enhanced
by allowing her or him to fully understand and
remember the rules. Additionally, parents can
more effectively monitor fewer rules and enforce
Disciplining
them consistently. However, the process of gener-
ating these rules is different for adolescents versus
younger children. Adolescents no longer accept
“just because” as a justification for the existence
of rules. Rather, they wish to understand, or be
convinced of, the importance of household limi-
tations (Forehand and Wierson 1993) and thus
require a more developed rationale for house
rules from their parents. It is in this realm that
the give-and-take component of authoritative par-
enting is important. House rules need to be nego-
tiated and agreed upon by both parent and teen in
order to increase the likelihood of compliance and
to facilitate the development of adolescent inde-
pendence (Forehand and Weirson 1993; Patterson
and Forgatch 2005). Both parents and teens must
acquire effective communication skills (e.g., be a
good listener, paraphrase back what has been
heard, honestly and calmly express feelings) and
problem-solving skills (e.g., define the problem,
generate solutions, evaluate solutions, select
agreed upon option, implement solution, evaluate
implementation of solution) to reach compro-
mises that are at least minimally acceptable to
both parties (Barkley and Robin 2014; Forgatch
and Patterson 2005).
Rewards and Consequences. In addition to
changes in the generation of house rules, enforce-
ment of rules must also evolve for adolescents. The
authoritative parent provides a teenager with
age-appropriate rewards for clearly defined desir-
able behaviors and age-appropriate negative con-
sequences for clearly defined undesirable
behaviors. For younger children (i.e., 2–7 year
olds), rewards often consist of praise or attention
from parents, while time-out is used as the primary
consequence for negative behaviors (Forehand
and Long 2010; McMahon and Forehand 2003).
Although parent attention remains important for
teens, it is often not sufficient because peers
increase in importance and tangible objects (e.g.,
iPod, cell phones) take on more value (Forehand
and Weirson 1993). Therefore, identifying adoles-
cent age-appropriate rewards and consequences is
critical. The following discussion focuses on neg-
ative consequences for inappropriate behaviors as
these are typically considered “disciplinary strate-
gies” (see Barkley and Robin 2014, for how to set
1019
up rewards for an adolescent; see Galeazzi
et al. 1988, for an example of a survey to identify
rewards for adolescents).
Before delineating appropriate consequences,
it is important to note which disciplinary strategies
should be avoided because they are, at best, inef-
fective, and at worst, harmful to adolescents. First,
corporal punishment is not recommended for use
with a child of any age. Corporal punishment has D
been defined as “the use of physical force with the
intention of causing a child to experience pain but
not injury for the purposes of correction or control
of the child’s behavior” (Straus 1994, p. 4). In a
review of 88 studies, Gershoff (2002) examined
the relation between corporal punishment and
immediate and long-term outcomes for children
and adolescents. Although corporal punishment
was related to immediate compliance, it was also
related to numerous negative short-term (e.g.,
aggression) and long-term (e.g., mental health
problems) outcomes. Gershoff (2002) concluded
that corporal punishment has many adverse con-
sequences that mitigate the short-term benefit of
immediate compliance. Subsequent research has
supported these conclusions (e.g., Callender
et al. 2012; Ferguson 2013). It is important to
note that consequences do not have to be physical
to lead to negative outcomes for children. For
example, McKee et al. (2007) found that harsh
verbal criticism was related to young adolescents’
behavior problems, even after positive parenting
was taken into account. Furthermore, Rakow
et al. (2009) reported a positive relation between
parental guilt induction and child internalizing
problems such that children whose parents uti-
lized unwarranted, inappropriate blame and dec-
larations of disappointment more often were more
likely to evidence higher levels of internalizing
symptoms. And, encouragingly, McKee
et al. (2014) found that a family-based preventive
intervention effectively reduced parent use of
guilt induction, leading to a reduction in internal-
izing problems.
As noted, time-out is the disciplinary strategy
of choice for young children (Forehand and Long
2010; McMahon and Forehand 2003) and is also a
component of some parenting intervention pro-
grams for children as old as 12 years (Wells
1020
et al. 2008) and even up through the teen years
(Barkley and Robin 2014). However, when used
with 10–12 year olds, the procedures are modified
substantially in terms of length and location of the
time-out. For example, instead of a three-minute
time-out in a chair in a corner as suggested for
young children (McMahon and Forehand 2003),
Wells et al. (2008) recommends 10–20 min time-
outs in a room devoid of entertainment for older
children, and Barkley and Robin (2008) state that
time-out for adolescents “means telling your teen
to leave the room or sit down and be quiet until he
cools down” (p. 182). Thus, “traditional” time-out
(McMahon and Forehand 2003) is not appropriate
or recommended for use with teenagers. Not sur-
prisingly, as the value of parental attention
decreases, time-out from such attention is less
effective and other consequences should be
considered.
In their seminal treatment manual for parents
of adolescents with behavior problems, Patterson
and Forgatch (1987) asserted, “For parents with
adolescents, the five-minute work chore is
clearly the punishment of choice” (p. 189). This
conclusion had not changed 18 years later as
Patterson and Forgatch made the same assertion
in 2005 (p. 143). The five-minute work chore
(i.e., short tasks to be completed at home in
addition to an adolescent’s typical responsibili-
ties) is given immediately for failure to comply
with established rules or for engaging in clearly
defined inappropriate behavior. Another exam-
ple of an appropriate disciplinary strategy for
teens is removal of a privilege for a period of
time (Wells et al. 2008). For example, computer
or cell phone usage could be removed. The
length of time such privileges are lost can depend
on the severity of rule violating behavior
displayed by the adolescent; however, being
realistic about the length of time is critical:
Removing a privilege “until you are no longer
living in my home” is not only very unlikely to
be enforced but also negatively impacts the
parent-adolescent relationship.
Because adolescents value the opinion of and
access to peers (e.g., Chan et al. 2012; Forehand
and Wierson 1993), social reinforcers (e.g., later
curfew, permission to go to certain parties, ability
Disciplining
to date) may be particularly salient and motivat-
ing. As such, removal of these reinforcers can
serve as another disciplinary strategy. Of course,
it is important once again to consider what is
realistic: Extended “grounding” of a teenager is
not only aversive for the parent living with the
adolescent but also negatively impacts the parent-
teen relationship and reduces opportunities for
positive and normative social development with
peers (see Barkley and Robin 2008, for a discus-
sion on grounding).
In order for consequences to be effective, the
way they are executed is also important. First,
consistency is essential (Barkley and Robin
2014). Parents should not state consequences,
either positive or negative, that they are unwilling
to impose, monitor, and carry through to comple-
tion! Second, parents should administer conse-
quences calmly. Parents have been encouraged
to become like a “brick wall” or a “robot” when
delivering discipline so that they are able to
calmly state and consistently enforce the rules
without being drawn into bickering (Hembree-
Kigin and McNeil 2007). Third, Patterson and
Forgatch (2005) highlight the importance of not
lecturing as a source of discipline. While lecturing
may intuitively seem to parents to elucidate the
rationale for a given punishment, it actually pro-
vides attention for inappropriate negative behav-
iors, is often used to induce guilt, and, particularly
with adolescents, encourages arguments. Rather
than lecturing when discipline is imposed,
Patterson and Forgatch (2005) recommend stating
the rule that was violated, imposing the conse-
quence (e.g., work chore), and discussing the rea-
sons for the consequence at a later time. This
eliminates the role of attention and arguments
when negative consequences are used and pro-
vides a chance for parents and adolescents to
discuss house rules later in a calm give-and-take
environment that bolsters the parent-child alli-
ance. Fourth, parents should carefully plan how
they will talk to and implement discipline with
their adolescent. Planning can be a key to effective
use of consequences. Finally, use of the commu-
nication and problem-solving skills we delineated
earlier is critical (also see Barkley and Robin
2008; Forgatch and Patterson 2005).
Disciplining
Monitoring. The third component of discipline,
monitoring, also changes as children age. When
children are younger, parents have ready access to
them and can monitor and supervise closely in
order to provide for safety and other basic needs.
In many ways, monitoring younger children is
easier than keeping tabs on adolescents, who are
more mobile and independent. As a rule of thumb,
parents of teens should consider the four W’s as
they monitor their adolescents: Who are you
with?; What are you doing?; Where will you
be?; and When will you be home? Monitoring is
associated with more knowledge about youth
activities, which can help parents deter adolescent
problem behaviors (Criss et al. 2015). Although
there has been debate about monitoring (Stattin
and Kerr 2000), evidence (e.g., Lahey et al. 2008)
continues to provide strong support for this par-
enting behavior being important for healthy ado-
lescent development. Furthermore, monitoring is
becoming recognized as a complex behavior
consisting not only of the four W’s (i.e., knowl-
edge about the adolescent) but also of parental
involvement with the adolescent and adolescent
openness about her/his activities (e.g., Criss
et al. 2015). As a component of discipline, moni-
toring is an important, but as yet understudied and
not sufficiently understood, construct.
Regardless of the complexity of this construct,
it is important for parents to be clear with adoles-
cents about what the four W’s involve and what
their expectations are for the adolescent. These
should be reviewed with the adolescent before
she or he departs from the house. Furthermore, if
one or more of the four W’s is violated (e.g., an
adolescent goes somewhere other than agreed
upon or does not come home on time), then one
of the consequences discussed previously should
be implemented.
For adolescents, monitoring also can include
having the teenager involved in the implementa-
tion and self-reinforcement of rules and conse-
quences by letting them take responsibility for
monitoring some of their own behaviors
(Forehand and Weirson 1993). If parents continue
throughout the adolescent years to maintain all
control, successful development of internal con-
trol can be hindered. Adolescents increasingly
1021
have the cognitive and emotional skills to guide
their own behavior. When parents gradually turn
over monitoring and decision-making, adoles-
cents have the opportunity to develop into self-
directed individuals who make responsible
decisions.
An emerging area of importance for monitor-
ing that deserves mention concerns adolescent
technology use. Youth technology use (e.g., D
smartphones, television, video games, computers,
tablets) averages over 7 h per day (Rideout
et al. 2010), far exceeding the 2 h recommended
by the American Academy of Pediatrics (2013).
Not only do adolescents have a higher usage than
younger age groups, they also appear to be less
shaped by general and technology-specific parent-
ing behaviors (Sanders et al. in press-a, b).
Although some research suggests that parent
mediation (e.g., restrictions, discussion of con-
tent) of youth media consumption impacts usage
and influences behavior and emotional outcomes
(Vaala and Bleakely 2015), other data suggest that
parental restrictions may not eliminate online risk
(i.e., Livingstone and Helsper 2008) and in some
cases may be associated with increased electronic
communication (i.e., Len-Ríos et al. 2015). The
development of parenting programs for teaching
parents how to monitor and control their adoles-
cents’ technology represents a critical need as our
society moves forward in the digital age.
The Context of Discipline
The context in which discipline occurs is impor-
tant in determining its effectiveness. We will con-
sider three contexts as examples: other parenting
behavior (i.e., warmth), the family, and culture.
Warmth. Implementation of the three steps of
discipline in the appropriate fashion is necessary,
but not sufficient, to produce positive parenting:
Discipline is only one of the two components of
authoritative parenting. Discipline must occur
within the context of a high quality parent-child
interaction (Patterson and Forgatch 1987), and in
order to create an atmosphere conducive to a pos-
itive relationship, parents must be attentive to, and
supportive of, their adolescents (Forehand and
1022
Wierson 1993). One specific parenting skill, paren-
tal warmth, defined by McLeod et al. (2007) as “a
sense of positive regard expressed by the parent
toward the child, pleasant interactions shared
between the parent and child, or parenting involve-
ment in children’s activities” (p. 161), has been
shown to be associated with positive mental health
outcomes for youth (Masten and Coatsworth 1998;
McKee et al. 2008, 2013). When considered in
combination with discipline, warmth is particu-
larly important. For example, recent research has
shown that low levels of warmth plus harsh disci-
pline is especially detrimental for adolescents
(Wang et al. 2015).
Like discipline techniques, methods of
expressing warmth evolve as a child becomes an
adolescent. While in early childhood warmth may
be expressed verbally through attending to or
praising a child’s behavior or by affectionate
appropriate touches (McMahon and Forehand
2003), in adolescence it becomes more complex
and often subtle. For example, ongoing parental
attention is not desirable for most teens: rather, a
parent who is available to talk at a moment’s
notice, attends performances (e.g., sporting events,
theater productions) by the adolescent, and allows
an adolescent to choose some family activities
(e.g., which movie to watch or restaurant to eat)
is displaying an age-appropriate warmth which
will facilitate the parent-teen relationship. Without
warmth, discipline will hinder the development of
a positive parent-adolescent relationship and ado-
lescent outcome (e.g., Lowe and Dotterer 2013).
Therefore, discipline should be reserved for a
select few behaviors and imposed only for a short
period of time within the context of a parent-child
relationship dominated by positive reinforcement
and support (Patterson and Forgatch 2005).
Family. Discipline, as well as other parenting,
occurs within the context of the family. Substan-
tial attention in the research literature has been
devoted to how parental and interparental “adjust-
ment” can influence parenting and, in turn, youth
outcome. For example, it has been estimated that
7.5 million parents will experience an episode of
depression during a child’s formative years
(England and Sim 2009), leading to negative par-
enting (e.g., harsh discipline) (see Lovejoy
Disciplining
et al. 2000, for a review) and subsequent youth
problem behaviors (for reviews, see England and
Sim 2009; Goodman et al. 2011). Fortunately,
preventive intervention programs, which include
a parenting component, are being developed and
evaluated (e.g., Compas et al. 2009, 2011), includ-
ing which components of the program are critical
for adolescent outcomes. For example, Compas
and his colleagues have found that parenting is
one mediator of adolescent behavior change (e.g.,
Compas et al. 2010).
Although parental depression is a major influ-
ence in how parents raise their children and ado-
lescents, it is by no means the only parent
“adjustment” variable that can influence parent-
ing. Parent ADHD symptoms, anxiety, excessive
alcohol use, and physical illness have all been
found to influence parenting, including the use
of discipline (e.g., see Johnston et al. 2012, for a
review of parent ADHD).
The family context of parenting goes beyond
the parents’ own personal “adjustment” as the
relationship between the two caregivers can
shape parenting. It is important to note that when
both caregivers are parents (whether biological or
nonbiological), the context may be one of a mar-
ried, cohabiting, divorced, or remarried family.
Regardless of this context or the gender of the
parents, a substantial literature indicates that inter-
personal conflict, particularly when it occurs in
front of, or involves, the youth, is detrimental (for
reviews see Buehler et al. 1997; Evans et al. 2008;
Jouriles et al. 1991; also see Peisch et al. in press),
partially because conflict disrupts parenting (e.g.,
use of effective discipline). Such data highlight the
need to create effective interventions for families
affected by adult conflict (see Reynolds et al. 2014).
Beyond identifying variables that can be dis-
ruptive to parenting behaviors, such as discipline,
recent research is beginning to focus on personal
and interpersonal variables that promote effective
parenting. For example, mindful parenting (e.g.,
present-centered attention during parent-child
interactions, regulation of reactivity to child’s
behavior) has been shown to enhance effective
parenting with youth ranging in age from 3 to
17 years old (Parent et al. 2016). When interper-
sonal variables are considered, substantial work
Disciplining
has focused on the construct of coparenting (i.e.,
two adults jointly provide care for children) (see
McHale and Lindahl 2011) regardless of the fam-
ily form (e.g., married, cohabiting) in which it
occurs. When parents effectively coparent
together, both are involved in daily childrearing
activities and youth adaptive behavior is enhanced
(e.g., Forehand et al. 2014b, 2015).
Culture. In addition to other parenting behav-
iors and the family system as important contexts
within which specific disciplinary strategies must
be considered, the cultural norms of different
racial, ethnic, and socioeconomic groups may
shape parent socialization goals. Harkness and
Super (2006), for example, suggest that parent
ethnotheories about how best to raise children
are informed by the larger culture. Although
decades of research have replicated a robust core
of findings regarding the impact of positive par-
enting behaviors such as warmth and behavioral
control on youth social and emotional health,
scholars have questioned whether research, largely
conducted in the West with European American
families, is equally applicable to families from
different ethnic and cultural backgrounds.
Some research has suggested that authoritative
parenting may not be as critical for youth well-
being as hypothesized, depending upon the context
in which it is delivered. In her oft-cited papers,
Chao (1994, 2001), for instance, makes the case
that Chinese parenting, which she describes as
“training” youth to engage in socially appropriate
behavior, is deployed and interpreted in a collec-
tivist context that values complete obedience and
deference to family and authority. As such, she and
others (i.e., Rudy and Grusec 2006) indicate that
parenting behaviors considered controlling or puni-
tive through a more individualist lens may not be
perceived as negative, harsh, or lacking warmth by
Chinese youth and parents. In other words, if the
intent is benign and the parenting behaviors judged
as reasonable, then the youth developmental out-
comes will be positive even when warmth is low.
This notion has been challenged by recent empiri-
cal work and by those arguing a cultural equiva-
lence model. This perspective claims that youth in
all cultural contexts benefit from authoritative and
directive parenting, which is equivalent to an
1023
authoritative stance with regard to amount of con-
trol but with only moderate warmth and autonomy
support (Baumrind et al. 2010; see also Sorkhabi
and Mandara 2013, for a review). For example,
harsh discipline has been related to detrimental
outcomes for Chinese youth living in both the
United States (e.g., Benner and Kim 2010), Taiwan
(Wang et al. 2015) and China (Chang et al. 2003),
while warmth has been associated with adaptive D
outcomes for Chinese Canadians (Yoo and Miller
2011). Furthermore, a cross-cultural examination
of adolescent youth in twelve cultures has validated
extant measures of positive parenting and suggests
that such parenting behaviors are associated with
beneficial youth outcomes around the globe
(McNeely and Barber 2010).
Given increasing globalization and the
diverse makeup of US society, clinicians must
be aware of cultural values that may impact par-
enting ethnotheories and behaviors. Forehand
and Kotchick (1996) originally called for
therapists and researchers to investigate the
effectiveness of cultural adaptations of parenting
interventions. More recently, Ortiz and Del
Vecchio (2013) revisited these concerns and rec-
ommendations. Although they found that the
diversity of families included in parent training
research had increased and that a number of
culturally tailored interventions had been devel-
oped; unfortunately, they also reported that such
adaptations have not been tested against the orig-
inal versions and thus fail to provide evidence of
superiority.
Conclusions
As is evident, discipline is not a simple construct.
It requires an awareness of an adolescent’s devel-
opmental level, thoughtful planning around
expectations and rules, and a commitment to
implementing appropriate consequences and
monitoring adolescent behavior. Finally, disci-
pline should be implemented in the context of
parental warmth to promote healthy adolescent
adaptation and parental use of discipline and per-
haps its effectiveness depends in part on the fam-
ily and cultural context.
1024
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Discrimination
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Discrimination
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
While it is common to prefer members of an indi-
vidual’s own group, discrimination involves the
unfair treatment of others based on their member-
ship to these inherent groups. Although individuals
can opt to belong to groups that are discriminated
against, often members belong to discriminated
groups to which they do not choose to belong,
such as those based on categories of race, gender,
age, sexual orientation, and physical appearance.
The extent to which categories, and individuals
within those categories, are discriminated against
varies from society to society as well as from group
to group depending on both broad social forces and
narrow individual circumstances.
The variety of categories to which individuals
can belong means that adolescents can be
Discrimination
discriminated against for a variety of reasons.
They can be discriminated due to their age, gen-
der, race, sexual orientation, appearance, and so
forth, all of which can vary considerably to the
extent that these factors can interact and have
different meanings in different contexts. A recent
study of adolescent immigrants in the United
States (Medvedeva 2010), for example, found
that adolescents who felt discriminated against
by school peers were more likely to report speak-
ing and reading English less than “very well.”
Those who did report speaking and reading
English “very well” were more likely to feel dis-
criminated against by teachers and counselors at
school and also reported perceived societal dis-
crimination. Other studies also have found, for
example, a persistent negative effect of accultura-
tion on the link between discrimination and ado-
lescents’ developmental outcomes, such that
adolescents who are more acculturated experience
more deleterious effects of discrimination on both
socioemotional and academic outcomes (see
Benner and Kim 2009).
Discrimination appears on a continuum, rang-
ing from overt hostility directed at an entire group
to subtle social exclusion of an individual. Subtle
discrimination is the most prevalent form of dis-
crimination and commonly goes unnoticed by
members of the dominant social group. Indeed,
this is a form of discrimination that often goes
unnoticed because the discrimination that results
is purported to result from factors not related to the
specified discrimination, for example, individuals
can be treated differently for belonging to a group,
such as a racial group, but the reason for the differ-
ent treatment can be viewed as based on economic
considerations (see Dovidio and Gaertner 2004).
The challenge of identifying more subtle forms of
discrimination transfers to research. While explicit
discrimination may be measured through surveys
or document analysis, subtle forms of discrimina-
tion require sophisticated techniques. Researchers
may measure verbal and nonverbal behavior, such
as how much help a subject gives to another, how
long they converse with them, or how far away
they sit. Researchers may also use computer pro-
grams that measure subjects’ reaction times. These
methods have helped the study of discrimination
1027
make important progress, but they tend to be the
subject of criticism to the extent that they, for
example, are not necessarily applicable to other
contexts and may not be readily obvious and sig-
nificant enough to be seen as resulting in actual
discrimination, which happens to be one of the key
points about subtle forms of discrimination itself: it
is difficult to identify and, because of that, combat.
Researchers may investigate discrimination on D
an individual or societal level. At the individual
level, individuals are likely to discriminate when
they hold negative stereotypes of an entire social
group and who are prejudiced toward them. These
prejudices and negative views emerge from the
need to increase self-esteem or out of a sense of
moral judgment. At the societal level, social con-
formity plays an important role. Social norms are
powerful motivators of action, such that members
of a group being discriminated against sometimes
adopt discriminatory views about their own social
group. Importantly, if individuals perceive that
discrimination is not a social norm, then they
will not discriminate. Thus, interventions fre-
quently will focus on changing social norms in
hopes of reducing discrimination.
One of the key factors relating to discrimina-
tion, and that helps to perpetuate it, involves the
challenge of identifying it. Identifying discrimi-
nation may prove difficult, for example, due to
multiple individual perceptions of any one event.
In many instances, there may not be enough evi-
dence to prove a definite attribution, which can
lead to a lack of perception and official reporting.
To further complicate matters, while members of
inferior social groups, such as women and minor-
ities, report discrimination against their social
group, they do not report experiencing it person-
ally (Crosby 1984). In addition, the reporting of
discrimination is difficult, and it is so for a variety
of reasons (see Stangor et al. 2003). Reporting
may be difficult because it may be psychologi-
cally costly to victims who might have to come to
terms with the unfair advantages for others. Social
consequences to reporting discrimination, such as
embarrassment, ostracism, and termination, might
also cause a victim to decide against reporting the
incident. Indeed, numerous factors have been
identified that relate to the likelihood of reporting
1028
discrimination, such as belief in a just world, need
for approval, need for control, identification with
the in-group, stigma consciousness, and mood. In
addition, victims of discrimination may make
internal or external attributions for the discrimi-
nation. If an internal attribution is made, such that
the victim feels to blame for their victimization,
lowered self-esteem, increased self-blame, and
misidentification with the in-group may occur.
Importantly, again, these effects vary depending
on people’s own experiences and abilities, such as
their age or cognitive abilities (see Seaton 2010).
Although it may be challenging to identify dis-
crimination and especially difficult to report some
instances of it, it is clear that discrimination may
have important psychological consequences for
victims, particularly if it is experienced frequently.
Individuals who feel discriminated against report
more psychological distress, depression, and lower
levels of life satisfaction. At the societal level,
discrimination can contribute to the high percent-
age of minorities in poverty and their lack of access
to higher paying jobs. Discrimination that contrib-
utes to a lack of access to resources also has been
linked to such negative outcomes as higher rates of
earlier mortality, access to less and poorer quality
health care, delayed diagnosis, and failure to man-
age chronic diseases. In addition to these observ-
able effects, discrimination also may have indirect
effects on individuals. Perceived past, present, or
future discrimination influences a variety of out-
comes. Individuals may alter the way they interact
with others, or even inadvertently perform worse
on tasks, for example, stereotype threat occurs
when an individual becomes anxious about perfor-
mance stereotypes, such as women’s not being
good at math, and thus performs worse than they
would have otherwise (Steele and Aronson 1995).
Clearly, discrimination, both at the individual and
broader social level, has negative and long-term
outcomes for its victims.
Cross-References
▶ Affirmative Action
▶ Equal Access Act
▶ Equal Protection Laws
Disease
▶ Racial and Ethnic Discrimination
▶ Racism
▶ Segregation and Desegregation
References
Benner, A. D., & Kim, S. Y. (2009). Experiences of dis-
crimination among Chinese American adolescents and
the consequences for socioemotional and academic
development. Developmental Psychology, 45,
1682–1694.
Crosby, F. J. (1984). The denial of personal discrimination.
The American Behavioral Scientist, 27, 371–386.
Dovidio, J. F., & Gaertner, S. L. (2004). Aversive Racism.
In M. P. Zanna (Ed.), Advances in experimental social
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Medvedeva, M. (2010). Perceived discrimination and lin-
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Seaton, E. K. (2010). The influence of cognitive develop-
ment and perceived racial discrimination on the psy-
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Stangor, C., Swim, J. K., Sechrist, G. B., DeCoster, J., Van
Allen, K. L., & Ottenbeit, A. (2003). Ask, answer and
announce: Three stages in perceiving and responding to
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797–811.
Disease
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Overview
Disease generally refers to conditions harmful to
an individual’s well-being or health. Although
different cultural definitions and conceptions of
disease have been proposed, in the context of
adolescence the concept of disease most com-
monly adopts a medical focus, with the harm
most often taking physical and/or psychological
dimensions. Research on disease in adolescence
differs from research on adults in that it involves
Disease
additional dynamics relating to treatment and
decision-making because adolescents generally
are under the authority of parents and caregivers.
Recognizing diseases and adherence/compliance
to treatment and the role of self-perception on
outcomes have been found to vary greatly
among adolescents; they also have been found to
be affected by parents, peers, and even how dis-
ease is explained or understood. Despite impor-
tant developments in understanding how
adolescents experience diseases, much remains
to be investigated, particularly in terms of how
cultural and individual conceptions of disease can
influence outcomes.
Defining and Conceptualizing Disease
Disease can be defined as a condition potentially
harmful to the well-being or health of an individ-
ual or as circumstances that place individuals at
the mercy of potentially disadvantageous conse-
quences. The factors that need to exist in order for
a condition to qualify as a disease are established
and defined from norms and expectations within
the culture in which they occur, as adverse conse-
quences in one culture may not be viewed in the
same light as another cultural perspective or view-
point (Michaud et al. 2001). Disease can affect
various dimensions of a person. Although dis-
eases tend to be viewed as physical, they can
also impact emotional and psychological aspects
of mental health and well-being. Indeed, it is
likely that diseases are an expression of physical
as well as psychosocial conditions. Several terms
are often used interchangeably with disease, with
those terms including abnormality, affliction,
defect, deficiency, disability, disorder, distur-
bance, dysfunction, illness, and impairment. As
these terms connote, a focus on disease tends to
involve a medical focus.
The medical focus is important to highlight
because conceptions of disease guide responses
to it. For example, the dominant medical model of
disease addresses severe condition and stresses
diagnosis, labeling, medication, control, and
manipulation of individuals. Among other things,
the model increases willingness to explore
1029
treatment options and discourages blaming one-
self in scenarios where there is really no one to
blame. This approach has important repercus-
sions. As an example, adopting a disease model
can be beneficial in that it can be more psycho-
logically reassuring than it would otherwise be
through other models (Meurk et al. 2014).
Despite the medical model’s important
strengths, there are other models that influence D
efforts to address diseases. Notably, the dominant
medical model of disease takes a different view of
disorders and problems than models that are
deemed more strength based. Strengths perspec-
tives focus on individuals’ strengths, capacities,
competencies, and possibilities (including those
of their social environment) and seek ways to
facilitate those strengths, such as building better
social environments for adolescents. Strengths-
based approaches focus on empowerment, resil-
ience, and membership in an appropriate group or
community (Saleebey 1996; Simmons et al.
2016). The strengths approach developed to coun-
ter the negative view of the disease model, and, as
may be expected by those roots, the strengths
model has been criticized, for example, for down-
playing real problems and approaching the causes
of disease in ways that defuse responsibility (see,
e.g., Saleebey 1996). Despite criticisms, it is
important to note that the strengths-based
approach has many variations, with some becom-
ing highly influential (e.g., positive psychology;
see Seligman and Csikszentmihalyi 2000).
Disease in Adolescence
In the study of adolescence, conceptions of dis-
ease are important for at least two reasons.
Although adolescents ostensibly appear to be in
the prime of their health (Call et al. 2002), the
tumultuous quality of this developmental period
often belies this expectation. Several important
diseased are diagnosed during the adolescent
period, or soon thereafter, such as severe psy-
chotic disorders like schizophrenia (Tarbox and
Pogue-Geile 2008). The adolescent years provide
opportunities to identify clues to the development
of pathological processes and could potentially
1030
improve early identification of diseases as well as
suggest potential targets for intervention (Tarbox
and Pogue-Geile 2008). The adolescent period
also is an ideal time for preventing the develop-
ment of diseases since the period is one marked by
engaging in risk behaviors linked with a variety of
diseases, such as those relating to substance use
and sexual activity (see D’Amico et al. 2005;
Brookmeyer and Henrich 2009).
Although the adolescent period is important
for understanding and addressing diseases in gen-
eral, there is much about the adolescent period that
distinguishes it from others in terms of how to
approach disease during adolescence. Adoles-
cents’ dependency on others contributes to the
need to explore how the intersection of the roles
of parent and child with caregiver and patient can
affect – generally, either improve or complicate –
how adolescents face disease. For example, posi-
tive self-perceptions correlate positively with
health-related quality of life, which has led
researchers to highlight the benefits of explaining
to adolescents how their own bodies are fighting/
dealing with disease and help increase their self-
confidence to improve alongside the course of
their medical treatment (Mussatto et al. 2014).
Relatedly, adolescents’ tolerance for pain and dis-
comfort generally is lower than adults’. This
makes managing adolescents’ pain and discom-
fort differently complicated because of adoles-
cents’ development. Adolescent patients who
are most difficult to assess by doctors and
caregivers – most often those who could most
use their attention – are known to be more anxious
than their calmer peers (Josset-Raffet et al. 2016).
Although psychological dimensions are known to
be important to address for all patients, it appears
that considering adolescents’ developmental
and psychological needs plays a particularly
important role.
The need to consider adolescents’ psychologi-
cal and developmental status relates to other
dimensions of efforts to address diseases that
afflict adolescents. Adolescents face unique chal-
lenges relating to adherence and compliance with
treatment. For example, parents and adolescents
have been found to not only forget to take certain
disease treatment regimens – such as medications
Disease
or therapeutic actions – but also to commonly
believe that it is the other party’s fault (Hommel
et al. 2011). Even when adolescents claim to fol-
low medical treatment instructions, other issues
arise. For example, adolescents with asthma, a
common diagnosis in adolescence, have been
found to report using medication, yet their medi-
cations were not dispensed and they did not have
access to anyone else’s (Dahlén et al. 2016). In
addition, even though parents and adolescents
could agree about the need for treatment, they
may not agree on how to go about obtaining
important aspects of treatment. Parents have
been found to generally focus on longer-term
concerns, while adolescents generally focus
more on immediate quality of life (Lipstein et al.
2016). These divergences may be understandable,
but they complicate how to address diseases that
have long-term implications as much as those that
raise acute concerns during adolescence.
Conclusion
Understandings of disease in adolescence have
tended to coalesce around a medical focus. As a
result, it explores the intersection of how parents,
medical professionals, and caregivers might bal-
ance their good intentions with the complexities
of adolescent personality and maturity in the face
of sometimes quite “adult” challenges. Although
the medical model has been adopted to address
disease, the period of adolescence raises impor-
tant cultural, social, and psychological issues for
getting and responding to diseases.
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Disgrace
▶ Humiliation
1031
Dishonor
▶ Humiliation
Dispositions in Law
D
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Dispositions, when used in law, refer to the final
statement or ruling on a matter made by a deci-
sion maker, such as a court. In criminal proce-
dure, for example, it is the imposed sentence or
other final statement made regarding a case or
particular issue. When dealing with adolescents
in the juvenile justice system, dispositional rul-
ings are deemed dispositions rather than
sentences. In juvenile courts, judges typically
are deemed to have considerable discretion to
determine the needed dispositions in specific
cases. Although sometimes referred to by other
names, there tends to be six available disposi-
tional alternatives available to juvenile courts:
Commitment to a mental health institution, cus-
todial confinement in a secure facility, custodial
confinement in nonsecure facilities such as foster
homes, home supervision or probation, commu-
nity service, and reparation or restitution. Each of
these alternatives is meant to be imposed after a
dispositional hearing, which tends to occur sep-
arate from an adjudication hearing meant to
determine whether the juvenile was responsible
for alleged offenses.
In the United States, the wide variety of possi-
ble dispositions typically exists in theory as courts
tend to focus on a few alternatives. Probation
remains the most common disposition. Yearly,
approximately 60% of youth who are adjudicated
delinquent participate in some form of
community-based probation (see Snyder and
Sickmund 2006). Probation programs use case
management to monitor youth and enforce the
courts’ rulings. These programs vary from infre-
quent monitoring to intensive monitoring. The
1032
second most frequently used disposition, which
covers over 20% of adjudicated cases, involves
institutional placements (Snyder and Sickmund
2006), and these also vary considerably in their
focus and intensity as they range from group
home placements and detention centers to train-
ing schools. Despite several potential alterna-
tives, then, the vast majority of courts tends to
rely persistently on two major approaches to
dealing with youth who are found to have
offended.
Decisions making use of dispositional alter-
natives typically involve two sometimes compet-
ing approaches. One approach focuses on
community protection and identification of risk,
as exemplified by a continuum of “graduated
sanctions.” Graduated sanctions are those that
range from least restrictive to most restrictive,
such as from diversion to confinement (see
Howell 1995, 2003). These alternatives theoret-
ically are based on such legal factors as offense
severity, offense history, and risk of future
offending. These concerns are different from
the other main approach which focuses on the
offenders’ treatment needs, such as the need to
promote their healthy development. Although
both concerns can be different and competing,
they also can be related. They can be related in
that the graduated sanctions could speak to the
issue of the severity of sanctions needed in a
particular case while treatment needs can deter-
mine the nature of the intervention. Together,
these approaches confront the key issues in deter-
mining dispositions: the offense, the offender,
and community’s needs.
Researchers have examined approaches taken
by courts when they choose dispositional alterna-
tives. In practice, their options are considerably
limited by the services available to them, and
courts tend to take a legalistic approach that
focuses on the offenses more so than offenders’
special needs. When courts do focus on offenders’
special needs, that consideration runs the risk of
increasing the severity of the disposition. Thus,
juvenile courts tend to view mental health needs
as indicating a need for more restrictive, and
severe, dispositions rather than a need for more
therapeutic alternatives. Prior involvement in
Dispositions in Law
social service interventions, along with identified
treatment needs, may increase youths’ chances for
receiving harsh juvenile court sanctions, as
revealed by studies indicating that alcohol and
drug abuse predict more severe dispositions
(Campbell and Schmidt 2000; Lyons et al.
2001). How these factors are affected by legal
factors (such as offense history, severity of instant
offense, and past incarceration), however, remains
debatable. One important study has reported that
only drug use problems predicted confinement
beyond legal factors, but it did note that other
individual factors under study were not available
to courts (Cauffman et al. 2007). Other studies,
however, tend to show that legal factors consis-
tently predict the severity of dispositions
(Campbell and Schmidt 2000; Leiber and Mack
2003; Leiber and Stairs 1999). Equally important
to consider are findings showing that demo-
graphic variables like gender and race also may
influence the severity of dispositions. Although
studies report important nuances and not all find
similar results, studies do tend to find that
girls receive more restrictive dispositions than
boys once they are referred to juvenile court
(Chesney-Lind and Sheldon 2003; MacDonald
and Chesney-Lind 2001), and research on race
shows a disproportionate confinement of minor-
ity youth as well as other more severe disposi-
tions for at least some groups of minority youth
(Leiber and Fox 2005). Thus, although much
research indicates that courts follow legal factors
that appear to privilege a graduated sanctions
approach, it is not clear whether they do so, nor
is it clear what effect following legal factors has
on different groups.
The study of dispositions in juvenile justice
decision making is of significance beyond efforts
to ensure that the system works fairly. Disposi-
tional decisions are supposed to be based on a
wide variety of factors and protect youth from
arbitrary and unfair outcomes. In addition, the
actual dispositions dispensed by juvenile courts
are key to understanding the extent to which they
abide by their mandate of customizing disposi-
tions to youth based on a case-by-case consider-
ation of each youth’s distinct rehabilitative
needs. Theoretically, this customization should
Dissociation
result in different juvenile court dispositions for
adolescent offenders whose personality charac-
teristics and social backgrounds differ but who
may commit similar offenses. If research finds
that legal factors are more important to determin-
ing dispositional outcomes, as research now
tends to find, then the juvenile court approxi-
mates the formality of the criminal court and,
debatably, is moving away from its original
mission.
References
Campbell, M. A., & Schmidt, F. (2000). Comparison of
mental health and legal factors in the disposition out-
come of young offenders. Criminal Justice and Behav-
ior, 27, 688–715.
Cauffman, E., Piquero, A. R., Kimonis, E., Steinberg, L.,
Chassin, L., & Fagan, J. (2007). Legal, individual, and
environmental predictors of court disposition in a sam-
ple of serious adolescent offenders. Law and Human
Behavior, 31, 519–535.
Chesney-Lind, M., & Sheldon, R. G. (2003). Girls, delin-
quency, and juvenile justice (3rd ed.). Belmont:
Wadsworth.
Howell, J. C. (1995). Guide for implementing the compre-
hensive strategy for serious, violent, and chronic juve-
nile offenders. Washington, DC: Office of Juvenile
Justice and Delinquency Prevention.
Howell, J. C. (2003). Preventing and reducing juvenile
delinquency: A comprehensive framework. Thousand
Oaks: Sage.
Leiber, M. J., & Fox, K. C. (2005). Race and the impact of
detention on juvenile justice decision making. Crime &
Delinquency, 51, 470–497.
Leiber, M. J., & Mack, K. Y. (2003). The individual and
joint effects of race, gender, and family status on juve-
nile justice decision-making. Journal of Research in
Crime and Delinquency, 40, 34–70.
Leiber, M. J., & Stairs, J. M. (1999). Race, contexts, and
the use of intake diversion. Journal of Research in
Crime and Delinquency, 36, 56–86.
Lyons, J., Baerger, D., Quigley, P., Erlich, J., & Griffin,
E. (2001). Mental health service needs of juvenile
offenders: A comparison of detention, incarceration,
and treatment settings. Children’s Services: Social Pol-
icy, Research, and Practice, 4, 69–85.
MacDonald, J. M., & Chesney-Lind, M. (2001). Gender
bias and juvenile justice revisited: A multiyear analysis.
Crime & Delinquency, 47, 173–195.
Snyder, H. N., & Sickmund, M. (2006). Juvenile
offenders and victims: 2006 national report.
Washington, DC: U.S. Department of Justice, Office
of Justice Programs, Office of Juvenile Justice and
Delinquency Prevention.
1033
Dissociation
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Overview
D
Dissociation refers to disconnects or disruptions
in an individuals’ thinking or bodily functions.
Those disruptions, in turn, cause abnormal inter-
actions between consciousness and awareness.
Dissociation’s relevance to adolescence comes
from research indicating that adolescent victims
of trauma are more likely to experience dissocia-
tion as well as see long-term negative mental
and/or physical consequences if improperly
addressed. Distinctions are drawn between
psychoform and somatoform dissociation, with
the later involving both physical and mental
symptoms and the former only mental symptoms.
Several theories of dissociation have been pre-
sented over the past few decades, with the most
influential being the behavioral trauma theory and
the behavioral states model. Most effects of dis-
sociation are negative, although some situations
do reveal a few positive and curative results.
Advances in assessment have helped increase
accuracy in distinguishing dissociation from per-
sonality disorders. The study of dissociation as it
relates to adolescents would benefit from explor-
ing more precisely the neurological sources of the
symptoms (mental and especially physical) of
dissociation and the processes underlying these
experiences.
The Nature of Dissociation
Dissociation literally means disconnecting or
splitting apart elements that have something in
common. In psychiatry and other clinical sci-
ences, dissociation refers to an experience of hav-
ing disruptions relating to one’s thinking (such as
one’s memory, consciousness, perceptions, or
identity) or bodily functions (such as sensations
and movement) (see Diseth 2005). In
1034
dissociations, these disruptions result in different
streams of consciousness that flow concurrently in
ways that occur simultaneously or outside of
awareness (see American Psychiatric Association
2000). The different forms of disruptions are asso-
ciated with different traumas and prevalence rates.
Somatoform dissociation involves both physical
and mental symptoms and is general indicative of
a deeper-rooted problem, while psychoform dis-
sociation involves only mental symptoms and is
generally the most prevalent (see Nilsson et al.
2015). Moreover, dissociative disorders are dif-
ferentiated from borderline personality disorders
by their general lack of overt identity alteration,
although misdiagnoses between these two pathol-
ogies persist (Sar et al. 2016).
Epidemiological studies have historically not
conclusively assessed the prevalence of dissocia-
tive disorders in the general population of adoles-
cents, although recent research has identified
more specifics including the link between trauma-
tized populations and populations with dissocia-
tive symptoms (Gusic et al. 2016). It does appear,
however, that a high proportion of patients in
adolescent psychiatry experience significant dis-
sociative symptomatologies. Studies reporting the
prevalence of dissociative symptoms among sex-
ually abused or maltreated children provide esti-
mates ranging from 19 to 73%, with inpatient
adolescents cohorts ranging from 23 to 45% (see
Silberg 2000). These findings help support the
generally accepted view that dissociation relates
to chronic traumas and disruptions in develop-
ment. These disruptions include a history of sex-
ual abuse, family disruptions such as removal
from the home, and witnessing the abuse of family
members (for reviews, see Ogawa et al. 1997;
Silberg 2000).
Dissociation and Development
Findings have led to the development of several
developmental theories relating disruptions to dis-
sociation, two of which are illustrative and espe-
cially relate to developmental issues. The first is
betrayal trauma theory (Freyd 1996). Betrayal
trauma theory posits that violence perpetrated by
Dissociation
someone on whom the victim is dependent will
lead to memory disruptions and dissociations as a
response to the need to maintain the needed (but
dysfunctional) attachment (Freyd 1996). Under
this model, dissociation is a mechanism used to
block trauma-related information, a finding
supported by research indicating higher incidence
dissociation symptoms of intrafamilial versus
extrafamilial juvenile victims of violence
(Plattner et al. 2003). The role of lived experience
can be especially critical because hearing voices
can stem from irrepressible memories of real-life
voices during traumatic events (Longden et al.
2012). In fact, recent research consistently reveals
that female adolescents who were sexually abused
exhibit higher levels of persistent dissociation
than their peers, especially if the abuse involved
family members (see Lev-Wiesel and Zohar
2014). And the danger runs both ways: dissocia-
tion also has been linked to being the aggressor in
sexual abuse situations among adolescents
(Leibowitz et al. 2011).
The second major theory relating to dissocia-
tion is the discrete behavioral states model
(Putnam 1997). That model purports that patho-
logical dissociation develops as a result of chil-
dren’s failure to learn to integrate states. The
model proposes that parents are instrumental in
teaching very young children to move fluidly
between states, such as a distressed to a neutral
one. These parenting needs are at risk of not being
appropriately met when there are atypical experi-
ences, such as violence. And, as with the other
model, evidence does suggest that, for example,
children’s perceptions of their mothers’ parenting
relates to the development of post-trauma symp-
toms, including dissociative symptoms. A leading
study revealed, for example, that children related
to their mothers in ways that revealed disorga-
nized or avoidant attachment styles were at higher
risk for developing dissociation in adolescence
(Ogawa et al. 1997). Both of these theories and
research supporting them highlight well how fam-
ily members can increase or decrease the risk of
children’s developing dissociative symptoms.
Although many adhere to the general model
that traumatic childhood experiences can result in
dissociative states, considerable controversy has
Dissociation
emerged to challenge that view. Among others,
critics used socio-cognitive models to argue that
dissociative states, especially multiple personality
disorder, were artifacts of psychotherapy that
were created, legitimized, and maintained by
social reinforcement, as they have been socially
created by other mechanisms in other societies
(see Spanos 1994). One of the most important
claims that gained remarkably wide and popular
attention was that dissociative disorders resulting
from “recovered memories” of early trauma actu-
ally are based on “false memories” (see Lofthus
1993; Merskey 1995). Although this often was
seen as a broad indictment of this area of research,
the criticisms are much more narrow than popular
commentaries suggest given that they rest on
delayed recalls. Still, evidence does reveal that
the delayed recalls could contain both true and
false memories. There may not be agreement
that there is a direct link between trauma and
dissociation, but there is agreement that trauma
creates vulnerability and that early traumatization
is one of the strongest predisposing factors for
dissociation, and this is especially the case for
repeated and severe traumas of emotional, physi-
cal, or sexual character (see Diseth 2005).
Although dissociation tends to be viewed in a
negative manner, not surprisingly given its associ-
ation with trauma, it is important to emphasize that
some forms of dissociation are part of normal,
everyday life. Dissociation can range from norma-
tive dissociation, such as daydreaming, to psycho-
pathological dissociations, such as would be found
in multiple personality disorders (see Putnam
1995). Dissociation also can be a way to adapt to
stress, which again can be a normal response or
become pathological when it leads to functional
loss or altered behavior. As expected, when there
is significant and overwhelming trauma, massive
psychological responses help children cope, such
as through psychic numbing, denial, repression,
aggression, and dissociation (Putnam 1997).
Research does confirm that dissociation can be
used in positive ways. It can be used to reinforce
activities or pay attention to negative ones to
enhance performance. For example, in suicidal
adolescents or adolescents who have already
attempted suicide, dissociation can cause a
1035
“decline in suffering” which can in turn prevent
suicide attempts and/or enable adolescents just
enough introspection to seek the help they need
(Levinger et al. 2016). And dissociation can pre-
sent a first step on the path toward long-term
healing from childhood trauma, to later be
replaced by deep introspection (Gusic et al. 2016).
Despite some possible positive aspects to dis-
sociation, there is no getting around the generally D
negative focus. Notably, the DSM-IV-TR
(2000) restricts mental dissociation to its patho-
logical forms, such as amnesia, depersonalization,
derealization, fragmentation, absorption, and
identity confusion. And in some cases, psycholo-
gists are obliged to turn to ego-state therapy to
treat adolescents with dissociation because it can
get so deeply embedded in their personalities and
because it is one of the few generally positive
treatment methods (da Silva and Fritz 2012).
Researchers have developed a number of ques-
tionnaires to assess dissociative tendencies in both
clinical and research settings (Kihlstrom et al.
1994). By far, the most popular of measure has
been the Dissociative Experiences Scale (DES;
Carlson and Putnam 1993), which has been dem-
onstrated to screen effectively those who might be
at risk for dissociative disorder (see Kihlstrom
2005). Other instruments, such as the Perceptual
Alterations Scale, the Questionnaire on Experi-
ences of Dissociation, the Dissociation Question-
naire, and the Dissociative Processes Scale,
strongly correlate to one another (for a review,
see Kihlstrom 2005). The different questionnaires
also focus on absorption, which, in this context,
refers to an individual’s (actually a personality’s)
tendency to be open to experiences and alter con-
sciousness by markedly narrowing or expanding
their focus of attention and blurring the boundary
between self and world (e.g., the extent to which a
personality is open to hypnosis and hypnotizabil-
ity) (Roche and McConkey 1990). Cutoff scores
of the DES reveal that 5–15% of individuals in the
general population are deemed “at risk” for disso-
ciative disorder (Kihlstrom et al. 1994), but it is
important to recognize that the range likely inflates
the presence of dissociation given that the measure
taps into normal levels of absorption and lead to a
significant number of high false positives that can
1036
be best addressed through more structured clinical
interviewing which, itself, remains fraught with
controversy in this area. Furthermore, one of the
most powerful recent developments in assessing
dissociation in adolescents has come in the form of
the Somatoform Dissociation Questionnaire-20
(SDQ-20) and its brief version, SDQ-5. Although
differences manifest between somatoform and
psychoform dissociation, these measures exhibit
high-quality psychometric properties and thus
represent yet another useful tool in assessing dis-
sociation in both clinical and research settings
(Nilsson et al. 2015).
Conclusion
Dissociation represents a powerful mental and/or
physical experience that can be caused by a num-
ber of possible conditions during adolescence. It
deserves the growing attention given by new
research because its nuances are one of the few
definitive links between physical and mental
pathologies sharing a root in perception. Research
has yet to favor one leading model over another,
as the trauma theory and the behavioral states
model are supported by different forms of
research – and the distinction between
psychoform and somatoform dissociation further
underscores the complexity of these potential dif-
ferences in causes. Dissociation as a means of
coping with stress, suicidality, or even one’s own
growing personality has been explored with
increasing success through the use of new assess-
ment methods. While there are seemingly few
positive and many negative dimensions of disso-
ciation, it appears useful to accept the wide variety
of dissociations that can occur and continue to
grow this nascent body of research.
References
American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders (4th ed.).
Washington, DC: American Psychiatric Association.
(Revised Text).
Carlson, E. B., & Putnam, F. W. (1993). An update on the
dissociative experiences scale. Dissociation, 6, 16–27.
Dissociation
Da Silva, J., & Fritz, E. (2012). The experiences of educa-
tional psychologists who utilise ego-state therapy to
address dissociation in adolescents. South African
Journal of Psychology, 42(2), 169–181.
Diseth, T. H. (2005). Dissociation in children and adoles-
cents as reaction to trauma – An overview of concep-
tual issues and neurobiological factors. Nordic Journal
of Psychiatry, 59, 79–91.
Freyd, J. J. (1996). Betrayal trauma: The logic of forgetting
childhood abuse. Cambridge, MA: Harvard University
Press.
Gušić, S., Cardeña, E., Bengtsson, H., & Søndergaard,
H. P. (2016). Types of trauma in adolescence and their
relation to dissociation: A mixed-methods study. Psy-
chological Trauma: Theory, Research, Practice, and
Policy, 8(5), 568–576.
Kihlstrom, J. F. (2005). Dissociative disorders. Annual
Review of Clinical Psychology, 1, 227–253.
Kihlstrom, J. F., Glisky, M. L., & Angiulo, M. J. (1994).
Dissociative tendencies and dissociative disorders.
Journal of Abnormal Psychology, 103, 117–124.
Leibowitz, G., Laser, J., & Burton, D. (2011). Exploring
the relationships between dissociation, victimization,
and juvenile sexual offending. Journal of Trauma &
Dissociation, 12(1), 38–52.
Lev-Wiesel, R., & Zohar, G. (2014). The role of dissocia-
tion in self-injurious behavior among female adoles-
cents who were sexually abused. Journal of Child
Sexual Abuse, 23(7), 824–839.
Levinger, S., Holden, R., & Ben-Dor, D. (2016). Examin-
ing the importance of mental pain and physical disso-
ciation and the fluid nature of suicidality in young
suicide attempters. Omega, 73(2), 159–173.
Lofthus, E. F. (1993). The reality of repressed memories.
The American Psychologist, 48, 518–537.
Longden, E., Madill, A., & Waterman, M. G. (2012).
Dissociation, trauma, and the role of lived experience:
Toward a new conceptualization of voice hearing. Psy-
chological Bulletin, 138(1), 28–76.
Merskey, H. (1995). Multiple personality disorder and the
false memory syndrome. The British Journal of Psy-
chiatry, 166, 281–283.
Nilsson, D., et al. (2015). Somatoform dissociation among
Swedish adolescents and young adults: The psycho-
metric properties of the Swedish versions of the SDQ-
20 and SDQ-5. Nordic Journal of Psychiatry, 69(2),
152–160.
Ogawa, J. R., Sroufe, L. A., Weinfield, N. S., Carlson,
E. A., & Egeland, B. (1997). Development and the
fragmented self: Longitudinal study of dissociative
symptomatology in a nonclinical sample. Development
and Psychopathology, 9, 855–879.
Plattner, B., Silvermann, M. A., & Redlich, A. D. (2003).
Pathways to dissociation: Intrafamilial versus extra-
familial trauma in juvenile delinquents. The Journal
of Nervous and Mental Disease, 191, 781–788.
Putnam, F. W. (1995). Development of dissociate disor-
ders. In D. Cicchetti & D. J. Cohen (Eds.), Develop-
mental psychopathology (pp. 581–608). New York:
Wiley.
Dissociative Disorders
Putnam, F. W. (1997). Dissociation in children and ado-
lescents: A developmental perspective. New York:
Guilford.
Roche, S. M., & McConkey, K. M. (1990). Absorption:
Nature, assessment, and correlates. Journal of Person-
ality and Social Psychology, 59, 91–101.
Sar, V., Alioğlu, F., Akyuz, G., Tayakısı, E., Öğülmüş,
E. F., & Sönmez, D. (2016). Awareness of identity
alteration and diagnostic preference between borderline
personality disorder and dissociative disorders. Journal
of Trauma & Dissociation, 18(1), 1–17.
Silberg, J. L. (2000). Fifteen years of dissociation in
maltreated children: Where do we go from here?
Child Maltreatment, 5, 119–136.
Spanos, N. P. (1994). Multiple identity enactments and
multiple personality disorder: A sociocognitive per-
spective. Psychological Bulletin, 116, 143–165.
Dissociative Disorders
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Some of the most controversial forms of psycho-
pathology fall under the broad umbrella of dis-
sociative disorders (DDs). This group of
disorders shares the common characteristic of
having an alteration in consciousness that affects
memory and identity (American Psychiatric
Association 2000). These disorders have been
attributed to pathological levels of psychological
stress, with the levels of stress disrupting the
normal integration of personality and mental
life to the extent that some aspects of experience,
thought, and action are split off from conscious-
ness. It is this split that leads to the use of the term
“dissociation.” Disorders from this group are
based on clinically relevant dissociative charac-
teristics not because of the mere presence of
dissociation or its use as a defense in due to
trauma; rather dissociative states are relevant
because the dissociation continues and has
important effects once the immediate trauma
has passed.
In the Diagnostic and Statistical Manual
(DSM-IV-TR, American Psychiatric Association
2000) identifies five major dissociative disorders.
The first is the dissociative identity disorder,
1037
which is formerly known as multiple personality
disorder characterized by a patient’s appearing to
posses two or more distinct personalities (e.g., a
host and one or more alters) that alternate in their
control of the individual’s conscious experience,
thought and action separated, in varying degrees,
by amnesia. The second is the dissociative fugue
which involves amnesia relating to part or all of an
individual’s life. In this context, fugues involve a D
loss of identity and often physical relocation, such
as forgetting who one is and adopting a new
identity in a new location. The third, dissociative
amnesia, involves the loss of autobiographical
memory for certain past experiences; memory
loss must be more extensive than normal forget-
fulness and not explainable by a physical or neu-
rological condition. Dissociative amnesia
typically involves the inability to recall con-
sciously traumatic periods, especially from child-
hood. Depersonalization disorder, the fourth DD,
is characterized by a sudden sense of being out-
side oneself and having the sense of watching
ones actions as though one were watching a
movie. The last DD, dissociative disorders not
otherwise specified, is a catchall category used to
label patients who display some dissociative
symptoms but not to the extent that they qualify
for one of the major diagnoses.
Controversy continues to surround this group
of disorders. There is some consensus that they
typically develop as a way to cope with trauma,
especially chronic physical, sexual, or emotional
abuse or even a frightening or highly unpredict-
able home environment (see Kihlstrom 2005).
But, some rightly argue that evidence in this
respect mainly consists of retrospective self-
reports made by the patients, which makes it
difficult to determine whether reports reflect indi-
viduals’ vivid imaginations, their views of their
own problems, or their therapists’ suggestions
(Id.). Although considerable progress has been
made toward understanding the nature of disso-
ciative disorders, as well as their assessment and
treatment, including as they relate to children and
adolescents (see Silberg 2000), reviews continue
to find much of this area of research, especially
those relating to etiological pathways, unconvinc-
ing (Kihlstrom 2005).
1038
Cross-References
▶ Dissociation
▶ Dissociative Identity Disorder
References
American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders (4th ed., Rev.
Text). Washington, DC: Author.
Kihlstrom, J. F. (2005). Dissociative disorders. Annual
Review of Clinical Psychology, 1, 227–253.
Silberg, J. (2000). Guidelines for the evaluation and treat-
ment of dissociative symptoms in children and adoles-
cents. Journal of Trauma & Dissociation, 1, 105–134.
Dissociative Identity Disorder
Scott Weber
Nursing and Public Health, University of
Pittsburgh, Pittsburgh, PA, USA
Overview
Dissociated cognition is defined as thinking and
feeling that have not become successfully inte-
grated into the usual sense of self. This results in
discontinuities in conscious awareness and dis-
ruptions in ongoing linkages and connections in
the development of identity. Dissociation is
believed to be one of the most common underly-
ing psychological processes among children and
adolescents receiving mental health treatment, but
most of the dissemination of information about
dissociation has occurred among psychiatrists and
psychologists. Clinicians familiar with the char-
acteristics of dissociative identity disorders can
identify early symptoms of dissociation in chil-
dren and adolescents; those who practice in psy-
chiatric settings, emergency departments, and
community health should be especially cognizant
of the clinical features of dissociation in pediatric
patients. Prognosis in children and adolescents
can vary widely among patients and between the
specific types of dissociative disorder. Experi-
enced clinicians and researchers underscore that
Dissociative Identity Disorder
early, intense treatment offers the greatest likeli-
hood of full recovery. Illness identification
methods for the specific components of the disor-
der that most often affect children and adoles-
cents, amnesia and depersonalization, as well as
modes of treatment, will be described in this
essay. Recognizing that dissociative identity dis-
order includes a continuum of symptoms during
development, the terms child and adolescent are
used interchangeably in this essay.
Dissociative Identity Disorder
Dissociation may be seen as a developmental
disruption in the integration of adaptive memory,
sense of identity, and the self-regulation of emo-
tion. Adaptive memory provides elastic capacity
to draw constructive lessons, and create linkages,
from difficult or painful experiences and includes
the capacity to actually alter memories to integrate
more constructively with identity and baseline
collective memories. Sense of identity is the
foundation of context upon which memories and
experiences interrelate to derive meaning of
experiences. Identity can qualitatively modify
experiences before they are fully integrated into
memory, but identity itself can likewise be altered
if stimuli are so powerful or painful so as to leave a
lasting imprint or scar.
Self-regulation of emotions involves the medi-
ating capacity an individual uses, in an organized
manner, to interpret experiences, emotions, and
memories. According to Siegel (2007), integra-
tion is broadly defined as “how the mind creates
a coherent self-assembly of information and
energy flow across time and context” (p. 316)
and create whole, cohesive identifies. Neuronal
firings create associations between these compo-
nents of memory, identity, and this unimpeded
energy flow allows us to regulate, process infor-
mation, and organize memories – and thereby
create cohesion. Siegel (2007) sees the develop-
ment of an integrated self as an ongoing process
by which the mind continues to make increasingly
organized connections that allow adaptive action.
There is no clear consensus on the exact
etiological pathway for the development of
Dissociative Identity Disorder
dissociative symptomatology, but newer theoreti-
cal models stress impaired parent-child attach-
ment patterns (Liotta 1999; Barach 2006; Ogawa
et al. 2007). A second theory emphasizes trauma-
based disruptions in the development of self-
regulation of state transitions (Putnam 2006;
Siegel 2007). Newer thinking ties maladaptive
attachment patterns directly to dysfunctional
brain development that may inhibit integrative
connections in the developing child’s brain
(Schore 2001).
Children and adolescents may present with a
variety of dissociative symptoms that reflect a lack
of coherence or integration in the self-assembly of
mental functioning, including the following typi-
cal characteristics:
1. Inconsistent consciousness may be reflected in
symptoms of fluctuating attention, such as
trance states or “black outs.”
2. Autobiographical forgetfulness and fluctua-
tions in access to knowledge may reflect inco-
herence in developmental memory processes.
3. Fluctuating moods and behavior, including
rage episodes and regressions, may reflect dif-
ficulties in self-regulation.
4. The child’s belief in alternate selves or imagi-
nary friends that control the child’s behavior
and may reflect disorganization in the develop-
ment of a cohesive self.
5. Depersonalization and derealization may
reflect a subjective sense of dissociation from
normal body sensation and perception, or from
a sense of self (Schore 2001).
Dissociative symptoms have been found to
correlate with traumatic histories of significant
sexual abuse or physical abuse (Trickett et al.
2001; Macfie et al. 2005; Coons 2006; Dell and
Eisenhower 2008; Hornstein and Putnam 2009),
as well as war trauma (Cagiada et al. 2005) and
natural disasters (Laor et al. 2002.) Dissociative
symptoms in children have also been associated
with parenting styles described as severely
neglectful (Brunner et al. 2000; Sanders and
Giolas 2001; Ogawa et al. 2007), including
behavior that is severely rejecting and highly
inconsistent (Mann and Sanders 2004). However,
1039
it should be noted that each individual’s reaction
to life events is a constructive process that is
idiosyncratic, and what might overwhelm one
child or adolescent may not overwhelm another.
On the other hand, events which have not been
thought of as major trauma, such as repetitive
losses of attachment figures, peer rejection, obser-
vation of domestic violence, medical procedures,
chronic living instability, and emotional abuse, D
have nevertheless been found in the backgrounds
of children and adolescents displaying dissocia-
tive symptoms. There may be individual differ-
ences in children’s susceptibility to dissociative
symptoms which may be related to other traits,
such as fantasy-proneness (Rhue et al. 1995) or
other inherited personality traits (Jang et al. 2008).
The contribution of genetic factors in the devel-
opment of dissociative symptoms is somewhat
more controversial (Grabe et al. 1999).
Among adolescents, there are four recognized
categories of dissociative symptom disorders
which reflect the manifestations of the illness in
each person. For lay individuals, it might make
more sense to think of these as four continuous
disorders rather than as subcomponents of the
same diagnostic cluster. With added experience
and exposure in practice, it will become easier to
recognize interrelationships between the catego-
ries. It is important to recognize that these precise
subcategories might not be relevant for younger
children who are more likely to manifest more
generalized, non-specific symptoms, including
potentially with pronounced features of one or
more of the main subcategories. Younger children
usually display symptoms of either amnesia or
depersonalization. By contrast, true identity dis-
order, or what was previously called “fugue,” is
extremely rare even among adolescents in their
late teens.
Current DSM-IV-TR (American Psychiatric
Association 2004) are available for adults; there
are currently no separate pediatric criteria in
DSM-IV-TR but an initiative is underway to
develop pediatric and adolescent criteria for
DSM-V. Child and adolescent patients most
clearly reflect traits from the depersonalization
and derealization criteria as well as the amnesia
criteria; as noted, identity disorders are rare
1040
among children but may be partially expressed in
older adolescent patients.
Trauma and Abuse, and Development of
Dissociated Cognition
There is a strong correlation between traumatic
events and dissociative symptoms (Edwards et al.
2004; Kluft 2004). Thus, some children and ado-
lescents will present for evaluation with both dis-
sociative symptoms and a documented legal and
social service history of trauma. Others will pre-
sent with only the symptoms or the history but not
both. Still others will present with neither symp-
toms nor history. Trauma history may be masked
by a type of protective amnesia in the child or by
the family’s denial. It should not be considered
surprising if there is later disclosure by the child,
the family, or other witnesses to abusive behaviors
over the course of an extended assessment period.
Trauma Assessment
Clinicians in community health or emergency set-
tings who suspect child abuse, trauma or other
underlying cause of dissociative illness in chil-
dren should request an immediate referral to a
professional who is trained to evaluate pediatric
or adolescent patients with these disorders. These
professionals could include child psychiatrists,
psychologists, pediatric or psychiatric social
workers, nurses, nurse practitioners, or clinical
nurse specialists who have training and experi-
ence working with children and adolescents with
dissociative symptoms or pediatric mental health.
This initial practitioner might, in turn, refer a
pediatric patient to an advanced specialist who
focuses in working with patients with these clin-
ical symptoms and history. The initial evaluating
clinician should conduct a thorough assessment of
traumatic events in the child’s or adolescent’s
history. This assessment should include a review
of the following domains, including the function-
ality of the patient within each domain:
• Physical abuse, emotional and psychological
abuse, and sexual abuse; severe peer rejections
or isolation; witnessing marked violence,
Dissociative Identity Disorder
warfare, and war-related atrocities; “ethnic
cleansing”; and involvement in organized
criminal activities such as child pornography
or other types of sexual or behavioral exploi-
tation (Bidrose and Goodman 2006)
• Severe neglect or highly inadequate
attachment
• Devastating loss, including death of a parent or
loss of a parent through separation; and cata-
strophic illness or experiences with impending
death of the child, or illness or death of other
family members and close friends
Trauma and Amnesia
A child’s memory may or may not be affected by
trauma. Some autobiographical amnesia is under-
stood to be a normal developmental phenomenon
(Siegel 1996). While the frequency of traumatic
amnesia in children and adolescents is unknown,
clinical experience suggests that children and ado-
lescents may have sudden recall of previously
unavailable traumatic memories during or outside
of therapy sessions. This process has been
documented in cases where the traumatic events
were corroborated (Duggal and Sroufe 1998;
Corwin and Olafson 2007). Because children’s
memory is enhanced from practice and rehearsal
and is superior for events that are familiar
(Ornstein 2005), sexual abuse experiences may
not be as accessible to recall, especially when
shrouded in secrecy. Memory for traumatic events
for children in incest-committing families may
also be affected by the intense contradictory
pulls for attachment and for safety, as when the
source of abuse is also the source of nurturing
(Freyd 2006). In addition, violent threats from a
perpetrator may produce powerful incentives to
dismiss certain traumatic events from conscious
awareness so that an individual can more effec-
tively cope with day-to-day expectations.
An important point to remember in assessing
children and adolescents for trauma is that these
patients may lack verbal memories for traumatic
events but might instead be able to demonstrate
knowledge of events through sensorimotor
modalities or somatic symptoms (Burgess et al.
1995; Fivush et al. 2007; Stein and Waters 2009).
Evaluators should assess how children’s play, art,
Dissociative Identity Disorder
behavioral re-enactments, and somatic concerns
may be reflections of, or communicate informa-
tion about, highly traumatic signal events and
life patterns. In assessing and documenting the
severity of dissociative symptoms, all treating
advanced practice clinicians need to take into
consideration how severely the symptoms disrupt
normal developmental experiences such as
playing with peers or attending school, and how
far the child’s behaviors and experiences deviate
from what is characteristic of normal develop-
mental patterns (Schore 2001).
Assessing Memory Changes in Children
Memory loss and changes resulting from severe
trauma range from completely restricted to
broadly affecting major categories of a child’s or
adolescent’s memory. Trance states or “black
outs” may occur and may span the range from
momentary absences of attention (normal in chil-
dren and adolescents), to longer periods of non-
responsiveness, to excessive sleeping or fainting,
all the way to states described as “coma” or
“coma-like” (Cagiada et al. 2005). These lapses
must be distinguished from the neurological phe-
nomena of petit mal seizures in epilepsy. The
evaluator should determine what elicits these
absences in attention, how long they last, what
seems to interrupt them, how they end, what con-
sequences these disruptions have for the individ-
ual, and what the child or adolescent experiences
during these states.
True amnesia about one’s own recent behav-
ior is quite rare and is considered diagnostic of a
more severe dissociative process. More common
is amnesia for past traumatic signal events and
life patterns. More common still is transient for-
getting which quickly disappears once the child
or adolescent is working with an empathic ther-
apist. Parents may report that the child has no
memory of an event; children may use the
expression “I forgot” as a distraction, out of
guilt or shame, or because of lack of rapport
with the assessing therapist. In this context, one
therapist suggests asking children about whether
they forget good things (good grades, birthday
parties), as well as misbehavior or angry epi-
sodes that may help the therapist to discriminate
1041
between amnesia and a simple unwillingness to
report (Hornstein 1998).
Other useful techniques have proven effective
for assessing memory problems, but these
methods require significant training and should
be carefully considered and undertaken only by
trained therapists who are experienced in
implementing these modalities with children and
adolescent patients. These techniques include care- D
fully interviewing the child with the parent out of
the room, helping the patient express feelings asso-
ciated with the forgotten behaviors, role-playing
the forgotten behavior, providing abundant contex-
tual clues, and interventions to decrease the child’s
considerable sense of shame. If the patient reports
imaginary playmates or peers, the therapist should
take special care to differentiate normal imaginary
playmates or peers and fantasy material from path-
ological dissociative symptoms. Dissociative
pathology is suggested when the involvement in
fantasy interferes with normal activity, when the
child feels his behavior is outside of his or her
control, when the child experiences the imaginary
playmates as real, and when the child perceives
imaginary figures in conflict with each other
(Trujillo et al. 2006; Silberg 2008).
Assessing Changes in Affect and Behavior
Children normally go through changes in affect
and behavior during the course of an interview.
The therapist should be very careful not to pathol-
ogize normal state shifts. To gauge changing
affect, the therapist might inquire about the sub-
jective sense of discontinuity and about any stim-
uli that preceded a change in state, mood, ability,
or perceived identity (Carrion and Steiner 2000).
Frequently, the stimulus may be a feeling associ-
ated with a traumatic event or associated thoughts
which patients find too frightening or em-
barrassing to acknowledge. Children with disso-
ciative symptoms often have very colorful ways
of describing these phenomena that make it clear
that their changes feel dramatic, uncontrollable,
and puzzling. Even during assessment, the thera-
pist should try to connect these initially puzzling
changes with the child’s own perceptions, feel-
ings, goals, intentions, and communicative mean-
ings even if these are not obvious initially.
1042
Making these connections during assessment
will give therapists a better idea of the patient’s
receptivity to treatment as well as a sense of the
severity of the dissociation. Shifts that are dra-
matic and perplexing to the child or adolescent
may involve sudden regression, rage behavior,
apparent loss of consciousness, and they could
include suddenly talking about oneself in the
third person or with a new name. These shifts
suggest difficulty in the integration of affect,
consciousness, and identity. The therapist
should assess the reactions of caregivers, family
members, and others to these shifts in order to
gain a context for understanding the ongoing
influences shaping, promoting, or mitigating
dissociation.
Post-Traumatic Symptoms
Post-traumatic symptoms include positive or
overt symptoms, such as nightmares, night terrors,
disturbing hallucinations, intrusive traumatic
thoughts and memories, re-experiencing or flash-
backs, and traumatic re-enactments. Also
included could be negative or covert symptoms
such as numbing and avoidance. Standardized
screening instruments that might be helpful in
identifying these symptoms include the Trauma
Symptom Checklist for Children (Briere 2005),
the Trauma Symptom Checklist for Young Chil-
dren (Briere et al. 2001), or the Children’s PTSD
Inventory (Saigh et al. 2000).
Self-Injurious Behavior
Self-injurious behavior is common among disso-
ciative teens and young adults. This behavior may
include cutting, burning, scratching, or head-
banging. The behavior might be secretive, it
might serve an affect-regulating function, and it
might be performed while the patient is in a dis-
sociative trance-like state. The behavior could
also be used to facilitate or interrupt such a state.
The therapist should carefully inquire about all
stages of self-harm (cutting, burning, hitting)
including planning, preparing, engaging, and
recuperation, since some or all of these stages
might be performed in a dissociated state
(depersonalized, numbed, trance state, robotic
state, dream-like state). Therapists might find it
Dissociative Identity Disorder
useful to inquire as to relief experienced by such
self-harm; the infliction of physical pain com-
monly reduces emotional pain (Johnson 2002).
Standardized Assessment Measures
Psychotherapists who work with dissociative
patients should understand that no single instru-
ment could definitively diagnose clinical dissocia-
tive identity disorder. However, the measures
described in Table 1 are well established in the
field and may be employed as adjuncts in a multi-
faceted process of differential assessment.
Treatment of Dissociative Identity
Disorders in Children and Adolescents
Clinicians at the front lines of the healthcare team
are generally in ideal practice environments for
initial identification of key features of dissocia-
tion in children and adolescents with whom they
work. Yet, significant lack of awareness of this
disorder cluster still exists even among experi-
enced clinicians in community health, emer-
gency care, and in pediatric and adolescent
mental health care – settings in which clinicians
are most likely to initially screen individuals with
dissociative identity disorder and related illness.
Practitioners in these settings could have signif-
icant positive impact in immediately referring
children and adolescents to advanced practice
clinicians who are most expert in evaluation
of individuals with dissociative symptoms.
Early identification and care of children and
Dissociative Identity Disorder, Table 1 Assessment
tools for pediatric dissociative identity disorders
Adolescent Dissociative Experiences Scale (A-DES), a
first-stage screen; 30 items; average Cronbach alpha
coefficient = 0.93
Dissociative Experiences Scale for Children (DES-C),
first-stage screen; 44 items; average Cronbach alpha
coefficient = 0.94
Structured Clinical Interview for DSM-IV Dissociative
Disorders-Revised (SCID-D-R), diagnostic screen;
277 items; average Cronbach alpha coefficient = 0.95;
may be used for children, adolescents, or adults
Dissociative Identity Disorder
adolescents with these disorders is the main
determinant of improved prognosis.
Several therapeutic modalities that have
proven especially successful in treating children
and adolescents with dissociative identity disor-
der. It is important to know that treatment
approaches must be tailored to each patient.
While the state of the science of treatment
methods for dissociation is somewhat uneven
depending on the modality, new evidence is pro-
viding firmer foundations for improved applica-
tion of these approaches, especially gestalt and
play therapies for both children and older adoles-
cents (Laporta 2002; McMahon and Fagan 2003).
Examples of Therapeutic Goals
The treating psychotherapist can help the patient
achieve a sense of cohesive identity and whole-
ness if the child has had a difficult time achieving
this sense of integrated selfhood. The therapist can
enhance motivation for growth and future success
by helping the patient believe in his/her own skill,
potential, and capacity for wellness. A goal should
be to enhance motivation for success and future
accomplishments (Siegel 2007). This approach
promotes integration and helps defeat the resis-
tance to change. Therapists can employ the tech-
nique of teaching about how dissociation
prohibits growth and change. This encourages
the insightful adolescent patient to consciously
abandon dissociative strategies over time
(Schore 2001).
Another goal is to promote self-acceptance of
behavior and self-knowledge about feelings pre-
viously considered unacceptable. Dissociation
may protect the individual from awareness or
experience of deeply personal feelings of rage,
disappointment, grief, self-doubt, fear, shame,
physical pain, or sexual pain, abuse, or humilia-
tion (Schore 2001). Enhancing insight and aware-
ness of these features will promote integration.
Education about sexuality and affect may assist
with this process (Wieland 2007). Teaching how
to recognize early implicit memories and how
they can affect one’s developmental integration
can also help both adolescents and their parents
1043
to understand the deeply personal experience of
dissociation.
Intervention Techniques
Gestalt techniques involving dramatizing, and
thus “giving voice to,” a variety of opposing and
conflicting feelings may stimulate this process of
self-awareness and promote acceptance of disso-
ciated feelings (Waters and Silberg 1998a, b; D
Shirar 2006). The therapist could model the
acceptance of all contrasting feelings and remind
the patient of these feelings when they are not
otherwise immediately accessible. This technique
helps to break down dissociative barriers.
Another focus is to assist the child with reso-
lution of conflicting feelings, wishes, loyalties,
identifications, or contrasting expectations. The
child may perceive these as conflicts between
internal voices, imaginary friends, or conflicting
identities. The therapist helps the child find ways
to express these conflicts directly, examine both
sides of the conflict, and problem-solve toward
integrative solutions so that, over time, there is
no longer a need for dissociative escape or a
fragmented sense of identity.
One of the long-established and highly effec-
tive treatment methods used in working with chil-
dren and younger adolescents is play therapy in
which these various conflicts, contrasting role
expectations, or dissociated feelings are enacted
in play and brought to conscious awareness with
the therapist’s guidance. This process can encour-
age a natural integration and development of
cohesive identity in younger adolescents (Albini
and Pease 1999; Laporta 2002). This process may
be facilitated by specific play activities or by
imagery and even hypnotic techniques among
highly trained and experienced clinicians
(Waters and Silberg 1998b; Gil 2001; McMahon
and Fagan 2003; Kluft 2005; Shirar 2006). With
teenagers, some therapists recommend having the
client write letters to the self to dramatize aloud
internal dialogues as a way to facilitate resolution
of competing wishes or feelings. These exercises
promote self cohesion without reinforcing the
separateness of identities. Therapists should take
note of situations where these conflicts cannot be
resolved without a concomitant change in the
1044
environment (Gil 2001). For example, patients
may be caught in custody battles, with widely
divergent expectations between parents that may
lead to a fragmented sense of identity. The patient
alone often cannot resolve this inner conflict
unless the environmental pressure is lessened.
An effort to desensitize traumatic memories
and correct learned attitudes toward life resulting
from traumatic events may be attempted (Shirar
2006). Talk to the patient about overwhelming
experiences and their associated affects and
perceptions. This helps to desensitize the child’s
conditioned fear responses to any frightening
memories. The patient’s access to these memories
may be variable as treatment progresses. How-
ever, as the child moves towards a more cohesive
sense of self, such memories may become more
accessible. These memories may become more
accessible as the child moves toward a more cohe-
sive sense of self. The therapist should be careful
to gradually introduce discussions about trau-
matic content and not overwhelm the child
(James 1989). Play therapy with trauma patients
tends to involve more active intervention for
reworking of traumatic themes than other kinds
of play therapy.
Eye movement desensitization and
reprocessing (EMDR) therapy, when conducted
by a trained and experienced clinician, can assist
adolescent patients in working through experi-
ences for which they have very little or no explicit
memory, or experiences that they find too difficult
to talk about in detail (Greenwald 2003; Tinker
and Wilson 2008). Ego-strengthening and
calming techniques are advisable prior to using
EMDR to avoid destabilization (Greenwald
2003). Techniques that help improve the child’s
sense of efficacy and mastery are always encour-
aged when dealing with traumatic content (Gil
1996, 2001; Friedrich 2001; James 2004).
Traumatic re-experiencing may take the form
of flashbacks, in which the adolescent patient
experiences past events as if they were currently
actually happening. Imagery techniques that
guide the individual toward mastery experiences
may be helpful (Friedrich 2001; Williams and
Velazquez 2006). Families can set designated
times to discuss unpleasant memories so that
Dissociative Identity Disorder
these do not interfere with daily functioning
(Waters 1998). Some traumatized adolescent
patients engage in flashbacks during parental
fights or when asked to do chores; thus, under-
standing the complete context in which these
flashbacks occur is essential before designing
interventions.
Adolescent patients with dissociative symp-
toms arising from trauma may develop a variety
of learned attitudes which may include helpless-
ness, belief in a bad self, being destined for bad
things, and being unlovable. These beliefs need to
be corrected during therapy (Wieland 1997;
American Academy of Child and Adolescent
Psychiatry 1998; Deblinger and Heflin 2006).
Dissociative children may hold contradictory
beliefs or contradictory attachment styles with
associated beliefs which may make this aspect of
treatment particularly challenging (Liotta 1999).
Carefully pointing out these contradictions within
the context of an accepting therapeutic relation-
ship can eventually lead to successful integration.
The therapist should promote autonomy and
encourage the patient to independently regulate
and express affects and to self-regulate state
changes.
Therapists and caregivers can help adolescent
patients to identify precursors to state changes so
that they become better at self-monitoring (James
1989; Allers et al. 2001; Gil 2001). A highly
effective treatment approach for older children
with post-traumatic stress disorder has been
developed by Cohen and colleagues (Cohen
et al. 2004, 2005). Self-injury may become a
mood-altering addictive behavior that serves to
distract from emotional pain or expression of feel-
ings of despair and anger. Individuals engaging in
repetitive self-harm must learn alternatives
including more direct expression of feelings and
improved methods of mood regulation; family
members must assess ways in which they can
learn to reinforce positive methods of affect-self-
regulation.
Self-monitoring may be encouraged by use of
special code words whereby a parent, caregiver, or
teacher can let a child know a shift has occurred
or, conversely, these words or slogans can stimu-
late focused attention. Cognitive-behavioral
Dissociative Identity Disorder
techniques can help patients learn to manage self-
destructive and impulsive behavior, including
impulsive sexual behavior. Individual behaviors
can be reinforced for identifying changes in
moods or states, interrupting dysfunctional impul-
sive habits, and engaging in drawing, writing,
talking to adults, or other expressive alternatives.
Therapists can teach adolescent patients tech-
niques of promoting active attention that may
help interrupt sexual misbehavior or other disrup-
tive behavior that occurs during dissociative states
(Johnson 2002). Teaching use of positive imagery
and relaxation for self-soothing and stress reduc-
tion may be very useful.
Therapists and caregivers can encourage chil-
dren to communicate feelings of anger, fear, and
regressive needs to their caregivers so that these
are not enacted in dysfunctional ways. In addi-
tion, the therapist can teach caregivers to tolerate
these direct expressions. This interaction pro-
motes healthy attachment though it may be diffi-
cult for families that are uncomfortable with
affect and have poor boundaries. The goal should
be to help families and adolescents view the
therapist as a stable attachment figure, particu-
larly for patients and families from chaotic envi-
ronments. Group therapy may be useful,
particularly if it is psycho-educational in orien-
tation (Silberg 1997; Brand 1998). Promotion of
positive peer interactions may help build long-
term resiliency for children and adolescents with
dissociation.
Family Therapy
Work with the primary caregivers may include
education about dissociation (Waters 1998), spe-
cific guidance about parenting strategies which
facilitate therapy (Boat 2007), family sessions to
encourage the family to accept all aspects of the
child (Waters and Silberg 1998b), correcting inter-
active patterns that promote dissociation
(Benjamin and Benjamin 1993; Silberg 2001),
helping parents process guilt or denial about trau-
matic events (Keren and Tyano 2000), working
through of feelings about issues of safety and
betrayal to help establish trust (Waters 1998),
and straightforward parenting advice or training
which is part of all good child therapy.
1045
In educating parents, change any literal views
the family may have about the reality of “alter
egos” as separate from the child, while explaining
how dissociation evolves in a traumatized child.
Parents can be taught to encourage the child’s
direct expression of thoughts and feelings without
reinforcing dysfunctional dissociative strategies.
The therapist can also help the family identify
current reinforcers that maintain the symptom- D
atology, such as family indulgence or overly puni-
tive responses in the face of regressive behavior.
For children residing in original homes in
which maltreatment or unintentional exposure to
traumatic events occurred, acknowledgment of
the trauma and an apology for the lack of protec-
tion is a basic starting point for much of the family
therapy work (Deblinger and Heflin 2006). Dyad
work with the parent figure and the child can be
particularly valuable in helping the therapist
understand the subtle negative dynamics that
may be occurring in the home. This would be a
time when the therapist, parent and child can
develop ideas for handling problem situations
at home.
Hypnotherapy
Hypnotherapy for children and adolescents,
conducted by thoroughly trained and experienced
therapists, has been described for rapidly
accessing ego states and promoting integration
(Kluft 2000, 2005; Bowman et al. 2005; Dell
and Eisenhower 2008) or for containment of
intense affect, ego strengthening, education, and
support. Hypnotherapy is not advised for memory
retrieval (Williams and Velazquez 2006). In cases
where hypnosis is deemed appropriate, the thera-
pist should gain informed consent from caregivers
or guardians, as well as clients. The therapist
should explore all legal implications, given that
witness credibility for any upcoming court hear-
ings could be affected (American Psychological
Association 2008).
Pharmacotherapy
There are no controlled studies on the use of
medications with dissociative children, adoles-
cents, or adults. However, some clinicians have
found that psychotropic medication may be of
1046
benefit for children and adolescents with dissocia-
tive symptoms and disorders as an adjunct to
psychotherapy to ameliorate targetable symp-
toms, such as incapacitating anxiety, insomnia,
lability, behavioral dyscontrol, inability to focus
attention, and depression (Silberg et al. 1997;
Putnam 2006; Nemzer 2008). A consultation
with a psychiatric primary care clinician with
prescribing authority and experience in working
with dissociative children, or similar advanced
professional, should be obtained. Medications
may also be utilized to treat co-morbid conditions
such as attention deficit hyperactivity disorder,
major depression, obsessive-compulsive disorder,
or post-traumatic stress disorder. If they are sepa-
rate members of the care team, close communica-
tion and teamwork between the prescribing
clinician, pediatrician, and the psychotherapist is
essential.
Art Therapy
The goal with art therapy is to strike a balance
between art that encourages mastery and art that is
regressive, limiting the latter if it simply becomes
a form of traumatic re-enactment without trauma
resolution. Most child therapists use some art in
their work, and art therapy from a licensed art
therapist may be a useful adjunct to individual
treatment in some cases (Sobol and Schneider
2006).
Educational Interventions
Children and adolescents with dissociative symp-
toms may require special education modifications
if their disruptive behavior, mood instability, and
poor attention interfere with academic function-
ing. With supportive staff, however, many chil-
dren with dissociative symptoms can succeed in
regular classrooms (Deblinger and Heflin 2006).
Therapists will find it essential to work closely
with school staff in this domain of patient care.
School staff, in turn, should help encourage the
child or adolescent to stay focused even while
mood and attention fluctuate. It should be
assumed that the child or adolescent will bring
his or her full potential to the school setting and
an attitude of accountability is encouraged. The
school staff should convey an attitude of
Dissociative Identity Disorder
understanding and reward effort and approxima-
tions of desired goals (Benjamin and Benjamin
1993). Pre-arranged code words or signals that
stimulate attention and focus may be useful
(Waterbury 1998).
Therapists should ensure that school staff
encourages children and adolescents to monitor
themselves to access the greatest potential possi-
ble, should set clear and firm limits about expec-
tations, and provide regular opportunities for the
child to communicate about sources of stress in
the school environment or at home that may
impact on performance (Deblinger and Heflin
2006). Discourage special attention from other
students related to extreme shifts in behavior.
Designate one member of the staff to deal with
any dramatic shifts, such as age regression (Shirar
2006). School environments would be ideal set-
tings to incorporate expressive arts into the cur-
riculum for expression of feelings (Waterbury
1998). Teachers must be attentive to the child’s
or teenager’s needs to have stable attachment fig-
ures in the school setting (counselors, advisors, or
teachers) with whom they have a special relation-
ship and with whom they can frequently commu-
nicate (Koback et al. 2008).
Summary
Clinicians who screen and do first-level assess-
ments of youth with dissociative symptoms can
recognize basic features of this disorder and can
help to ensure that the proper referrals to special-
ized care are provided. A beginning understand-
ing of the characteristics of dissociative identity
disorders as they affect pediatric patients is nec-
essary. As children get older their symptoms may
emerge into adult forms of dissociation. Early
intervention helps to reduce the severity of symp-
toms and can significantly improve long-term
prognosis.
Primary care clinicians and school staff can
lead the way in helping children and adolescents
who suffer from dissociative symptom disorders
to become whole and healed, and to make the
transition to a healthy adulthood. An interdisci-
plinary program of treatment for children and
Dissociative Identity Disorder
adolescents with dissociative identity disorders
must address therapeutic needs in all domains of
growth and development, including school, home,
and relationships with peers.
Cross-References
▶ Dissociation
▶ Dissociative Disorders
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Diversion Programs D
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Diversion involves the use of a variety of mea-
sures other than formal adjudications in the juve-
nile court and juvenile justice systems. Decisions
to divert youth are made at intake, which is the
first point at which a juvenile is taken into custody
on suspicion of having committed a delinquent
act, status offense, or criminal act. Diversion
involves using other agencies, often private
ones, that will take on the challenge of rehabili-
tating offenders, typically those who are first-time
offenders and status offenders who pose no threat
to others or themselves. The use of diversion pro-
grams rests on the theory that, for some youth, the
formal justice system may do them more harm
than good (see Lundman 1993). Although for-
mally outside of the juvenile justice system,
these programs are meant to further the juvenile
courts’ notion that formal legal sanctions and pro-
cessing runs the risk of inadvertently stigmatizing
some youth for having committed relatively petty
acts and lead them to engage in more rather than
less problem behavior. In addition to furthering
these ideals, diversion programs also are meant to
help the juvenile and criminal courts avoid further
overburdening their systems and focus on more
serious offenders.
Considerable theory supports the view that
legal interventions by the juvenile justice system
may actually perpetuate delinquency, which is
what lead to the development of diversion pro-
grams to deal with cases that might be more
appropriately remedied in informal settings within
the community. This view has been held for a long
time; the President’s Commission on Law
1050
Enforcement and the Administration of Justice’s
report (1967) called for and led to the creation of
youth services bureaus to develop alternative pro-
grams for juvenile offenders within local commu-
nities. The establishment of these bureaus, which
quickly appeared in most communities, began a
movement toward diverting youth, especially sta-
tus offenders and nonserious delinquents, from
the juvenile court.
The movement to use diversion has not been
without its challenges. In addition to the reality
that not that many diversion programs exist, diver-
sion programs remain challenged by the need to
match offenders’ needs with programs’ services.
To complicate matters even more, evaluations of
diversion programs report mixed findings. Many
studies have demonstrated that diversion pro-
grams work, while some have found no impact,
while still others have found them to be detrimen-
tal (see Dembo et al. 2005). Reviews suggest that
the most successful diversion programs provide
more intensive and comprehensive services and
use more experienced caseworkers (see Dryfoos
1990), and such provisions tend to be much less
cost effective than was hoped and can actually be
as costly as traditional programs. Still, leading
evaluations have found that interventions, regard-
less of whether conducted in traditional juvenile
justice settings or in alternative programs, do
result in increases in levels of perceived labeling
and self-reported delinquency among youth (see,
e.g., Lipsey et al. 1981). These findings support
those from other studies indicating that client
characteristics, especially arrest history, likely
play an important role in determining the out-
comes of interventions (see Campbell and
Retzlaff 2000; Sullivan et al. 2007). These types
of findings are of considerable importance in that
they counter the reasons for using diversion pro-
grams as they also highlight the problems encoun-
tered by traditional programs.
The lack of successes reported for at least some
programs exacerbates other potentially negative
consequences of using diversion programs that
are deemed effective. Two potentially negative
repercussions are illustrative. The first concern is
that diversion programs can result in “net-
widening” effects. Net-widening occurs, in this
Diversion Programs
context, when programs bring more youth to the
formal juvenile justice system when they were
meant to do the opposite and when the youth
would have never entered the system in the first
place given that the system would have otherwise
ignored their offenses (see Decker 1985). The
second concern involves the disparate treatment
of minority youth; youth from some minority
groups fare worse than others at each subsequent
stage of processing by the juvenile justice system
(see Leiber and Stairs 1999). Although the rea-
sons for the disparate treatment are difficult to
entangle, research in this area raises concerns
about prejudice, discrimination, and civil rights
violations. Together, research in this area reports
important findings suggesting successes and mis-
steps, and it highlights the need for efforts to
proceed cautiously as they seek to assist youth,
families, and their communities.
References
Campbell, J. S., & Retzlaff, P. (2000). Juvenile diversion
interventions: Client characteristics and program out-
comes. Journal of Offender Rehabilitation, 32, 57–73.
Decker, S. H. (1985). A systemic analysis of diversion: Net
widening and beyond. Journal of Criminal Justice, 13,
207–216.
Dembo, R., Wareham, J., Schmeidler, J., & Chirikos,
T. (2005). Evaluation of the impact of a policy change
on diversion program recidivism and justice agency
costs: 12-month follow-up. Journal of Offender Reha-
bilitation, 41, 93–122.
Dryfoos, J. (1990). Adolescents at risk: Prevalence and
prevention. New York: Oxford University Press.
Leiber, M., & Stairs, J. (1999). Race, contexts, and the use
of intake diversion. Journal of Research in Crime and
Delinquency, 36, 56–86.
Lipsey, M. W., Cordray, D. S., & Berger, D. E. (1981).
Evaluation of a juvenile diversion program: Using mul-
tiple lines of evidence. Evaluation Review, 5, 283–306.
Lundman, R. J. (1993). Prevention and control of delin-
quency (2nd ed.). New York: Oxford University Press.
President’s Commission on Law Enforcement and the
Administration of Justice. (1967). Task force report:
Juvenile delinquency and youth crime. Washington,
DC: U.S. Government Printing Office.
Sullivan, C. J., Veysey, B. M., Hamilton, Z. K., & Grillo,
M. (2007). Reducing out-of-community placement and
recidivism – Diversion of delinquent youth with mental
health and substance use problems from the justice
system. International Journal of Offender Therapy
and Comparative Criminology, 51, 555–577.
Divorce
Divorce
Jennifer E. Lansford
Center for Child and Family Policy, Duke
University, Durham, NC, USA
Overview
This entry reviews research on associations
between parental divorce and adolescents’ adjust-
ment. First, evidence regarding associations
between parental divorce and adolescents’ adjust-
ment is presented. Although, on average, adoles-
cents whose parents divorce are at risk for more
externalizing and internalizing problems, lower
levels of academic achievement, and more prob-
lematic social relationships than are adolescents
whose parents do not divorce, most adolescents
whose parents divorce do not have long-term
adjustment problems. Second, consideration is
paid to methodological issues, including the nec-
essarily correlational nature of the data, control-
ling for potential confounds, and taking into
account not only the divorce of adolescents’ bio-
logical parents but also exposure to subsequent
remarriages and divorces. Third, controversies
involving mechanisms that have been hypothe-
sized to account for links between parental
divorce and adolescents’ adjustment are
reviewed. These include attention to interparental
conflict, economic disadvantage, disrupted par-
enting, and parents’ distress as mediators of rela-
tions between divorce and adolescents’
adjustment. Fourth, gaps in knowledge regarding
the extent to which genetic factors interact with
environmental factors to shape adolescents’
adjustment following their parents’ divorce are
discussed. The entry culminates in a summary of
conclusions.
Studying Parental Divorce’s Effects on
Adolescents
In the United States, approximately 50% of first
marriages end in divorce, and 50% of American
1051
children will experience their parents’ divorce.
Given the large number of families affected by
divorce, it is important to understand how
experiencing parental divorce affects adolescents’
adjustment. Two central questions are addressed
in this entry. First, how does the experience of
parental divorce affect the adjustment of adoles-
cents? Second, what are the methodological
issues, controversies, and gaps in knowledge that D
should be taken into account in understanding
links between parental divorce and adolescents’
adjustment?
The preponderance of the research evidence
suggests that divorce has some negative effects
on adolescents’ adjustment but that these effects
may be small in magnitude and not universal
(Lansford 2009). Externalizing behaviors (such
as aggression and delinquency), internalizing
problems (such as depression and anxiety), aca-
demic achievement (such as grades in school),
and quality of social relationships (with peers
and parents) are the most frequently examined
indicators of adjustment in the divorce literature
(see Amato 2010 for a review). The largest effects
appear to relate to adolescents’ relationships with
their fathers. Studies that have compared the
adjustment of adolescents whose parents have
divorced with the adjustment of adolescents
whose parents have not divorced generally have
found that adolescents whose parents have
divorced are at greater risk for externalizing and
internalizing problems, lower academic achieve-
ment, and more difficulties in social relationships,
both during adolescence and as they develop into
adulthood.
However, not all adolescents whose parents
have divorced demonstrate these problems. In
fact, Hetherington and Kelly (2002) concluded
that 25% of individuals whose parents divorce
have serious long-term behavioral, psychological,
or social problems in adulthood, in comparison to
10% of individuals whose parents have stayed
together. Therefore, 75% of individuals whose
parents divorce do not have serious long-term
impairment that lasts beyond adolescence into
adulthood. Similarly, Amato (2003) estimated
that 10% of children who experience parental
divorce experience poorer psychological
1052
adjustment in adulthood than they would have if
their parents had stayed together, 18% of children
who experience parental divorce have more con-
flict in their own marriages than they would have
if their parents had stayed together, and 35% of
children who experience parental divorce have
lower quality relationships with their fathers than
they would have if their parents had stayed
together. Even when differences are found
between adolescents whose parents divorced and
those whose parents stayed together, the effect
sizes typically are small. As a whole, an extensive
research literature suggests that the majority of
adolescents who experience parental divorce do
not have long-term adjustment difficulties, but the
risk of externalizing and internalizing problems,
poorer academic achievement, and problematic
social relationships is greater, on average, for ado-
lescents who experience parental divorce than for
adolescents who do not.
The timing of divorce may be important,
although studies have shown mixed results. Com-
pared to adolescents, children may be less capable
of realistically assessing the causes and conse-
quences of divorce, may feel more anxious about
abandonment, may be more likely to blame them-
selves, and may be less able to take advantage of
resources outside the family to cope with the
divorce. This explanation could account for find-
ings from some studies that children experience
more problems after parental divorce than do ado-
lescents. Other research suggests that adjusting to
parents’ remarriage following divorce may be
harder for adolescents than for children. One pos-
sibility is that divorce is most likely to affect
aspects of adjustment that are developmentally
salient at the time of the divorce. For example,
because of the developmental salience of aca-
demic achievement, identity development, sub-
stance use, and emerging romantic relationships
during adolescence, these aspects of adjustment
may be especially affected by divorce that occurs
during adolescence. Indeed, adolescents who
have experienced parental divorce have been
found to be at risk for early-onset sexual activity
and substance use in adolescence, as well as other
internalizing and externalizing problems that may
be less age dependent.
Divorce
In most studies, age is tied to the time of data
collection rather than the time of divorce, making
it difficult to interpret age differences because it is
not clear whether they merely reflect a recency
effect. The most common methodological
approach is to study children in a particular devel-
opmental stage (e.g., early childhood, middle
childhood, adolescence) and to compare the
adjustment of those whose parents have divorced
with the adjustment of those whose parents have
not divorced. A limitation of this approach is that
the length of time between the parents’ divorce
and the time of participation in the study will vary
considerably across the sample. To overcome this
limitation, Lansford et al. (2006) used the time of
divorce as an anchor point and modeled trajecto-
ries of adjustment over a period from 1 year prior
to the divorce to 3 years after the divorce, using
prospective longitudinal data collected annually
for 12 years. Results suggested that parental
divorce during childhood (between kindergarten
and grade 5) exerted more adverse effects than
divorce during adolescence (between grades
6 and 10) on internalizing and externalizing prob-
lems, whereas divorce during adolescence exerted
more adverse effects on academic achievement.
Methodologically, longitudinal trajectory ana-
lyses are important because although one can
control for prior adjustment in analyses predicting
adjustment at a single point in time, such analyses
do not allow for an examination of how develop-
ment unfolds over time. Adolescents often have
adjustment difficulties in close temporal proxim-
ity to their parents’ divorce, but after an initial
adjustment period, some of these difficulties may
subside. Other difficulties, however, may not
manifest themselves immediately after the
divorce but rather may not become apparent
until adolescence or adulthood, at developmen-
tally salient points in time. For example, parental
divorce may curtail educational achievement or
disrupt social relationships in ways that are not
apparent until children try to enter the labor mar-
ket, establish romantic partnerships, or become
parents. A more comprehensive understanding
of adolescents’ long-term adjustment is gained
by examining trajectories that extend from before
the parents’ divorce to well after the divorce.
Divorce
In addition to age, there are several other miti-
gating factors that contribute to whether and how
divorce is related to adolescents’ adjustment. One
of the most notable of these factors is adolescents’
adjustment prior to their parents’ divorce. There is
evidence from prospective longitudinal studies fol-
lowing participants from childhood into adulthood
that children whose parents eventually divorce
have more adjustment problems prior to the
divorce than do children whose parents do not
divorce, suggesting that differences in adjustment
after the divorce are not attributable entirely to the
divorce per se. Another mitigating factor is chil-
dren’s positive attributes (e.g., attractiveness, easy
temperament, social competence). Positive attri-
butes can promote resiliency following parental
divorce, perhaps in part because children with pos-
itive attributes are more likely to receive support
from teachers, peers, or others outside the family.
Many studies have investigated whether there are
gender differences in links between divorce and
adolescents’ adjustment. The findings have been
mixed and inconclusive, with some studies
reporting worse outcomes for girls who experience
parental divorce, some studies reporting worse out-
comes for boys who experience parental divorce,
and some studies reporting no gender differences in
outcomes associated with parental divorce.
Measurement Issues
Studies of links between parents’ divorce and ado-
lescents’ adjustment are necessarily correlational
because children cannot be randomly assigned to
family structure groups. Therefore, uncontrolled
variables may be responsible for links between
parental divorce and adolescents’ adjustment. To
overcome these measurement limitations, rigorous
studies have collected longitudinal data and con-
trolled for potential confounds. Examining longi-
tudinal trajectories of adjustment makes it possible
to track change over time from before the divorce
occurs to some period after the divorce. Because
adolescents whose parents eventually divorce
show poorer adjustment prior to the divorce than
do children whose parents do not divorce and
because parents who eventually divorce are also
1053
more likely to have other risk factors not shown by
parents who do not divorce, controlling for pre-
divorce adjustment, modeling trajectories of
adjustment that begin prior to parental divorce,
and handling selection effects in other ways is
important (Amato and Anthony 2014).
Another measurement issue is that many ado-
lescents whose biological parents divorce are
exposed not just to that divorce but also to subse- D
quent remarriages and divorces. In studies that do
not take into account adolescents’ exposure to
multiple marital transitions, adolescents’ adjust-
ment to divorce may be confounded with their
adjustment to additional marital transitions. Ado-
lescents exposed to multiple marital transitions
generally are at higher risk for adjustment diffi-
culties than are adolescents exposed to fewer mar-
ital transitions, and there is evidence that parental
remarriage (and issues associated with dating and
sexuality that remarriage raises) may be especially
difficult for adolescents given the developmental
salience of emerging romantic relationships in
their own lives.
Controversies
A main controversy in the divorce literature is
whether divorce per se accounts for differences
in adjustment between adolescents whose parents
have divorced versus those whose parents have
stayed together or whether differences between
these groups of adolescents can be accounted for
by other factors that are associated with parental
divorce. Theory and research on effects of divorce
on adolescents’ adjustment have suggested
interparental conflict, economic disadvantage,
disrupted parenting, and parental distress mecha-
nisms as explanations of why divorce is associ-
ated with adolescents’ adjustment (e.g., Weaver
and Schofield 2015). Each of these mechanisms is
discussed in turn. The preponderance of the evi-
dence suggests that taking into account these
explanatory mechanisms attenuates, but does not
entirely eliminate, associations between divorce
and adolescents’ adjustment.
First, an interparental conflict perspective has
received the most empirical support as an
1054
explanation of why divorce is associated with
adolescents’ adjustment. High levels of
interparental conflict have negative and long-
lasting implications for adolescents’ adjustment,
especially if this conflict leads adolescents to feel
caught between their parents or forced to take
sides. Adolescents exposed to overt interparental
conflict such as screaming, insulting, hitting, or
threatening have been found to show higher levels
of externalizing problems than adolescents not
exposed to overt interparental conflict. Exposure
to covert interparental conflict such as having the
adolescent carry messages between parents or
putting down the other parent in discussions
with the adolescent has been associated with
higher levels of internalizing problems for adoles-
cents. Dissolution of a high-conflict marriage
might reduce adolescents’ exposure to the stress
of daily conflict between parents and the modeling
of dysfunctional interpersonal interactions this
entails, resulting in improved adjustment for ado-
lescents. The dissolution of a low-conflict mar-
riage, on the other hand, may come as more of a
surprise for adolescents and they may experience
more of a sense of loss rather than relief, contrib-
uting to an increase in adjustment problems.
Taken together, the implication is that reducing
adolescents’ exposure to interparental conflict
benefits their adjustment, regardless of whether
parents are married or divorced (see Sandler
et al. 2008). Therefore, the effects of divorce will
depend, at least in part, on how the divorce relates
to adolescents’ exposure to interparental conflict.
Second, an economic disadvantage perspective
suggests that socioeconomic changes following
parental divorce mediate the association between
divorce and adolescents’ adjustment. A drop in
household income often accompanies divorce.
According to the US Bureau of the Census, 43%
of children in single mother and 26% of children
in single father households live in poverty, com-
pared to 10% of children in two-parent families.
Because adolescents most often live with their
mothers after their parents divorce, they may not
have access to the same financial resources as
before the divorce (especially if they are not receiv-
ing regular child support payments from non-
residential fathers). Having fewer financial
Divorce
resources also can be disruptive for adolescents
by leading to changes such as moves into more
dangerous neighborhoods or worse schools. Finan-
cial hardships can lead to behavioral and emotional
problems and may mediate the link between paren-
tal divorce and adolescents’ adjustment.
Third, according to a disrupted parenting per-
spective, divorce disrupts parents’ ability to par-
ent well, which, in turn, is detrimental to
adolescents’ adjustment. Regardless of family
structure, parenting problems are related to ado-
lescents’ adjustment difficulties. For example,
low levels of monitoring and supervision are
related to increases in adolescents’ problem
behavior such as substance use and risky sexual
behavior. Following divorce, parents may not be
able to monitor or supervise their adolescents as
closely because there is now one adult rather than
two adults to do the monitoring, and adolescents
may therefore spend more time at home without a
parent present. Furthermore, parent-adolescent
conflict often increases following divorce, and
parents’ discipline becomes less consistent.
Because positive relationships with parents can
serve a protective function in terms of reducing
adolescents’ vulnerability to negative peer influ-
ences, a decline in parent–child relationship qual-
ity can contribute to adolescents’ behavior
problems. However, just as adolescents with
divorced parents have been found to show worse
adjustment before the divorce than adolescents
whose parents do not divorce, parents who even-
tually divorce engage in more problematic parent-
ing practices before the divorce than do parents
who do not divorce. Therefore, neither parenting
problems nor adolescent adjustment problems can
be attributed solely to the divorce itself.
Fourth, a parental distress perspective suggests
that parents’ well-being mediates the link between
parental divorce and children’s adjustment. This
mechanism often is linked with economic disadvan-
tage and disrupted parenting perspectives to explain
the links as follows: Divorce and its attendant eco-
nomic implications increase parents’ depression,
anxiety, and stress, which disrupt parents’ ability
to parent well, which then negatively affects ado-
lescents’ adjustment. Conversely, this perspective
suggests that if parents cope well with the divorce
Divorce
and are able to maintain high-quality relationships
with their adolescents, then adolescents’ adjustment
will be less affected by the divorce.
In investigations of all four explanations for
why divorce is associated with adolescents’
adjustment problems, controlling for the explana-
tory factor (i.e., interparental conflict, economic
disadvantage, parenting problems, parent distress)
attenuates the link between parental divorce and
adolescents’ adjustment. However, the associa-
tion between divorce and adolescents’ adjustment
typically does not disappear entirely after control-
ling for these other factors. Researchers generally
have concluded that divorce poses a risk factor
above and beyond these other risk factors for
adolescent adjustment difficulties.
Gaps in Knowledge
A main gap in knowledge involves the extent to
which genetic factors interact with environmental
factors to shape adolescents’ adjustment following
their parents’ divorce. Parents with problems such
as depression, substance use, or antisocial behavior
are at risk of selecting spouses with similar prob-
lems, and these problems increase both marital
conflict and the likelihood that parents will divorce.
Offspring of parents with these problems are at risk
of similar problems because of both genetic and
shared environmental experiences (D’Onofrio
et al. 2006). It is clear that genetic and environmen-
tal contributions both shape whether individuals
will eventually divorce and, if they do, how their
adolescents may adjust to the divorce. For exam-
ple, the role of genetic factors in divorce has been
supported by twin studies showing that monozy-
gotic twins are more concordant than dizygotic
twins in their divorces. The role of environmental
factors has been supported by adoption studies
showing that children who experience their adop-
tive parents’ divorce have higher levels of behavior
problems than do children whose adoptive parents
do not divorce. Future research will help address
gaps in knowledge regarding the exact nature of
which genetic versus environmental factors con-
tribute to distinct developmental outcomes and
how genetic and environmental factors interact
1055
with one another to shape adolescents’ adjustment.
For example, future research would benefit from
examining how genetic factors influence adoles-
cents’ susceptibility to particular environmental
experiences, including parental divorce, and
whether problems associated with divorce are
evidenced primarily by adolescents at genetic risk.
D
Conclusions
Instead of simply comparing the adjustment of
adolescents whose parents have and have not
divorced, researchers have used increasingly
sophisticated longitudinal methods to understand
how trajectories of adjustment followed from
before to several years after parental divorce unfold
as well as mechanisms that may account for links
between parental divorce and adolescents’ adjust-
ment. Controlling for adolescents’ adjustment prior
to the divorce as well as other potential confounds
attenuates the association between the experience
of parental divorce and adolescents’ adjustment. It
is important to keep in mind the large variability
among individuals in adolescents’ trajectories of
adjustment before and after parental divorce.
Although, on average, adolescents whose parents
divorce are at risk for more externalizing and inter-
nalizing problems, lower levels of academic
achievement, and more problematic social relation-
ships than are adolescents whose parents do not
divorce, most adolescents whose parents divorce
do not have long-term adjustment problems.
A combination of interparental conflict, economic
disadvantage, disrupted parenting, and parental
distress that precedes and follows divorce interacts
in complex ways with divorce itself to affect adjust-
ment during adolescence and as adolescents
develop into adults.
References
Amato, P. (2003). Reconciling divergent perspectives:
Judith Wallerstein, qualitative family research, and
children of divorce. Family Relations, 52, 332–339.
Amato, P. R. (2010). Research on divorce: Continuing
trends and new developments. Journal of Marriage
and Family, 72, 650–666.
1056
Amato, P. R., & Anthony, C. J. (2014). Estimating the
effects of parental divorce and death with fixed effects
models. Journal of Marriage and Family, 76, 370–386.
D’Onofrio, B. M., Turkheimer, E., Emery, R. E., Slutske,
W. S., Heath, A. C., Madden, P. A., et al. (2006).
A genetically informed study of the processes underly-
ing the association between parental marital instability
and offspring adjustment. Developmental Psychology,
42, 486–499.
Hetherington, E. M., & Kelly, J. (2002). For better or
worse. New York: Norton.
Lansford, J. E. (2009). Parental divorce and children’s
adjustment. Perspectives on Psychological Science, 4,
140–152.
Lansford, J. E., Malone, P. S., Castellino, D. R., Dodge,
K. A., Pettit, G. S., & Bates, J. E. (2006). Trajectories of
internalizing, externalizing, and grades for children
who have and have not experienced their parents’
divorce. Journal of Family Psychology, 20, 292–301.
Sandler, I., Miles, J., Cookston, J., & Braver, S. (2008).
Effects of father and mother parenting on children’s
mental health in high- and low-conflict divorces. Fam-
ily Court Review, 46, 282–296.
Weaver, J. M., & Schofield, T. J. (2015). Mediation and
moderation of divorce effects on children’s behavior
problems. Journal of Family Psychology, 29, 39–48.
Domestic Violence
Sarah E. Evans1, Ruby Charak2, Laura E Watkins3
and David DiLillo1
1
Department of Psychology, Clinical Psychology
Training Program, University of
Nebraska – Lincoln, Lincoln, NE, USA
2
Department of Psychological Science, The
University of Texas-Rio Grande Valley, College
of Liberal Arts, Edinburg, TX, USA
3
Department of Psychiatry, Yale School of
Medicine, VA Connecticut Healthcare System,
National Center for PTSD-Clinical Neuroscience
Division, West Haven, CT, USA
Overview
Domestic violence is a widespread problem
throughout the world. A global research review
utilizing samples from 48 countries revealed that
10–69% of women reported experiencing physi-
cal violence at the hands of an intimate partner or
spouse (Heise et al. 1999). In the United States,
Domestic Violence
over one third of women (35.6%) and over one
fourth of men (28.5%) report experiencing phys-
ical, sexual, or stalking behavior by an intimate
partner (Black et al. 2011). Adding to these
alarming statistics is the fact that many instances
of domestic violence take place in the presence of
children and adolescents. Results from the
National Survey on Children’s Exposure to Vio-
lence conducted between 2013 and 2014 suggest
that 5.8% of children between ages 0 and 17 in the
United States witnessed a physical assault
between partners during the past year and that
15.8% of children witness a physical assault
between partners during their lifetime (Finkelhor
et al. 2015). Further, 43% of households that law
enforcement in a large Northeast county investi-
gated for domestic violence crimes had children
and nearly all of these children (95%) were
exposed to this violence (Fusco and Fantuzzo
2009). Some estimates have suggested that 9%
of adolescents are exposed to domestic violence
within their homes annually (Zinzow et al. 2009).
Because domestic violence is ongoing in many
households (Rand and Saltzman 2003), many of
these adolescents have been exposed to repeated
instances of violence between caregivers, begin-
ning in childhood and continuing throughout their
development.
Understanding Definitions and
Terminology
Domestic violence “broadly refers to the intimate
context within which one partner is abused by
another” (Holt et al. 2008, p. 798). This term
generally refers to physically, sexually, or psycho-
logically aggressive acts perpetrated by one inti-
mate partner against another. Acts of physical
aggression encompassed by domestic violence
include hitting, slapping, or kicking, while acts
of sexual aggression range from sexual coercion
to forced sexual intercourse. Psychological
aggression includes acts such as insulting, humil-
iating, or intimidating, and behaviors such as
stalking or isolating a victim from friends or fam-
ily. Although domestic violence is a commonly
used term to refer to violence that occurs between
Domestic Violence
caregivers within the home, in some countries
domestic violence refers to partner violence and
also encompasses child or elder abuse, or abuse by
any member of a household (World Health Orga-
nization [W.H. O.] 2012). Other terms used for
violence between caregivers, include, intimate
partner aggression, intimate partner violence,
interparental violence, domestic abuse, and mari-
tal violence. The terms “wife battering” and
“spousal abuse” came about because much of
the early domestic violence research focused on
male-perpetrated violence toward females (Wolak
and Finkelhor 1998). Recently, these terms have
fallen out of favor due to criticisms that they are
less inclusive. Literature suggests that women
perpetrate domestic violence as well (Straus
2005; Swan et al. 2008; Williams et al. 2008).
These findings indicate that many children and
adolescents are exposed to domestic violence in
which their mother is the perpetrator, to bidirec-
tional acts of violence between caregivers, and to
violence in same-sex relationships.
Different terms have been used to describe
adolescents who are affected by domestic vio-
lence. The earliest research in the field often used
the terms “observer” or “witness,” but recent
research has begun to use the term “exposed”
when referring to youth who have endured
these acts within their home (Holden 2003). Def-
initions of exposure vary with regard to the
threshold that must be met to consider a youth
“exposed.” Characteristics of the acts, such as the
frequency, the duration of exposure, and the level
of exposure (i.e., saw acts, heard acts from
another room, learned about acts later) all have
the potential to influence classification. While
some studies classify adolescents as victims if
they have ever been exposed to domestic vio-
lence, other studies only include adolescents
who have been exposed to domestic violence
during the past year. Still others require that
adolescents be exposed to at least two severely
violent acts in order to be classified as a victim.
Despite the lack of standardization across studies
regarding what constitutes exposure, most
researchers agree that exposure to domestic vio-
lence occurs when youth visually witness, over-
hear, are directly involved in (i.e., attempt to
1057
intervene), or experience the aftermath (i.e.,
injury, emergency response) of aggressive acts
that occur between caregivers (Evans et al.
2008).
Categories of Exposure
In response to the lack of consensus regarding D
what constitutes “exposure to domestic vio-
lence,” research trends have shifted from classi-
fying adolescents dichotomously as exposed and
nonexposed to the recognition that exposure to
domestic violence is a multifaceted, dimensional
experience. Holden (2003) concluded that there
are as many as ten different levels of exposure to
domestic violence, including, among others, pre-
natal exposure, eyewitness exposure, and partic-
ipation in the acts. While adolescents may
visually witness the acts as they occur, it is
equally plausible that exposure could include
overhearing the acts from another room, seeing
only the injury sustained or emergency response
following the acts, or even just learning about the
events from a family member at a later time.
Further complicating matters, additional vari-
ability exists with regard to the severity of the
acts to which youth are exposed. For example,
some adolescents may have been exposed to
verbal aggression only, while others may have
been exposed to physical aggression of varying
severity, ranging from slapping or throwing an
object all the way to strangulation and assault
with a deadly weapon. Still, others may have
been exposed to sexual aggression in the form
of low severity acts such as verbal coercion but
also in the form of unwanted touching and even
sexual assault (Holt et al. 2008).
Methodological Issues
The methodological issues that permeate research
on exposure to domestic violence have been well
documented (Clements et al. 2008; Edleson
1999a; Fantuzzo and Lindquist 1989). In general,
studies of exposure to domestic violence and its
effects have used a narrow range of samples, and
1058
yet a diverse range of assessments. Highlighted
here are some of the major methodological issues
concerning the study of exposure to domestic
violence.
Sampling Issues
One criticism of the exposure to domestic vio-
lence literature is the overreliance on samples
obtained from battered women’s shelters
(Edleson 1999a). Several concerns have been
raised with regard to these samples. Many previ-
ous studies recruiting from such settings have
assumed that the youth were exposed to domestic
violence rather than directly assessing levels of
exposure (Fantuzzo and Lindquist 1989; Kashani
and Allan 1998). Moreover, it has been postulated
that studying children and adolescents obtained
from this setting may result in findings that do not
generalize to all youth for two reasons. First, there
has been speculation that children in these settings
have been exposed to more severe violence,
resulting in more extreme outcomes. Furthermore,
some researchers have argued that residing in a
shelter is itself a stressor that may induce out-
comes similar to those hypothesized to occur in
victims of exposure to domestic violence
(Margolin 1998; McIntosh 2003).
Measurement Issues
There is inherent difficulty in measuring both
instances of domestic violence and youth. This
setting may result in findings that do not general-
ize to all youth for two reasons. First, they have
witnessed, and may assume the youth were not
exposed because they were asleep or outside of
the home during the acts (Holden 2003; Jaffe et al.
1990; McIntosh 2003). Other times, caregivers
may be hesitant to provide the information for
fear that doing so might result in legal conse-
quences to themselves (Clements et al. 2008;
Kantor and Little 2003). Few studies have
attempted to collect information regarding the
nature of the acts and resulting exposure from
more than one informant (Clements et al. 2008).
Those that have attempted to collect information
from multiple informants reveals low agreement
between the youth exposed to the violence, care-
givers, and law enforcement officials, both with
Domestic Violence
regard to whether the youth were exposed to the
acts and the nature of those acts (Holden 2003;
O’Brien et al. 1994; Sternberg et al. 1998). Addi-
tionally, child abuse and other adversities often
co-occur with domestic violence, and hence while
investigating the risk of domestic violence the
influence of other risk factors such as child mal-
treatment should be accounted for. Finally, differ-
ent types and levels of exposure to domestic
violence have different short- and long-term con-
sequences on a child’s functioning (Kitzmann
et al. 2003). Thus, a more comprehensive investi-
gation would include the unique effect of expo-
sure to domestic violence and the additive effect
of coexisting risk factors while taking into
account levels of severity.
Measurement Options
Another methodological issue, and likely contrib-
utor to the lack of consensus in defining exposure
to domestic violence, is that the standardized
options for assessing “exposure” are relatively
limited. As a result, many studies to date have
assumed the youth were exposed based on the
sample source (i.e., domestic violence shelter).
Other studies have simply utilized unstandardized
screening questions to classify youth dichoto-
mously as either exposed or nonexposed. Increas-
ingly, researchers have adapted a standardized
caregiver self-report measure or interview to
assess caregivers’ perceptions of whether their
child had been exposed to domestic violence.
The original and revised Conflict Tactics
Scales (CTS; Straus 1979; Straus et al. 1996) are
the most common measure used to assess the
occurrence and frequency of domestic violence
and exposure to domestic violence (Hamby and
Finkelhor 2001). The CTS is used to detect fre-
quency and severity of aggressive behaviors
occurring within the context of an intimate rela-
tionship. The instrument assesses acts that
occurred both over the past 12 months and over
the entire history of the relationship. It includes
items designed to measure different aspects of
conflict including physical aggression and
resulting injury, psychological aggression, and
sexual coercion. Studies using the CTS have gen-
erally fallen into three categories: those that have
Domestic Violence
administered the CTS to a caregiver and then
assumed that dependents were exposed to the
acts, and those that utilized a version of the CTS
adapted to assess more explicitly whether minors
in the household were exposed to the acts, and
those that utilized a version of the CTS adapted to
assess more explicitly whether minors in the
household were exposed to the acts (e.g., Kolbo
1996). Unfortunately, given the lack of a standard-
ized definition of “exposure,” adaptations of the
CTS vary widely (Jouriles et al. 2001). Moreover,
most studies using the CTS have been done with
school-aged children rather than adolescents
(Evans et al. 2008). Other less used standardized
measures of exposure to domestic violence
administered to caregivers include the Overt Hos-
tility/O’Leary-Porter Scale (Porter and O’Leary
1980) and the Family Disagreements Interview
(Salzinger et al. 1992). To date, however, there
appear to be no caregiver measures of child or
adolescent exposure to domestic violence that
have been subjected to meticulous psychometric
study (Edleson et al. 2007; Jouriles et al. 2001).
Several researchers have developed measures
of child or adolescent exposure to domestic
violence that have been subjected to meticulous
psychometric evaluation, including the Children’s
Perception of Interparental Conflict Scale
(CPICS; Grych et al. 1992), the Violence Expo-
sure Scale (Fox and Leavitt 1996), the Things
I Have Seen and Heard Scale (TISH; Richters
and Martinez 1992), and the Victimization Scale
(Nadel et al. 1996). An additional measure, the
Juvenile Victimization Questionnaire (JVQ;
Finkelhor et al. 2005) contains both a youth self-
report and a caregiver self-report scale. However,
the majority of these measures only assess expo-
sure in preschool and school-aged or middle
school children. Only one of these measures
(i.e., the JVQ) was designed to assess exposure
in adolescents up to age 17 (Finkelhor et al. 2005;
Hamby et al. 2011). Additionally, the suitability
of another (i.e., the CPICS) for use with adoles-
cents age 17 through 19 was explored post-
development (Bickham and Fiese 1997). One
promising option that may address the shortage
of empirically validated measures of exposure to
domestic violence is that of the Child Exposure to
1059
Domestic Violence Scale (CEDV; Edleson et al.
2008; Shin and Edelson 2007). Designed to assess
self-reported exposure to domestic violence in
youth ages 10–16, an initial study indicates that
this measure has demonstrated test–retest and
convergent validity (Edleson et al. 2008).
Outcomes of Exposure to Domestic D
Violence
Despite these methodological and measurement
issues, an increasing body of empirical studies
has established that exposure to domestic violence
is associated with adverse outcomes among both
children and adolescents. Moreover, numerous
reviews (Clements et al. 2008; Edleson 1999a;
Fantuzzo and Lindquist 1989; Holden 2003;
Holt et al. 2008; MacMillan and Wathen 2014;
Voisin and Sung Hong 2012) and meta-analytic
studies (Chan and Yeung 2009; Evans et al. 2008;
Kitzmann et al. 2003; Wolfe et al. 2003b) have
synthesized the literature documenting child and
adolescent outcomes associated with exposure to
domestic violence. In general, these outcomes
have been classified as biological/physical, cog-
nitive/academic, emotional/internalizing, behav-
ioral/externalizing, and social/interpersonal.
Biological/Physical
A growing body of literature conceptualizing
exposure as a traumatic event has attempted to
determine whether children and adolescents
exposed to domestic violence evidence effects in
their biological development. Consistent with
other childhood traumatic experiences,
researchers have suggested that, exposure to
domestic violence may cause biological alter-
ations to the hypothalamic-pituitary-adrenal
(HPA) axis stress response system and parts of
the brain (Gunnar and Donzella 2002; Saltzman
et al. 2005; Tsavoussis et al. 2014). Cortisol is the
major hormonal product of HPA system activation
and can be used as a physiological indicator of
stress. Several studies have examined cortisol
reactivity among children who have been exposed
to domestic violence. Overall, findings have
suggested greater cortisol reactivity to stressful
1060
or emotion-eliciting tasks among children
exposed to domestic violence as compared to
children who have not been exposed (Davies
et al. 2011; Hibel et al. 2011; Saltzman et al.
2005; Towe-Goodman et al. 2012). However,
some research has not replicated these findings,
with children exposed to violence showing no
differences in cortisol reactivity (Hibel et al.
2009) or demonstrating lower cortisol reactivity
in response to a laboratory simulation of
interparental conflict (Sturge-Apple et al. 2012).
Further, the majority of this work has examined
infants, toddlers, or young children. Thus, addi-
tional research is needed to clarify impact of
domestic violence exposure on cortisol reactivity
particularly among adolescents.
Similarly, differences in brain structure have
been found among children exposed to domestic
violence. For example, among child and adoles-
cent victims of co-occurring child maltreatment
and exposure to domestic violence who were
diagnosed with posttraumatic stress disorder, sev-
eral differences in brain development were noted
when compared to nontraumatized controls
(De Bellis et al. 1999; 2002). Further, young
adults who were exposed to domestic violence
as children, but not physical or sexual maltreat-
ment, demonstrated alterations in the brain when
compared to individuals who had not been
exposed to domestic violence or other forms of
child maltreatment (Choi et al. 2012). However,
none of these studies examined brain develop-
ment among a sample of only adolescents, and it
is impossible to say whether the differences noted
in the De Bellis studies are attributable to expo-
sure to domestic violence alone or to the
co-occurrence of multiple forms of exposure and
child maltreatment.
In addition to impacting biological function-
ing, domestic violence exposure may also affect
children’s physical health. Two studies demon-
strated a link between exposure to IPV and
increased risk for children being overweight or
obese (Boynton-Jarrett et al. 2010; Jun et al.
2012). However, no research has examined this
relationship among adolescents. Thus, further
research is needed utilizing adolescent samples
to determine the full extent of exposure to
Domestic Violence
domestic violence at this developmental level.
Additionally, longitudinal, prospective research
following exposed children into adolescence and
beyond is needed to determine the long-term
impact of exposure to domestic violence on bio-
logical and physical development.
Cognitive/Academic
Few studies have assessed associations between
exposure to domestic violence and cognitive or
academic abilities in adolescents. While findings
suggest that exposure to domestic violence is asso-
ciated with decreased attention, IQ, reading ability,
and verbal skills (Graham-Bermann et al. 2009;
Huth-Bocks et al. 2001; Horn Ratner et al. 2006;
Koenen et al. 2003; Towe-Goodman et al. 2012),
most studies to date have been conducted with
young children, rather than adolescents. One
investigation of youth age 11–13 did link exposure
to family violence with decreased academic per-
formance (Thompson and Massat 2003). More-
over, the meta-analysis conducted by Kitzmann
et al. (2003) examined linkages between exposure
to domestic violence and academic outcomes.
Results revealed significantly lower outcomes for
youth exposed to domestic violence. However,
this effect was found across all age groups, rather
than specifically for adolescents. Given the dearth
of research in this area, it is not possible to draw
conclusions regarding the impact of exposure to
violence on the academic and cognitive function-
ing of adolescents specifically.
Emotional/Internalizing
In contrast to the dearth of research on the cogni-
tive effects of exposure to domestic violence, a
large body of literature has examined emotional,
behavioral, and social outcomes. Adolescents
who have been exposed to domestic violence
demonstrate greater overall psychological dis-
tress, including anxiety, depression, and external-
izing behaviors (Ellonen et al. 2013) and more
general internalizing symptoms (Moylan et al.
2010). More specifically, teens exposed to domes-
tic violence tend to exhibit greater levels of
depression (Zinzow et al. 2009), anxiety (Mrug
and Windle 2010; Pelcovitz et al. 2000), and
posttraumatic stress disorder symptoms (Lang
Domestic Violence
and Smith Stover 2008; Zinzow et al. 2009) than
adolescents not exposed to domestic violence.
Effect sizes from meta-analyses range from
d = .38 to .50 for internalizing symptoms
(Chan and Yeung 2009; Evans et al. 2008;
Kitzmann et al. 2003; Wolfe et al. 2003b). Three
of four meta-analyses reveal positive linkages
between exposure to domestic violence and
trauma symptoms (Chan and Yeung 2009; Evans
et al. 2008; Kitzmann et al. 2003), although the
number of studies aggregated to produce these
outcomes was only k = 4, k = 6, and k = 12,
respectively. Interestingly, some research suggests
that both child and adolescent females may be
more prone to experience internalizing and trauma
symptoms in response to exposure to domestic
violence than are males (Buka et al. 2001; Moretti
et al. 2006). Further research is needed to clarify
potential gender differences in emotional and
internalizing symptoms among adolescents
exposed to domestic violence.
Behavioral/Externalizing
Similar to internalizing symptoms, and consistent
with the arguments of social learning theorists,
adolescents exposed to domestic violence have
an increased risk for a range of behavioral or
externalizing symptoms. Data from numerous
empirical studies suggest greater rates of conduct
problems and delinquency (Baldry 2007; Ellonen
et al. 2013; Ireland and Smith 2009), as well as
more aggression toward parents, peers, and ani-
mals (Duncan et al. 2005; McCloskey and Lichter
2003; Moretti et al. 2006). Further, witnessing
domestic violence during adolescence has been
linked to greater frequency of drug use among
girls, but not boys (Fagan and Wright, 2011),
and increased likelihood of problematic alcohol
use in young adulthood for women, but not men
(Smith et al. 2010). Effect sizes from meta-
analyses range from d = .42 to .47 for externaliz-
ing symptoms (Chan and Yeung 2009; Evans et al.
2008; Kitzmann et al. 2003; Wolfe et al. 2003b).
In contrast to the gender differences with internal-
izing symptoms, several studies suggest that
males are more prone to experience externalizing
symptoms than are females (Baldry 2007;
Flannery et al. 2001; Sternberg et al. 2006).
1061
However, not all studies have found these gender
differences (Grant et al. 2004), and these differ-
ences appear to be reversed when examining sub-
stance or alcohol use problems (Fagan and Wright
2011; Smith et al. 2010).
Social/Interpersonal
Finally, evidence also links exposure to domestic
violence to disturbances in adolescents’ interper- D
sonal functioning. Meta-analyses reveal that chil-
dren and adolescents exposed to domestic
violence have significantly poorer social out-
comes than do nonexposed youth (Chan and
Yeung 2009; Kitzmann et al. 2003). Specifically,
adolescents exposed to domestic violence may
have less secure attachment styles (Levendosky
et al. 2002) and more disturbances in peer rela-
tionships (Dawud-Noursi et al. 1998). Youth who
are exposed to domestic violence also may rely on
avoidance as a coping strategy for social problems
(McGee and Baker 2002).
In addition, exposure to domestic violence may
impact beliefs about aggression and aggressive
behavior during adolescence. Adolescent males
exposed to domestic violence appear more likely
to approve of violent acts in general and to believe
that acting violently bolsters one’s social reputa-
tion (Carlson 1991; Spaccarelli et al. 1995). More-
over, some evidence suggest that adolescents who
are exposed to domestic violence may be more
aggressive toward others (Moretti et al. 2006;
Mrug and Windle 2010; Sousa et al. 2011). How-
ever, other research has found a lack of an associ-
ation between witnessing domestic violence and
adolescent violence (Fagan and Wright 2011).
Driven in part by the intergenerational transmis-
sion of violence theory (see Widom 1989), one
domain of adolescent aggressive behavior that has
received attention in relation to exposure to
domestic violence is that of teen dating violence
(Ireland and Smith 2009). Consistent with social
learning theory, it has been postulated that adoles-
cents who are exposed to domestic violence learn
styles of expressing anger that put them at risk for
perpetrating violence in teen dating relationships
(Wolfe and Foshee 2003). Indeed, several
research studies suggest that adolescents exposed
to domestic violence within the home are at an
1062
increased risk of both perpetrating and being vic-
timized by dating violence (Foshee et al. 2008;
O’Keefe 1998), with adolescent males being more
likely to perpetrate violence than are females
(O’Keefe 1998). However, other studies have
failed to establish a link between exposure to
domestic violence and subsequent dating violence
(Gagne et al. 2005). Thus, research linking expo-
sure to domestic violence and later aggressive
behavior is somewhat mixed. Further research
identifying potential mediators or moderators
may help explain this inconsistent relationship.
Developmental Considerations
Because coping abilities and cognitive appraisal
in response to violent acts may evolve with age,
effects of exposure to domestic violence may
manifest differently in youth of different develop-
mental stages. However, no known critical or
sensitive period for the child’s exposure to IPV
has been established. In tandem with this,
although research has been conducted on children
in various developmental stages, no clear pattern
of age-related symptoms has emerged (Margolin
1998). Of the four meta-analytic studies, only one
revealed significant age effects (i.e., Wolfe et al.
2003b), finding that exposure to domestic vio-
lence resulted in higher effect sizes for school
age children than for adolescents or preschoolers.
However, follow-up analyses excluding two stud-
ies hypothesized to be outliers resulted in the age
effect disappearing. Findings from empirical stud-
ies suggest that adolescents may not be as affected
by exposure to domestic violence as are younger
children (Levendosky et al. 2002). A few expla-
nations have been posited for these findings. It
could be that adolescents are better able to remove
themselves from the situation, are generally more
emotionally distant from caregivers due to their
developmental stage, or are better able to under-
stand that the acts are not their fault (Graham-
Bermann and Levendosky 1998; Levendosky
et al. 2002).
On the other hand, the few longitudinal studies
that have been conducted so far on children and
adolescents suggest that exposure to domestic
Domestic Violence
violence has a detrimental impact on adolescent
health. Specifically, studies have found that expo-
sure to intimate partner violence during childhood
increases the risk of substance use disorder among
older adolescents (Skeer et al. 2009), and expo-
sure during the past year during adolescence is
associated with psychological distress and sub-
stance use in young adults (Schiff et al. 2014).
Hence, recent studies have started to address the
issue of short- and long-term effects of domestic
violence on adolescents although the need for
studies examining different types of psychopath-
ological outcomes is warranted.
Theoretical Considerations
Several theories have been postulated to explain
the mechanisms by which domestic violence may
impact children and adolescents. Attachment the-
ory states that, in interacting with caregivers and
other family members, children develop mental
representations, or working models, of them-
selves. If the family environment is volatile and
childcare is compromised, then a young child
representations, or working models results in the
child developing attachments of poor quality
(Shemmings and Shemmings 2011). Insecure or
disorganized attachment patterns in turn being a
chain reaction of aggression and interpersonal
problems in children and adolescents. Researchers
advocating a social learning perspective (Bandura
1986), particularly a cognitive-ecological model
within this broader view, suggest that through
exposure to domestic violence, children and ado-
lescents learn to use aggression as a means of
resolving conflict (Hotaling and Sugarman
1986). Social learning theory has been used to
explain the intergenerational transmission of vio-
lence in which children who are abused or who
witness violence are at higher risk of perpetrating
similar acts later in life. According to Margolin
(1998), “the intergenerational data, taken as a
whole, indicate that the childhood experience of
witnessing interparental violence can lay the foun-
dation for an aggressively oriented behavioral
repertoire as well as different expectations regard-
ing aggression in adult intimate relationships”
Domestic Violence
(p. 63). To date, however, support for a social
learning perspective on exposure to domestic vio-
lence, and the intergenerational transmission of
violence, has been mixed (see Stith et al. 2000
for a review). Moreover, while social learning
theory is helpful in explaining the externalizing
and behavioral symptoms (i.e., childhood aggres-
sion, adolescent delinquency, and dating violence)
observed in violence-exposed youth, it is less
useful in accounting for the broad range of inter-
nalizing sequelae.
In contrast, family systems theorists postulate
that exposure to domestic violence creates a par-
adox that leads youth to interpret their families,
which are supposed to provide safety and protec-
tion, as chaotic (Margolin 2005). Simultaneously,
violence perpetrated between caregivers may
result in increased risk of psychopathology
among the victimized caregiver. These processes
work in tandem and cause strain to the family unit,
which in turn may increase stress levels and sub-
sequent psychopathology among the exposed
youth (Margolin 1998, 2005). Similarly, trauma
theory posits that exposure to domestic violence is
an environmental stressor that threatens a youth’s
sense of personal safety and security (de Bellis
2001). This theory holds that these perceived
threats lead to disturbances in cognitive, biologi-
cal, and psychological functioning that are seen in
traumatized youth. Moreover, these disturbances
at a young age can set the stage for the develop-
ment of additional emotional and behavioral dis-
turbances as the youth matures (Margolin 2005).
In addition to these theories, the ecological theory
elucidates the role of violence faced across multi-
ple nested levels or contexts, such as family,
school, neighborhood, and society on an adoles-
cent family (Bronfenbrenner 1979). Oftentimes
child witnesses of domestic violence face addi-
tional adversities, such as poverty, low parental
education, and neighborhood crime that increase
the risk of adolescent psychopathology.
Mediating and Moderating Factors
While research suggests that exposure to domestic
violence can be detrimental to development, not
1063
all exposed children and adolescents have diffi-
culties. For example, the meta-analysis by
Kitzmann et al. (2003) revealed that 37% of
exposed youth were functioning as well or even
better than youth in nonexposed samples. Thus,
recent attention has been devoted to explaining
the variability in the functioning of youth who are
exposed to such acts. Several theories have been
offered to explain the variability in functioning D
observed in many empirical studies. One area
that has received much attention is the role that a
youth’s perception of the acts plays in subsequent
adjustment. Grych and Fincham’s (1990)
cognitive-contextual model posits that youth
respond to domestic violence by both trying to
interpret the meaning of the conflict and identify
the role they might have played in the events. This
theory holds that the impact of the conflict is
shaped by contextual as well as developmental
factors. Thus, different contextual, or mediating,
variables (i.e., exposure to other family dysfunc-
tion or community violence; co-occurring child
maltreatment) as well as the age and cognitive
level of the youth will influence how the child
perceives the conflict and ultimately reacts to it
(Grych and Fincham 1993). Consistent with this
theory, studies have shown that when children
blame themselves for conflict or perceive the con-
flict as a threat to their security, they exhibit more
adjustment problems (Fosco and Grych 2008;
Gerard et al. 2005). Examining externalizing
behavior, this framework emphasizes that sense
of threat leads to hypervigilance and heightens
sensitivity to signs of anger and conflict both
within and outside of the home (Fosco et al.
2007). Another mechanism between exposure to
intimate partner violence and externalizing behav-
ior is the belief in children that the aggression is
justified (Fosco et al. 2007; Jouriles et al. 2014).
Other mediational theories have focused on the
relationship between the youth and the parent. For
example, Davies and Cummings’s (1994) emo-
tional security hypothesis posits that the effects
of interparental conflict stem from the quality of
the relationship between the youth and the parent
as well as the quality of the caregiver to their
security; they exhibit more adjustment problems.
This theory holds the poor quality parent–child
1064
relationship, or assuaged if the parent–child bond
is relatively strong (Sturge-Apple et al. 2012).
Similarly, while originally developed to explain
the youth also have been hypothesized to medi-
ate associations between exposure and subse-
quent psychology (Buchanan et al. 1991).
Loyalty conflicts are thought to occur when, in
the context of intimate partner conflict, youth
feel pressured to align themselves with one par-
ent against the other. Indeed, some research indi-
cates that greater loyalty conflict is associated
with adjustment problems among adolescents
(Buchanan et al. 1991). Interestingly, however,
and consistent with the emotional security
hypothesis, loyalty conflicts were lower in ado-
lescents who perceived themselves as closer to
their parents.
Other contextual variables present within the
home environment may also explain the variabil-
ity in the functioning associated with youth’ expo-
sure to domestic violence. The possibility of one
or more third variables accounting for the nega-
tive outcomes displayed by youth exposed to
domestic violence seems probable given that
higher levels of domestic violence occur in house-
holds that are also affected by poverty, community
violence, and general family dysfunction (Carlson
1984; Higgins and McCabe 2003; Tolman and
Raphael 2000). These moderating variables
could be antecedent events in existence prior to
exposure and are likely to continue to act as
stressors during the domestic violence exposure.
Furthermore, other risk factors for youth psycho-
pathology, such as parental psychopathology and
child maltreatment, may also co-occur with expo-
sure to domestic violence (Owen et al. 2009). For
instance, one of the most common mental health
sequelae among victimized women is depression
(World Health Organization 2000), while alcohol-
ism and drug abuse are prevalent in perpetrators of
domestic violence (Kantor et al. 1994; Thompson
and Kingree 2006). Each of these types of parental
psychopathology has been associated with behav-
ioral and emotional difficulties similar to those
found in youth exposed to domestic violence
(Ritter et al. 2002). Finally, child maltreatment,
especially physical abuse, often overlaps with
exposure to domestic violence (Appel and Holden
Domestic Violence
1998; Edleson 1999b). The various emotional and
behavioral problems of child maltreatment have
been well documented and are similar to the
sequelae of exposure to domestic violence
(Widom 2000). Several researchers have argued
that the field of child maltreatment have been well
documented and are similar to the sequelae of
exposure to domestic violence between youth
who have and have not been exposed to domestic
violence (Clements et al. 2008; Edleson 1999a;
Fantuzzo and Lindquist 1989; Hanson et al.
2006).
There are also protective factors that buffer or
moderate the association between exposure to
intimate partner violence and problem behavior
among youth. Parenting characteristics such as
acceptance and respect for the child, and peer
trust and peer communication has been found to
reduce problem behavior in youth exposed to
domestic violence (Tajima et al. 2010). Positive
sibling relationship is also shown to act as a buffer
between self-blame for interparental conflict and
anxiety symptoms among adolescents (Iturralde
et al. 2013). Hence, the presence of some mediat-
ing or moderating variables can lead to exacerba-
tion of problem behavior, while others can
alleviate symptoms of problem behavior in
adolescents.
Is Exposure to Domestic Violence a Form
of Child Maltreatment?
Evidence of a dual exposure to domestic violence
and child maltreatment is suggestive of its addi-
tive and negative sequelae in adolescents (Moylan
et al. 2010). However, one controversy within the
field is whether exposure to domestic violence
itself should be classified as a form of child mal-
treatment. Many advocates and researchers have
argued that exposure to domestic violence should
be classified as either as a form of neglect (i.e.,
failure to protect) or as psychological maltreat-
ment (i.e., Holden 2003; Kalichman 1999).
Indeed, some Australian jurisdictions mandate
the report of exposure to domestic violence as an
independent form of child maltreatment (Higgins
et al. 2009). While some US states classify
Domestic Violence
exposure to domestic violence as child maltreat-
ment, and more specifically as a form of child
neglect, other states mandate an enhanced penalty
if an assault is committed in the presence of a
minor (Child Welfare Information Gateway
2013; Edleson 2004). However, Australia and
the United States do not classify exposure to
domestic violence as a reportable form of mal-
treatment on a federal level (Bross et al. 2002).
Critics of efforts to classify exposure as a form
of child maltreatment argue that doing so would
broaden mandatory reporting requirements,
which would increase burden on the already over-
extended child protection system (Edleson 2004;
Kantor and Little 2003). An additional argument
against legally mandated reporting of exposure to
domestic violence is that these laws may actually
have a detrimental effect due to the potential to
blur the boundaries of culpability. That is, crimi-
nalizing these acts by labeling them as child mal-
treatment may further deter adult victims of
domestic abuse from seeking help for fear that
they would be charged with failure to protect
dependents who witnessed the acts, particularly
if they decide to return to the relationship in which
domestic violence was legally documented
(Kantor and Little 2003).
Prevention and Treatment
Increasingly, advocates and researchers are recog-
nizing the need for prevention and treatment pro-
grams aimed at reducing instances of exposure to
domestic violence and its consequences. Several
initiatives involving collaborations between
researchers, child protective services, policy
makers, and law enforcement officials have been
developed to diminish the risk of reoccurring vio-
lence and to reduce the trauma associated with
such acts (Jaffe et al. 2012). One example of
such a program is Project Safe Care, a home-
based parent-training program aimed at family
preservation, which has been found to be effective
at reducing families’ subsequent involvement in
the legal system due to allegations of child
maltreatment (Gershater-Molko et al. 2002,
2003). Additionally, the Violence Intervention
1065
Program, a system of care program successfully
implemented within the New Orleans, Louisiana
Police Department, has been shown to increase
law enforcement sensitivity to children in domes-
tic violence situations as well as their capacity
to refer such children to appropriate treatment
(Osofsky et al. 2004). However, to date, the
majority of these prevention programs have been
implemented only with young children, rather D
than with adolescents.
Given the overwhelming evidence
suggesting that exposure to domestic violence
negatively impacts children and adolescents,
emerging research has begun to explore the
effectiveness of treatments for victims of expo-
sure to domestic violence (for reviews, see
Cohen et al. 2006b; Vickerman and Margolin
2007). In general, clinicians working with ado-
lescents exposed to domestic violence should
approach treatment in a developmentally sensi-
tive manner that encourages an open discussion
about the events (Kerig et al. 2000). Cognitive
restructuring techniques and therapeutic inter-
pretation of the events may be utilized to help
adolescents minimize maladaptive feelings and
attributions, and gain an understanding of the
symptoms they have developed as a result of
violence exposure. Finally, long-term treatment
may help adolescents reestablish trust and break
the cycle of violence within their homes as
adults (Kerig et al. 2000).
Consistent with these recommendations, sev-
eral established treatments have been utilized to
reduce both the internalizing and externalizing
sequelae of exposure to domestic violence.
Trauma-Focused Cognitive Behavioral Therapy
(TF-CBT; Cohen et al. 2006a), originally devel-
oped to treat child sexual abuse, has been utilized
to reduce trauma symptoms in adolescents ages
13 and 18 exposed to domestic violence, and is
considered a “well supported and efficacious”
treatment (de Arellano et al. 2008). Recently, the
trauma-narrative component of TF-CBT is being
tested with a web-based digital storytelling cur-
riculum with children as young as 9 years
(Anderson & Cook 2015). Group treatment with
children and adolescents exposed to domestic
violence are widely used interventions and are
1066
also more economical in contrast to individual
therapy (Edelson and Greenleaf 2006). The Kids
Club (Graham-Bermann 2000; Graham-Bermann
et al. 2007) has been used to target trauma symp-
toms with 13-year-old adolescent victims of phys-
ical abuse and exposure to domestic violence. In
an evaluation study of youth ages 5–13, the Kids
Club was successful at reducing trauma symp-
toms, but not depressive symptoms or impulsivity
(Graham-Bermann 2000). The London Commu-
nity Group Treatment Programme for Child Wit-
nesses of Women Abuse (Jaffe et al. 1986), a
group intervention for exposed youth age 4-16,
has been found to be effective at changing atti-
tudes regarding the acceptability of violence
reducing participants self-blame for the acts, and
increasing awareness about community resources
and avenues for help. Finally, the Youth Relation-
ship Project (Wolfe et al. 1996) is a secondary
prevention program for 13- to 17-year-old adoles-
cent victims of physical abuse and exposure to
domestic violence, aimed at promoting healthy
social and dating relationships. This treatment
has been shown to be effective in reducing inci-
dents of emotional and physical violence perpe-
trated by at-risk youth toward adolescent dating
partners (Wolfe et al. 2003a).
In addition to these clinical interventions,
efforts are being directed toward formulating
universal prevention strategies owing to the
vast number of children and adolescents being
exposed to domestic violence. In this context,
school- and community-based intervention
programs have gained momentum. One such
school-based program is Safe Dates, with a
focus of changing norms regarding partner vio-
lence, gender roles, and social skills relating to
relationship violence among adolescents
(Foshee et al. 2005, 2014). Another universal
program directed toward prevention of future
incidents of intimate partner violence targeting
dating violence and related risk behaviors is the
Fourth R (Wolfe et al. 2009). This classroom
based intervention conducted by trained
teachers has been effective in decreasing dating
violence and increasing assertiveness and com-
munication skills among adolescents (Wolfe
et al. 2009).
Domestic Violence
Conclusion
Many children and adolescents are exposed to
domestic violence between caregivers within
their homes. Clear links have been established
between exposure to this violence and detrimental
physiological, cognitive, emotional, behavioral,
and social outcomes among youth. Several theo-
ries have been proffered to explain these out-
comes, including social learning theory, family
systems theory, and trauma theory. Recent
research has moved beyond establishing linkages
to attempting to understand the influence of medi-
ating and moderating factors that explain variabil-
ity in the functioning of youth who have been
exposed to domestic violence. Finally, as more
becomes known about the effects of exposure to
domestic violence on children and adolescents,
treatment and prevention programs have been
developed to treat both the internalizing and exter-
nalizing sequelae of exposure as well as to reduce
the risk of subsequent exposure.
Although the study of exposure to domestic
violence has advanced steadily in the past few
decades, much remains to be learned. For example,
to date, the majority of the literature has examined
the correlates of domestic violence in combined
samples of children and adolescents, which tends
to obscure developmental differences in coping
and responses. More longitudinal studies are
needed to reveal the particular impact of exposure
to domestic violence on adolescents and to track
the developmental trajectory of this group. As this
literature base expands, it will undoubtedly con-
tinue to inform legal policy related to adolescent
exposure to domestic violence as well as the for-
mulation of treatments to address the negative cor-
relates of these events in youth and their families.
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Doping
Edward M. Castillo1 and R. Dawn Comstock2,3
1
Department of Emergency Medicine, University
of California, San Diego, CA, USA
2
College of Medicine, Department of Pediatrics
and College of Public Health, Division of
Epidemiology, The Ohio State University,
Columbus, OH, USA
3
Center for Injury Research and Policy, Columbus
Children’s Hospital, Columbus, OH, USA
Overview
Performance enhancing substances and dietary
supplements have long been used by athletes to
improve physical performance and endurance,
but the use of such substances among adolescents
is not well documented. The majority of peer-
reviewed studies focusing on adolescents have
examined this population’s use of anabolic
steroids and creatine, while little work has
Doping
addressed adolescents’ use of other supplements.
Similarly, little is known about potential health
risks of such substances in adolescents. There has
been a worldwide effort to standardize and regu-
late the use of performance enhancing substances
by adult athletes, but attempts over the past
decade to extend such efforts to younger athletes
have generally found that widespread screening
and testing is not feasible. Additionally, there are
many dietary supplements that are used by ado-
lescents as performance enhancers and/or to
improve body image that are not regulated and
are widely available. Further research is needed
to determine the prevalence of use as well as
reasons for use of performance enhancing sub-
stances and dietary supplements among the gen-
eral adolescent population. This research should
also focus on factors leading to their use as well
as potential long-term physical and psychologi-
cal impacts.
Introduction
The use of performance enhancing substances in
sports, also known generally as doping, has been
pushed to the forefront of professional sports and
the Olympics in recent decades and has even
sparked US Congressional investigational hear-
ings on the extent of doping in sports. This has
resulted in an ongoing debate about the ethical
implications as well as potential negative impact
to the health of those who use these substances.
However, doping is not new. Athletes have always
utilized methods to improve physical performance
including improved nutrition, physical fitness,
and specialized training. The use of exogenous
substances to assist these efforts has been prac-
ticed for thousands of years and dates back to as
early as ancient Greece (Emmanquel 1947).
Although these substances have been com-
monly used throughout competitive sports, the
use of performance enhancing substances among
adolescents is not well documented. This is par-
ticularly troubling because of sparse safety data
on the health effect of such substances in this
population. Few studies have focused on the use
of performance enhancing substances and dietary
Doping
supplements among adolescents with most studies
to date focusing on a single supplement (i.e.,
anabolic steroids, creatine, etc.). Additionally,
safety data for such substances is essentially
lacking for adolescents and must be extrapolated
from studies in adults if available. This is insuffi-
cient given the biophysiological differences
between adolescents and adults. The purpose of
this essay is to provide an overview of dietary
supplement use among adolescents in the USA
with a focus on the substances used to enhance
physical performance, also known as ergogenic
aids, which are commonly used by athletes. It will
also address alternative reasons adolescents use
these types of substances.
Overview of Performance Enhancing
Substances and Sports
The term, “performance enhancing substances” is
commonly used to refer to a wide range of sub-
stances that can ultimately be separated into three
main categories: (1) illegal substances or those
that can only be obtained legally through a pre-
scription from a medical doctor and that are
banned by some or all sports, such as anabolic
steroids and the hormone precursor androstenedi-
one; (2) legally available substances that are
banned by some or all sports, in general or in
competition only, such as diuretics and caffeine;
and (3) legally available substances that are not
banned, such as many types of dietary supple-
ments. Determining which category a substance
falls into can be difficult because the lists of sub-
stances banned by the various sporting governing
bodies is frequently amended and, while less fre-
quent, a substance’s legal status can also change
(e.g., the US Food and Drug Administration’s
banning of the sale of supplements containing
ephedrine alkaloids in 2004) (Castillo and
Comstock 2007).
In the last decade, there has been a worldwide
effort to standardize and regulate the use of per-
formance enhancing substances by athletes. In the
USA, the United States Anti-Doping Agency
(USADA) was established in 2000 following a
recommendation by the United States Olympic
1073
Committee’s (USOC) Select Task Force on Exter-
nalization. The USADA is an independent, non-
profit, nongovernmental agency that manages a
comprehensive, national anti-doping program
that includes education, testing, and research and
administers its own protocols and policies as well
as those of the USOC. During the same time that
the USADA was being established, the Interna-
tional Olympic Committee established the World D
Anti-Doping Agency, which developed the World
Anti-Doping Program. The program consists of
three main sections including (1) the World Anti-
Doping Code (Code), which was developed to
standardize anti-doping rules and sanctions on a
worldwide basis; (2) the International Standards
for Testing, Therapeutic Use Exemptions, Labo-
ratory Practices, Protection of Privacy and Per-
sonal Information, and The Prohibited List; and
(3) Models of Best Practice, which provides and
encourages up-to-date solutions in different areas
of anti-doping. These efforts led to a standard
definition of doping, which defined by the Code,
is the occurrence of one or more of the following
anti-doping rule violations (US Anti-Doping
Agency 2010a):
• The Presence of a Prohibited Substance or its
Metabolites or Markers in an Athlete’s Sample.
• Use or Attempted Use by an Athlete of a Pro-
hibited Substance or a Prohibited Method.
• Refusing or failing without compelling justifi-
cation to submit to Sample collection after
notification as authorized in applicable anti-
doping rules or otherwise evading Sample
collection.
• Violation of applicable requirements regarding
Athlete availability for Out-of-Competition
Testing including failure to file required where-
abouts information and missed tests which are
declared based on rules which comply with the
International Standard for Testing. Any com-
bination of three missed tests and/or filing fail-
ures within an 18-month period as determined
by Anti-Doping Organizations with jurisdic-
tion over the Athlete shall constitute an anti-
doping rule violation.
• Tampering or Attempted Tampering with any
part of Doping Control.
1074
• Possession of Prohibited Substances and Pro-
hibited Methods.
• Trafficking or Attempted Trafficking in any
Prohibited Substance or Prohibited Method.
• Administration or Attempted administration to
any Athlete In-Competition of any Prohibited
Method or Prohibited Substance, or adminis-
tration or Attempted administration to any Ath-
lete Out-of-Competition of any Prohibited
Method or any Prohibited Substance that is
prohibited Out-of-Competition, or assisting,
encouraging, aiding, abetting, covering up, or
any other type of complicity involving an anti-
doping rule violation or any Attempted anti-
doping rule violation.
Currently the Code has been formally adopted
by many sports governing organizations and has
been instrumental in standardizing worldwide
anti-doping efforts, especially among the Olym-
pic movement.
According to the US Anti-Doping Agency, a
performance enhancing substance can be placed
on the prohibited list (i.e., is banned by some or all
sports) if it meets two of three criteria: it has the
potential to enhance or enhances sport perfor-
mance, it represents an actual or potential health
risk to the athlete, or it violates the spirit of sport.
To aid athletes, the US Anti-Doping Agency
annually publishes a guide to help athletes under-
stand how prohibited substances affect them with
specific attention paid to medications available on
the US market (US Anti-Doping Agency 2010b).
The US Food and Drug Administration deter-
mines the legal status of substances (i.e., if a
prescription is required to obtain the substance
legally). While performance enhancing sub-
stances have traditionally been used by athletes
to improve performance, a growing number of
individuals, both athletes and nonathletes, have
adopted the use of such substances to improve
body appearance as well. Additionally, athletes
and nonathletes alike have increasingly adopted
the use of the growing number of dietary supple-
ments which similarly claim to improve physical
performance and body appearance.
The use of dietary supplements has dramati-
cally risen over the last two decades. The Dietary
Doping
Supplement Health and Education Act of 1994
states that the dietary supplement business in the
USA had annual sales of $4 billion (US Congress
1994), with a more recent estimate by the supple-
ment trade publication Nutritional Business Journal
of $27.3 billion (http://nutritionbusinessjournal.
com). Presently, the US federal government allows
for the marketing of any substance that affects the
structure or function of the body as a dietary or
dietary supplement without regulation. However,
the manufacturers must clearly state on product
labels that the dietary supplement is not evaluated
by the FDA and the product is not intended to
diagnose, treat, or prevent any disease. Also detailed
in the Dietary Supplement Health and Education
Act of 1994, “The term ‘dietary supplement’
means a product (other than tobacco) intended to
supplement the diet that bears or contains one or
more of the following dietary ingredients: a vitamin;
a mineral; an herb or other botanical; an amino acid;
a dietary substance for use by man to supplement the
diet by increasing the total dietary intake; a concen-
trate metabolite, constituent, extract, or combination
of any ingredient described above; is intended for
ingestion in the form of a capsule, powder, softgel,
or gelcap; or is labeled as a dietary supplement.”
These somewhat relaxed guidelines and definitions
are attributed to lobbying by the multibillion-dollar
dietary supplement industry, with continued discus-
sion of more stringent controls not yet resulting in
stricter guidelines or FDA oversight.
Uses of Performance Enhancing
Substances by Adolescents
Performance enhancing supplement use in adoles-
cents has not been adequately studied. Although
there have been a number of reports in the peer-
review scientific literature on the prevalence of ana-
bolic steroid and creatine use among adolescents,
few reports provide information on the knowledge,
attitudes, behaviors, and beliefs (KABs) regarding
their use, the reasons for using the substances among
athletes as well as nonathletes, and the prevalence of
use of other supplements.
The KABs held by adolescents regarding the
use of performance enhancing substances is
Doping
important to understanding the trends in their
behavior and reasons for their use. Data from
adolescent populations is limited and the majority
of it relating to KABs and performance enhancing
substances has come from national surveys such
as the Youth Sports Survey (YSS 2006) and the
Monitoring the Future Study (Johnston
et al. 2009).
The Youth Sports Survey was administered by
the Josephson Institute Center for Sports Ethics to
5275 randomly selected high school students
throughout the USA (www.charactercounts.org).
This survey asked two specific questions regard-
ing performance enhancing substances. The
results of these two questions were that 7% of
boys and 10% of girls disagreed with the state-
ment, “No athlete should use performance
enhancing drugs because it’s unhealthy” and
15% of boys and 11% of girls disagreed with the
statement, “No athlete should use performance
enhancing drugs because it’s cheating.” These
findings suggest that adolescent athletes may not
hold negative beliefs about the appropriateness of
use of these types of substances (YSS 2006).
The Monitoring the Future Study is an ongoing
study of the behaviors, attitudes, and values of
approximately 50,000 American secondary
school students, college students, and young
adults (www.monitoringthefuture.org). This sur-
vey specifically asked respondents their percep-
tions regarding steroid use. When asked how
much people risked harming themselves if they
took steroids, the percentage of 12th graders
responding that use of steroids posed “great risk”
ranged from a high of 70.7% in 1992 to a low of
55.0% in 2003. The range of respondents who
indicated that they disapproved of people taking
steroids ranged from a high of 92.1% in 1992 to a
low of 86.0% in 2003 (Johnston et al. 2009).
Sports-Related Use of Performance
Enhancing Substances
Although adolescent athletes are generally held to
the same standard as collegiate or Olympic ath-
letes regarding doping, the high costs associated
with testing and lack of testing resources represent
1075
ydrug testing of high school athletes (Holland-
Hall 2007). The most studied performance
enhancing substances in adolescent populations
include anabolic steroids (Buckley et al. 1988;
Krowchuk et al. 1989; Whitehead et al. 1992;
Johnson et al. 1989; Tanner et al. 1995; Scott
et al. 1996; Faigenbaum et al. 1998; Stilger and
Yesalis 1999; Radakovich et al. 1993; DHHS
2008; YRBSS 2007; Elliot et al. 2007) and crea- D
tine (Smith and Dahm 2000; Metzl et al. 2001;
Ray et al. 2001; McGuine et al. 2001, 2002;
Reeder et al. 2002; Kayton et al. 2002), with a
few other studies investigating the use of human
growth hormone (Rickert et al. 1992) or general
“dietary supplements” by adolescents (Reeder
et al. 2002; Kayton et al. 2002).
Anabolic steroids have long been used by pro-
fessional and recreational athletes to improve ath-
letic performance and physical appearance and
were not classified as a controlled substance
until the Anabolic Steroid Control Act of 1990.
Their use among US adolescent athletes report-
edly first occurred in 1959 (Yersalis et al. 1993).
Anabolic steroids are synthetic substances that
mimic testosterone and are used for increasing
fat-free muscle mass and strength. They have
potentially severe adverse effects. Although only
available by prescription now, they continue to be
used illegally by both adults and adolescents.
Studies in the peer-reviewed literature focus pri-
marily on high school students, with a few studies
including younger students (Castillo and
Comstock 2007). The prevalence of use among
adolescent athletes has been reported to range
from as low as 1% (Krowchuk et al. 1989) to as
high as 11% (Johnson et al. 1989) with more
recent reports of 3.9% from a national survey
(YRBSS 2007).
The trends in use and reasons for using ana-
bolic steroids have remained consistent in most
studies (Castillo and Comstock 2007). Adoles-
cents involved in sports used steroids more often
than those who did not, but use was also noted
among nonathletes (Buckley et al. 1988;
Whitehead et al. 1992; Scott et al. 1996). Use
varied by sport, with football being the most com-
mon sport played by users. Although participating
in football was common among users, users also
1076
participated in other sports including gymnastics,
weight training, basketball, and baseball (Buckley
et al. 1988; Whitehead et al. 1992; Radakovich
et al. 1993). Reasons for using steroids ranged
from improving athletic performance and improv-
ing strength among athletes to improving appear-
ance or building self-esteem among nonathletes
(Buckley et al. 1988; Scott et al. 1996;
Radakovich et al. 1993).
Creatine is possibly the most popular perfor-
mance enhancing substance currently used by
adolescents. Similar to anabolic steroid studies,
the prevalence of creatine use among adolescents
has largely focused on high school students with
one including middle school students (Castillo
and Comstock 2007). Creatine is a naturally
occurring compound in the body that supplies
energy to muscle and is used to enhance recovery
after a workout, build muscle mass, and improve
strength. Among high school athletes, the preva-
lence of use ranged from 8.2% to as high as 30.0%
among football players. Its use also varies by sport
and gender. McGuine et al. (2002) reported the
distribution of use in sports by gender. Among
girls, creatine use was most frequent among ath-
letes who participated in track (5.4%), gymnastics
(4.7%), tennis (4.6%), and volleyball (3.8%).
Among boys, creatine use was most frequent
among athletes who participated in football
(30.1%), swimming (28.4%), hockey (28.0%),
and baseball (26.5%).
There are many other types of performance
enhancing substances available to adolescents
today, both legally and illegally. However, the
prevalence for the use of the majority of perfor-
mance enhancing substances among adolescents
is largely unknown. A few reports have described
prevalence of use of a few additional types of
performance enhancing substances such as
human growth hormone (HGH). HGH is used to
increase muscle mass and strength and has
received an increase in media attention and prod-
uct marketing in the past few years. However,
little is currently known about the prevalence of
its use as a performance enhancing supplement.
Rickert et al. (1992), currently the only peer-
reviewed publication that has reported the preva-
lence of use among adolescents, reported the use
Doping
among 10th-grade boys was about 5%. Other
studies that have reported the prevalence of use
of various other performance enhancing sub-
stances among adolescents have been limited
(Castillo and Comstock 2007).
Non-Sports-Related Use of Performance
Enhancing Substances
Although performance enhancing substances
have been commonly used by athletes to improve
physical fitness and athletic performance, there
has been an increase in their use among nonath-
letes and athletes alike to improve their physical
appearance. As with most behaviors, several fac-
tors contribute to the use of dietary supplements
including age, history of smoking, alcohol use,
and physical activity. In adolescents, dietary sup-
plements are becoming increasingly popular
among individuals attempting to improve body
appearance and achieve healthier lifestyles. This
increase continues despite the limited information
on efficacy and safety for the vast majority of
products available.
Through the normal course of development,
adolescents often become obsessed with their
body image and peer acceptance. Performance
enhancing substances become a method to easily
self-esteem through improved physical fitness and
performance, often with disregard to the potential
negative short- and long-term health effects. Stud-
ies focusing on the association between body
image and performance enhancing substance use
are limited. A study by Kanayama et al. (2006)
investigated body image issues among male adult
anabolic-androgenic steroid users. They con-
cluded that those who used steroids showed
more issues with body image and although they
could not conclude that it was the reason for their
steroid use, they believed it was a possibility.
Field et al. (2005) investigated the exposure to
mass media, body shape concerns, and the use of
supplements to improve weight and shape among
adolescents. They suggest that both girls and boys
who thought about wanting toned or well-defined
physiques were at increased risk of using poten-
tially unhealthy supplements or other potentially
Doping
unhealthy means to achieve their desired image
goals.
Additional research is starting to investigate
the risk profiles among performance enhancing
substances users. A recent study by Buckman
et al. (2009) sought to determine if those who
reporting using performance enhancing sub-
stances were also more likely to use alcohol and
other social drugs. Users of performance enhanc-
ing substances are often thought of as athletes who
focus on healthy behaviors; however, little is
known about their substance abuse risk profile.
They found that performance enhancing sub-
stance users were more likely to report more prob-
lematic alcohol-use behaviors and alcohol and
drug use-related problems. Although the sample
population for this study was male college
athletes, it leads to some important questions
regarding the association between performance
enhancing substances and substance abuse and
may even pose broader implications for adoles-
cents. Additional research is needed to assess the
risk of increased alcohol and social illicit drug use
among young adults as well as adolescents who
also use performance enhancing substances.
Summary
The use of performance enhancing substances and
dietary supplements among adolescents appears
to be common, but is not well studied. In the last
decade, there has been a worldwide effort to stan-
dardize and regulate the use of performance
enhancing substances among athletes. Although
this has improved regulation and compliance
among professional and Olympic athletes, the
resources for screening the much larger popula-
tion of adolescent athletes are not available. There
have been a number of reports in the peer-review
scientific literature on the prevalence of perfor-
mance enhancement substance use among adoles-
cents, but they have focused on anabolic steroid
and creatine use. Few reports provide information
on the knowledge, attitudes, behaviors, and
beliefs regarding their use, the reasons for using
these substances, and the prevalence of use of
other supplements. Additionally, performance
1077
enhancing substances are also being used to
improve physical fitness and physique among
both athletes and nonathletes. Further research is
needed to determine the prevalence of use as well
as reasons for use of such substances among the
general adolescent population. This research
should also focus on factors leading to their use
as well as the potential long-term physical and
psychological impact they may have. D
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Yersalis, C. E., Courson, S. P., & Wright, J. (1993). History
of anabolic steroid use in sport and exercise. In C. E.
Yersalis (Ed.), Anabolic steroids in sport and exercise
(pp. 35–47). Champaign: Human Kinetics.
Youth Risk and Behavior Surveillance System (YRBSS) –
National Center for Chronic Disease Prevention and
Health Promotion. Healthy Youth! YRBSS, Youth
Online: Comprehensive Results. (2007). http://apps.
nccd.cdc.gov/yrbss/. Accessed 15 Mar 2010.
Youth Sports Survey (YSS). (2006). Josephson Institute.
http://charactercounts.org/index.html. Accessed
10 Mar 2010.
Double Standards
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Overview
The concept of double standard refers to flexible
principles that apply differently to certain groups
than others. In the context of adolescence, double
standards most frequently apply in the realms of
education, parenting, and sexuality. Gender par-
ticularly plays a large role in adolescents’ double
standards related to sexual debut, sexting, and
social groupings, among other behaviors, charac-
teristics, and attitudes. Adolescents are especially
susceptible to internalizing these double standards
for several reasons: they have not yet fully formed
their own belief systems, they are susceptible to
peer influences, and the double standards are
especially ubiquitous in adolescence. Research
has explored the dynamics of double standards
in adolescence. Although researchers have not
identified effective ways to reduce double stan-
dards, they still do have important implications for
adolescents as well as those who interact
with them.
Double Standards
Varieties of Double Standards
“Double standard” is a pejorative term that
denotes the use of a different set of principles for
evaluating different groups on similar behaviors,
abilities, characteristics, or attitudes. Most typi-
cally, the most salient forms of double standards
relate to intelligence, sexual activity, physical
looks, as well as political or sexual orientation.
At its core, the existence of double standards
implies that one set of principles is ideal and
acceptable for one group but not for another.
Double standards figure prominently in social
groups. Factors such as race, age, gender, religion,
social class, and other markers of difference serve
as the factors that determine where individuals
end up in terms of having the acceptable ideal or
having the unacceptable (taboo) concepts applied
to them. The double standard rests on categories
based on stereotypes, and they violate notions
of equality and impartiality when individuals
are held accountable according to different stan-
dards. Among the more troubling dynamics of
double standards is that their ubiquity is self-
reinforcing – individuals who engage with double
standards often find that they are so wide held that
it is easiest to believe them even without personal
experience with any direct evidence upon which
to base their beliefs (De Bock et al. 2012).
Double Standards and Adolescence
Although many double standards relate to adoles-
cent development, including those in the educa-
tional system and the effects on student outcomes
and self-esteem (see Himmler and Schwager
2013), the most studied are those that relate to
sexual double standards based on gender. Research
in the past has tended not to focus adolescents
(instead focusing on college students and adults)
(Crawford and Popp 2003; Visser and McDonnell
2012). But the relevance of this double standard for
adolescent sexual development and gender
inequality as well as other areas of research make
it an important concept to understand in and of
itself in addition to a concept that serves as an
exemplar of how and why double standards exist.
1079
Researchers routinely report studies
supporting the commonly held belief that people
judge sexual behaviors differently depending on
the gender of a sexual actor (see Milhausen and
Herold 2001; Fugère et al. 2008). For example,
girls and women are believed to be derogated and
stigmatized for nonmarital sexual contacts, while
boys and men are thought to receive praise and
positive attributions from others for similar D
behaviors. While this double standard is not as
overt and prevalent as it was during the 1950s and
1960s, it still exists in an undercurrent of language
and social behavior. For example, individuals in
social situations tend to adhere to the sexual dou-
ble standard because they believe that they are
displaying the accepted social norm, and since
they view the sexual double standard as the
norm, they act accordingly to avoid social con-
demnation (Marks and Fraley 2006, 2007).
Despite the above well-accepted findings, evi-
dence of the sexual double standard’s existence
has been elusive. Some research shows, for exam-
ple, that some rate the sexes who have had an
above average amount of sexual activity similarly
with some equally derogating men and women
who had similar sexual histories (see Gentry
1998; Marks and Fraley 2005). These similarities,
however, may disappear when studying unusual
sexual acts (e.g., multiple partners at once) rather
than common ones (see Browning et al. 2000;
Jonason and Marks 2009). Furthermore, recent
research exploring specifically adolescent sexual
debut has found the double-standard to have pre-
dictable but often unvoiced negative effects on
both adolescent boys and girls. Girls who do not
have their sexual debut by a certain age might be
seen as “prudes,” while those who do so “too
early” are “whores,” while for boys it is a large
issue of image in terms of demonstrating sexual
“prowess” (Kreager et al. 2016).
Research also reveals that, although the stan-
dard may be held widely by the general public,
findings on the sexual double standards remain
equivocal and nuanced as it reveals itself in mul-
tiple ways that might not be expected. Research
that has examined the place of other sexual double
standards during adolescence reports support
for it. Among other factors, the rise of online
1080
communication and use of social media among
adolescents has had strong impacts on strengthen-
ing double standards. For example, adolescent
males are quite likely to feel that they “deserve”
nude photos (“sexting”) from their female peers,
while females who ask for such photos in
response are quite often stigmatized (Ringrose
et al. 2013). Additionally, research has examined
adolescents’ self-reported numbers of sexual part-
ners to their relative acceptance by peers (Kreager
and Staff 2009). That research reveals that the
association between lifetime sexual partnerships
and peer status varies significantly by gender;
greater numbers of sexual partners correlates pos-
itively with boys’ peer acceptance but correlates
negatively with girls’ peer acceptance. Boys with
many sexual “conquests” were expected to be
well liked, while permissive girls ended with a
low status in school-based networks, regardless
of whether their sexual behaviors occur within
“romantic” relationships. Importantly, the study
also noted that the relationship between boys’
sexual behaviors and peer acceptance was moder-
ated by socioeconomic origins. Sexually permis-
sive boys from disadvantaged backgrounds had
more friendships than permissive boys from more
advantaged backgrounds; that link was not
supported for girls. Notably, permissive boys did
not lose status among girls, and permissive girls
did not appear to gain status from male peers, even
though they were clearly sexually active. The
study supported the existence of an adolescent
sexual double standard and suggests that sexual
norms vary by both gender and socioeconomic
origins. Moreover, adolescents’ individual identi-
ties being not fully formed renders them increas-
ingly susceptible to holding on to double
standards as an easy way of conforming and
avoiding overly complex decision-making,
whether in terms of romantic relationships
(Tolman et al. 2016) or even consumer behaviors
(Williams and Steffel 2014).
Conclusion
The study of all double standards but especially
sexual double standards reveals important key
Double Standards
points. It shows how perceptions are highly
influenced by social norms. Those norms are
influenced by a variety of factors, such as gender,
social class, and ethnicity. This area of study also
shows how, in some situations, those who suffer
from derogation appear to accept the double stan-
dards. The reliance on social stereotypes, even by
those who may be negatively affected by them,
further reveals the challenges facing efforts that
seek to address them. Adolescents’ entrenchment
in double standards can be reinforced by develop-
ing identities, values, senses of self, peer influ-
ences, and online communication and social
media. While there may be much to learn, enough
evidence reveals the importance of increasing
awareness of double standards and their effects,
especially as they relate to adolescents and their
development.
Cross-References
▶ Sexism
References
Browning, J. R., Hatfield, E., Kessler, D., & Levine, T.
(2000). Sexual motives, gender, and sexual behavior.
Archives of Sexual Behavior, 29, 135–153.
Crawford, M., & Popp, D. (2003). Sexual double stan-
dards: A review and methodological critique of two
decades of research. Journal of Sex Research, 40,
13–26.
De Bock, T., Vermeir, I., & Van Kenhove, P. (2012).
“What’s the harm in being unethical? These strangers
are rich anyway!” exploring underlying factors of dou-
ble standards. Journal of Business Ethics, 112(2),
225–240.
Fugère, M. A., Escoto, C., Cousins, A. J., Riggs, M. L., &
Haerich, P. (2008). Sexual attitudes and double stan-
dards: A literature review focusing on participant gen-
der and ethnic background. Sexuality and Culture, 12,
169–182.
Gentry, M. (1998). The sexual double standard: The influ-
ence of number of relationships and level of sexual
activity on judgments of women and men. Psychology
of Women Quarterly, 22, 505–511.
Himmler, O., & Schwager, R. (2013). Double standards in
educational standards – Do schools with a disadvan-
taged student body grade more leniently? German Eco-
nomic Review, 14(2), 166–189.
Dress Codes and Uniforms
Jonason, P., & Marks, P. (2009). Common vs. uncommon
sexual acts: Evidence for the sexual double standard.
Sex Roles, 60, 357–365.
Kreager, D. A., & Staff, J. (2009). The sexual double
standard and adolescent peer acceptance. Social Psy-
chology Quarterly, 72, 143–164.
Kreager, D., Staff, J., Gauthier, R., Lefkowitz, E. S., &
Feinberg, M. E. (2016). The double standard at sexual
debut: Gender, sexual behavior and adolescent peer
acceptance. Sex Roles, 75(7), 377–392.
Marks, M. J., & Fraley, R. C. (2005). The sexual double
standard: Fact or fiction? Sex Roles, 52, 175–186.
Marks, M. J., & Fraley, R. C. (2006). Confirmation bias
and the sexual double standard. Sex Roles, 54, 19–26.
Marks, M. J., & Fraley, R. C. (2007). The impact of social
interaction on the sexual double standard. Social Influ-
ence, 2, 29–54.
Milhausen, R. R., & Herold, E. S. (2001).
Reconceptualizing the sexual double standard. Journal
of Psychology & Human Sexuality, 13, 63–83.
Ringrose, J., Harvey, L., Gill, R., & Livingstone, S. (2013).
Teen girls, sexual double standards and “sexting”: Gen-
dered value in digital image exchange. Feminist The-
ory, 14(3), 305–323.
Tolman, D., Davis, B. R., & Bowman, C. P. (2016). “That’s
just how it is”: A gendered analysis of masculinity and
femininity ideologies in adolescent girls’ and boys’
heterosexual relationships. Journal of Adolescent
Research, 31(1), 3–31.
Visser, R., & McDonnell, E. (2012). ‘That’s OK. He’s a
guy’: A mixed-methods study of gender double-
standards for alcohol use. Psychology & Health,
27(5), 618–639.
Williams, E., & Steffel, M. (2014). Double standards in the
use of enhancing products by self and others. Journal of
Consumer Research, 41(2), 506–525.
Dress Codes and Uniforms
Beth W. Freeburg1 and Jane E. Workman2
1
School of Education, Saint Louis University,
St. Louis, MO, USA
2
School of Architecture, Fashion Design and
Merchandising Program, Southern Illinois
University, Carbondale, IL, USA
Overview
The purpose of this chapter is to summarize
research related to dress codes and uniforms in
K-12 settings. The summary includes 21 major
studies that are either atheoretical or framed
1081
within one of three theories (a) human develop-
ment theory, (b) risk taking theory, or (c) social
norm theory. A variety of variables and methods
are used to study specific segments of the popula-
tion of kindergarten through high school students,
as well as teachers, parents, and school personnel.
Controversies regarding student dress and the
rationale of proponents and opponents are
explained with findings from specific studies. D
Gaps in knowledge and measurement issues pro-
vide suggestions for further research. Dress code
policies should be designed as part of a school’s
social structure to facilitate students’ thriving
behaviors and growth into self-actualizing adults.
Introduction
Education is an important function of state and
local governments “because our society rests for
its continuance upon the growth of children into
well-developed and self-actualizing adults”
(Myhra 1999, p. 399). The school environment
has unique facets (a) a captive audience of
(b) students legally defined as minors who are
(c) a vulnerable population susceptible to peer
pressure, (d) cognitively immature, with (e) a
known proclivity for risky behaviors, and
(f) officials with power to act in loco parentis in
(g) a limited-public forum. Freedom of expression
in the school environment allows for endorsement
of unpopular and controversial opinions, but it
must be counterbalanced by society’s interest in
teaching students the parameters of civil behavior
or respect for others (LaVigne 1999). Dress code
policies outline the constraints of civil behavior
and are guidelines by which students’ right of
expression is limited because it may infringe on
others’ right to an education (Murphy 1991).
Dress code policies vary along a continuum of
restrictiveness: (a) no dress code policy at all,
(b) general dress code that outlines broad princi-
ples, (c) itemized dress code policy usually pro-
scriptive in nature (what not to wear),
(d) voluntary uniform policy, (e) mandatory uni-
form policy with an opt-out provision, and (f) a
mandatory uniform policy without an opt-out pro-
vision (Paliokas 2005). US public schools have
1082
traditionally had dress code policies; private
schools (e.g., parochial schools) have typically
prescribed uniforms (DelCampo and DelCampo
1998). There is a nationwide trend toward adop-
tion of more restrictive dress code policies as a
response to increasing school violence (DaCosta
2006; Paliokas 2005; Sanchez et al. 2012; Yeung
2009).
Major Theorists and Researchers
Scholars in various disciplines (e.g., sociology,
education, psychology, family studies, school
law) have studied dress codes and uniforms from
a variety of perspectives. This research can be
subsumed under the umbrella of three major the-
ories: human development theory, risk-taking the-
ory, and social norm theory. Guidelines for
student dress involve a context of social interac-
tion that can be described by its temporal, physi-
cal, and social environments (Workman and
Freeburg 2009). Human development theory
examines dress codes and uniforms from the per-
spective of the temporal environment, that is, the
past, present, and future. One focus is the life
stage of individuals and the accomplishment of
developmental tasks necessary to progress to the
next stage. Risk-taking theory examines dress
codes and uniforms from the perspective of the
physical environment, that is, material artifacts,
geographic location, and the setting in determin-
ing how to ameliorate risks to a vulnerable popu-
lation. Social norm theory examines dress codes
and uniforms from the perspective of the social
environment, that is, characteristics of people with
their statuses, roles, and relationships. Reviews of
case law represent an historical look at the process
of social control regarding dress code and uniform
policies.
Empirical research regarding dress codes and
uniforms includes 21 studies (see Table 1). A sum-
mary of the studies follows: (a) variables exam-
ined were the rationale for dress codes, content of
dress codes, sanctions for violating dress codes,
reasons for violating dress codes, and the relation-
ship of dress to student behavior, school climate,
safe-school planning, and psychological and
Dress Codes and Uniforms
physical security; (b) the research focused on ele-
mentary, middle, and high school populations;
(c) data sources included teacher survey
responses, interviews, observations, student sur-
veys and observations, newspaper articles, stu-
dent handbooks, and large databases referred to
as big data; and (d) data were analyzed using
quantitative descriptive statistics, t-tests, correla-
tion, analysis of variance, multivariate analysis of
variance, regression, content analysis, and
chi-square; and qualitative interviews, focus
group analysis, and content analysis of documents
(e.g., minutes from meetings, letters, brochures)
and field notes.
One necessary characteristic of quality
research is grounding in a theory that provides a
basis for explaining why something happens and
establishes a context for understanding events
(Wellington and Szczerbiński 2007). This under-
standing can potentially lead to generalizability or
broad application. A theory includes:
(a) interrelated concepts, definitions, and proposi-
tions used for specifying relationships among var-
iables; (b) a systematic strategy used to explain
behavior; (c) applicability in multiple content
areas; (d) unique terms; and (e) operationalized
components that are testable.
Human Development Theory
Human development theory is most often associ-
ated with the work of Erikson (1997). From the
theory of human development came the notion of
developmental tasks of early adolescence such as
physical maturation, emotional development, peer
group membership, and heterosexual relation-
ships. School dress code and uniform policies
are sometimes rationalized based on the idea of
assisting adolescents with achievement of devel-
opmental tasks.
Most public school dress code policies are
found at the junior and senior high level when
students are in early adolescence (ages 12–18).
Students in early adolescence tend to think in
concrete terms (Erikson 1997). Concrete thinking
involves literal interpretation of visual stimuli.
Thus, it is important in dress code policies to
Dress Codes and Uniforms 1083

Dress Codes and Uniforms, Table 1 Research regarding dress codes and uniforms: grades K–12
Researchers Year Variables Population Data source Method
Alleyne et al. 2003 Student dress (including Middle Black educators, Descriptive
uniforms) and student behavior school sixth graders, statistics, focus
eighth graders group data
analysis
Arnold and 2003 Offensive T-shirts, violent High school High school Descriptive
Workman behavior, consequences of students statistics, t-tests,
violent behavior, substance use, correlation
attitude toward school D
Baxter and 2008 Cultural meaning of fashion in High school Male high school Ethnography:
Marina marginalized subculture, subculture students interviews
demands for conformity
Brunsma and 1998 Student uniforms, attendance, Tenth grade Big Data: Descriptive
Rockquemore behavioral problems, substance National statistics and
abuse, academic achievement Educational weighted
Longitudinal regression
Study 1988
DaCosta 2006 School uniform policy, High School Big Data: Student Interviews over
compliance, academic Life in High 2-year period
performance Schools Project
(SLP)
Firmin et al. 2006 School uniform policies Christian Administrators, Interviews
K-12 schools faculty, staff,
students, parents
Freeburg 2004 Dress code rationale High school Student Content analysis
et al. handbooks
Han 2011 Mandatory school uniform K-12 Public Big Data: School Descriptive
policy and students’ problem schools Survey on Crime statistics,
behaviors and Safety’s analysis of
(SSOCS) variance, and
2003–2004 multiple
regression
Herbon and 2000 Content of dress and High school Student Content analysis
Workman appearance codes handbooks
LaPoint et al. 2003 Uniforms, dress-related Middle Black urban Descriptive
problems school middle school statistics,
students chi-square
Morris 2005 Race, class, gender inequities, Middle Students, Ethnography:
and regulation of students’ school teachers, aides, interviews,
bodies administrators observations, and
field notes
Murray 1997 Uniforms, school climate Middle Urban sixth, Descriptive
school seventh, and statistics,
eighth grade analysis of
students variance,
correlation
Ogle and 2002 Media dress-related responses, Columbine Dress-related text Content analysis,
Eckman who responded, rationale for (CO) High in two Colorado grounded theory
response School newspapers
O’Neal 1998 Risky behaviors related to dress High school Interviews Focus groups
Sanchez et al. 2012 Opinions about school Middle Student survey, Descriptive
uniforms by gender, grade school school police statistics,
level, benefits, race/ethnicity, records, and chi-square
and school violence and safety disciplinary data
(continued)
1084 Dress Codes and Uniforms

Dress Codes and Uniforms, Table 1 (continued)

Researchers Year Variables Population Data source Method
Studak and 2007 Civil behavior, safe-school US schools Dress-related text Content analysis
Workman planning, dress codes in the newspaper
Workman 2003 Ownership and visibility of Middle and Students in grades Descriptive
alcohol promotional clothing high school 7–12 statistics, t-tests,
items, alcohol use, perceived chi-square
parental approval of drinking
Workman and 2006 Dress codes, psychological High school Student Content analysis
Freeburg security, physical security handbooks
Workman 2004 Dress code violation sanctions High school Student Content analysis
et al. handbooks
Workman 2011 Message t-shirts and school High school Students and Descriptive
et al. safety (physical and teachers: Survey statistics,
psychological) with pictures ANOVA/
MANOVA, cross
tabs
Yeung 2009 School uniforms and student Kindergarten Big data: ECLS-K Descriptive
achievement and and NELS statistics, t-tests,
secondary and multiple
school regression

define and give specific examples of prescribed
(e.g., appropriate dress) or proscribed dress (e.g.,
immodest dress) for both boys and girls.
By providing boundaries and expectations
(e.g., through dress code policies), schools can
provide adolescents with the resources needed to
thrive (Scales et al. 2000). Adolescent thriving
can be assessed by indicators such as success in
school, helping others, physical health, ability to
delay gratification, and valuing diversity. These
positive indicators are in direct opposition to com-
mercial messages emphasizing instant gratifica-
tion, selfish indulgence, and materialistic values.
Schools can help students develop effective self-
regulation by reinforcing a commitment to posi-
tive values and social competencies such as civil
behavior. Adolescent well-being should be fore-
most in any rationale for dress code policies
(Freeburg et al. 2004).
Because of adolescents’ developmental stage,
they have not developed an ability to consistently
make mature decisions. “The First Amendment
rights of children are not as extensive as those of
adults because of children’s unique position rela-
tive to their parents and the state and because of
their less developed capacity to engage in rational
deliberation” (Myhra 1999, p. 365). Schools have
extensive power to protect students from possible
psychological and physical danger even if the
protection restricts some constitutional rights
(Myhra 1999). The constitution does not grant
individuals an absolute right to free expression
of ideas; this is especially true within the unique
context of the school (Miller 2002).
Risk-Taking Theory
Risk-taking theory examines dress codes and
uniforms from the perspective of the physical
environment, that is, the material artifacts,
geographic location, and the setting in deter-
mining how to ameliorate risks to a vulnerable
population. Material artifacts refer to tangible
objects (e.g., dress); setting refers to the place
where the event takes place (e.g., school build-
ing and grounds). Irwin (1993) defined risk
taking as deliberately choosing behaviors with
uncertain and possibly negative outcomes.
Experimenting with a wide range of behaviors,
including risky behaviors, is a normal part of
adolescent development (Irwin 1993). Cogni-
tive immaturity may partially explain why ado-
lescents make impulsive decisions, rationalize
impulsive choices by minimizing the potential
for personal risk, and appear insensitive to
Dress Codes and Uniforms
potential consequences of their actions (Bell
and Bell 1993; Gardner 1993).
School boards are entrusted to provide children
in their districts the skills necessary to cope in
society; thus, “school boards have a substantial
interest in creating and maintaining a safe and
effective learning environment” (Murphy 1991,
p. 1338). A commonly accepted notion is that it
is better to prevent or decrease significant risks to
a population than to deal with problems after they
have occurred. Three principles used to guide
school officials’ decisions are risk to others, risk
to self, and protection of vulnerable persons.
Avoidance of risk of serious harm to others is
known as the harm principle. Risk to self refers
to behavior that appears to affect only the person
engaging in it. Protection of vulnerable persons
involves safeguarding interests of individuals
who are not in a position to defend themselves.
Dress code and uniform policies are policies with
implications for risks to health, safety, and morals
of the school population.
Content analyses of dress code policies in pub-
lic secondary school handbooks and in news
reports revealed stated rationale, listed dress
items allowed and prohibited, and specified sanc-
tions for violation of dress code policies. Analysis
of school handbooks from 150 schools revealed
16 different rationales for dress codes of which
students’ right to a nondisruptive educational
environment was most frequent, followed by stu-
dents’ right to a safe and healthy environment
(Freeburg et al. 2004). Secondary school dress
codes generally specified required, acceptable,
and unacceptable clothing items with unaccept-
able items (e.g., tank tops, halter/backless/midriff
tops) most frequently listed (Herbon and Work-
man 2000). Sanctions for dress code violations
were found to be hierarchical in nature (e.g., ver-
bal warning, sent home to change, suspension)
with severity of sanctions increasing as the num-
ber of repeat violations increased (Workman
et al. 2004). Studak and Workman (2007) exam-
ined news reports (104 articles from 44 US news-
papers) to identify incidents that precipitated dress
code revisions. School safety (violence or threat
of violence in school, gang activity/influence,
neighborhood violence) was the predominant
1085
reason for dress code revisions. Dress code revi-
sions had an unstated but underlying goal of
encouraging civil behavior. These findings relate
dress code guidelines to the educational mission
of the school.
For some school districts, the rationale for a
dress code policy is reducing risks to physical and
psychological safety (Workman and Freeburg
2006). For example, in efforts to be fashionable, D
students want expensive items – designer clothes,
sneakers, or sports team gear – and have attacked
other students to acquire them (Why Dress Codes
n.d.). However, safety involves more than threats
of physical violence. Safety also implies social
and psychological security, for example, freedom
from fear of intimidation or peer discrimination.
Focus group interviews with 300 students in
grades 9–12 examined why students engaged in
risky behaviors related to dress (O’Neal 1998).
Students wore dress that had potential for negative
outcomes (e.g., physical abuse) in order to avoid
other negative outcomes (e.g., social or psycho-
logical abuse). Social and psychological abuse
(e.g., humiliation, intimidation, isolation, and
peer discrimination) were considered more likely
to occur than physical abuse.
For some schools, the rationale for a dress code
policy is reducing risks to students’ health, for
example, banning items with references to alco-
hol, tobacco, or illegal drugs. These products are
harmful and minors are not legally permitted to
use them. Arnold and Workman (2003) examined
the relationship between problem behavior among
high school students and ownership of T-shirts
advertising alcohol, tobacco, and weapons. Stu-
dents who owned these T-shirts, compared with
those who did not, were more likely to self-report
engaging in violent behavior, experiencing conse-
quences of problem behavior, engaging in sub-
stance use, and having a negative attitude toward
school. There were positive correlations between
ownership of a T-shirt that advertised alcohol and
students’ drinking behavior; ownership of a
T-shirt that advertised tobacco and students’
smoking behavior; and ownership of a T-shirt
that depicted a weapon and students’ having
used a gun or knife to take something from
someone else.
1086
Other dress code policies are instituted to
reduce risks to morality, for example, policies
prohibiting vulgar or obscene language on cloth-
ing (Weisenberger 2000). Immorality includes
sexual promiscuity, obscenity, and vulgarity. The
mass media devote vast resources to commercial-
ization of the fashion and entertainment industries
(Linn 2003), where traditional values and behav-
ioral constraint give way to innovativeness and
pushing boundaries. Commercial appeals to
sophistication and fashionability may pressure
female students to dress and act in sexually pro-
vocative ways (Linn 2003). The Supreme Court
noted that a legitimate concern of schools is to
protect children from exposure to material that is
sexually explicit, indecent, or lewd (DeMitchell
2002).
Social Norm Theory
Social norm theory assumes that (a) socialization
is one form of social control, (b) sanctions encour-
age compliance with norms, and (c) appropriate
behavior is learned through interaction with other
people within a specific social environment
(Schwartz and Ewald 1968; Workman and
Freeburg 2009). There are six steps in the process
of social control: norms (e.g., dress code policies),
violation of norms (e.g., students who ignore or
deliberately violate dress codes), recognition of
violation (e.g., teachers notice students who are
in violation of the dress code), report of violation
(e.g., teachers report student violators to the prin-
cipal), sanctions (e.g., consequences specified in
the school handbook), and enforcement of sanc-
tions (e.g., principal enforces sanctions by send-
ing student violator to detention). To apply this
theory to dress code policies, it is apparent that:
(a) such policies are socialization devices;
(b) sanctions associated with violation of dress
codes are written to encourage compliance with
norms; and (c) students learn appropriate and
inappropriate behavior while observing and
interacting with peers, teachers, administrators,
and other school personnel in the school environ-
ment. Morris (2005) identified a “. . .hidden cur-
riculum” (p. 28) purported to teach unspoken
Dress Codes and Uniforms
lessons about how schools regulate the appear-
ance of their students.
One goal of schools is to provide an atmo-
sphere conducive to learning. As one method of
social control, schools may employ narrowly
defined time, place, and manner regulations by
regulating, while students are in school, student
expression “that might reasonably be perceived to
advocate drug or alcohol use, irresponsible sex, or
conduct otherwise inconsistent with the shared
values of a civilized social order” (Murphy
1991, p. 1349). Regulations that are content
based have a goal of “suppression of the message
itself, while a content-neutral regulation is one in
which the impact on expression is only incidental”
(LaVigne 1999, p. 393). Uniform policies are
content neutral because they suppress all clothing
choice as a medium of expression for students
while at school; they are not targeted to suppres-
sion of one particular dress style, one specific
clothing item, or one particular message (Miller
2002). Another form of content-neutral regulation
available to schools is dress code policies. Spe-
cific messages are not prohibited and sufficient
options remain outside of school for expression
of the messages.
School boards have a compelling interest in
controlling threats to a safe and effective learning
environment (Murphy 1991). The school’s com-
pelling interest in controlling student appearance
in order to maintain discipline within the school
environment may outweigh students’ right of free
expression (Killen 2000).
While attending school, students – who have
the legal status of minors – are deprived of paren-
tal protection and have limited ability to protect
themselves. If students’ right to an education is
put at risk because of violence, disciplinary prob-
lems, negative attitudes toward school, and peer
pressure, school officials have an obligation to
take action. More and more, school officials take
action by invoking their constitutionally accept-
able power to enact dress code policies as one
means to control student behavior. Historically,
school officials get their authority to control stu-
dent behavior, including students’ dress and
appearance, from the principle of in loco parentis
(DeMitchell 2002). In loco parentis “encompasses
Dress Codes and Uniforms
the common law view of the legal status of minors
in the public school setting” (DeMitchell 2002,
p. 19). School employees assume the duty to
protect because they have supervisory responsi-
bility over students and have assumed the role of
parental substitute. Schools have implemented
dress code policies with stated purposes of con-
trolling the classroom atmosphere so that fear,
violence, and intimidation are nonexistent; inno-
cent nongang bystanders are protected; and learn-
ing is encouraged (Watkins and Hooks 1999).
Certain items of clothing symbolize lifestyles
related to gangs, drugs, violence, and disrespect
for authority (Killen 2000; LaPoint et al. 1993;
Murphy 1991). Thus, some schools have
established policies prohibiting signs of gang
membership such as jewelry, caps, bandannas,
and clothing that is all one color, especially red
or blue (Watkins and Hooks 1999).
Murphy (1991) analyzed the implications of
gang-related clothing as a form of overt intimida-
tion. Gang membership can be conveyed by wear-
ing specific colors, accessories, or garments.
Through clothing, gang members express pride
in associating with a particular gang. Dress code
policies prohibiting gang clothing may help con-
trol violence because, without symbols to ignite
violence, fights between rival gangs will be less
likely. Gang clothing can be intimidating because
students are aware that gangs maintain control
using violence and harassment. Gang members
who wear gang clothing or symbols in school are
trying to exert control while in school. When gang
clothing is prohibited other students are less
intimidated because gang members no longer out-
wardly declare control by their dress and covert
threats of violence are diminished.
Controversies and Related Research
Students’ clothing choices are silent personal
expression – expressed in school where they are
required to be (Nishigai 2001). Dress code poli-
cies limit students’ freedom to use dress as per-
sonal expression because it may infringe on other
students’ right to an education. Students are a
captive audience because they are required to
1087
attend school; a captive audience may include
some who are unwilling to be exposed to contro-
versial messages; the First Amendment assumes a
willing audience (Murphy 1991). When students
wear message T-shirts, the message is persistently
displayed – unwilling members of the audience
cannot ignore it. For example, 23 students were
suspended for wearing clothing with Confederate
flag symbols in violation of the high school’s D
dress code (Shapiro and Balingit 2015).
A spokesperson for the school said the symbols
were banned following racially motivated fights
linked to students wearing Confederate symbols.
The Confederate flag has a long history of contro-
versy: some see it as a symbol of Southern heri-
tage and others see it as a symbol of hatred,
slavery, and bigotry. Both students and teachers
gave the lowest ratings for feelings of safety to
being in the presence of someone wearing a Con-
federate flag T-shirt (Workman et al. 2011).
Graphic messages are not an issue when message
T-shirts are prohibited. Such narrowly defined
regulations only require students to change their
appearance while in school – not permanently
(Ruggiero 2002). Thus, the stage is set for contro-
versy. According to Mitchell and Knechtle (2003,
p. 491),
When weighing the possible likelihood of eliminat-
ing school violence, creating an environment con-
ducive for learning, structuring a level playing field,
reducing competition, and enhancing school pride
and self-esteem versus stymieing the freedom of
children to select their school wardrobe, it can be
argued that the sides of the scale are not even close
to being balanced.
Morris’s study (2005) of the hidden curriculum
was framed in reproductive theory, a variant of
social control theory that relies on social norms.
There were attempts to control middle school
students’ clothing on nonuniform days and at
school events. Findings revealed inequities across
gender, class, and race, which generated students
who oppose school, or at minimum, felt out of
place there. For example, wearing all blue – shirt
and pants – was interpreted to indicate gang mem-
bership only when worn by Latino boys. Asian
students were treated as a “. . .model-minority”
(p. 39) no matter their clothing choices. Morris
1088
concluded that schools unevenly convey the
styles of the dominant culture through unspoken
lessons, in addition to formal school dress codes.
Proponents
Proponents of prescriptive dress code policies
allege that these policies promote student safety
by reducing negative peer pressure, gang-related
activity, and fighting (LaPoint et al. 2003; LaPoint
et al. 1992). As a security measure, dress code
policies are less intrusive for students than other
security measures, such as metal detectors, secu-
rity guards, locker checks, locked doors, and zero-
tolerance policies.
Further, prescriptive dress code policies are
alleged to contribute to positive school attitudes,
lessen pressure on families to buy expensive
trendy clothing for their children, and decrease
absenteeism, disciplinary sanctions, and sub-
stance abuse (Holloman et al. 1996; LaPoint
et al. 1992, 2003). Principals reported that dress
code policies were effective in improving behav-
ior, reducing peer sexual harassment, and prepar-
ing students for the world of work (DeMitchell
et al. 2000). Advocates of school uniform policies
credit uniforms with enhancement of discipline,
respect, academic performance, attendance, posi-
tive attitudes, school climate, and safety (Sarke
1998). In addition, uniforms have been linked to
reduced peer pressure and reduced financial strain
on parents (Why Dress Codes n.d.).
Han (2011) used a nationally representative
School Survey on Crime and Safety findings
(i.e., big data) to examine the relationships
among a mandatory school uniform policy, stu-
dent problem behaviors, and various school safety
efforts in urban high schools where most such
policies are adopted. Problem behaviors ranged
in severity from minor (e.g., class disruption) to
serious and violent (e.g., rape, physical attack,
robbery). School safety efforts included parental
involvement, crime prevention programs for stu-
dents, teacher training programs, and community
efforts. School uniform policies significantly
reduced student problem behaviors at the elemen-
tary and middle school level.
Dress Codes and Uniforms
Opponents
Opponents of dress code and uniform policies
allege that benefits may be based on intuitively
accepted premises, as there is little statistical evi-
dence to support claims of benefits (Brunsma and
Rockquemore 1998; DaCosta 2006; Sarke 1998;
Yeung 2009). They point out that dress code and
uniform policies restrict youth from
experimenting with identity expression, an impor-
tant developmental task of adolescence. Oppo-
nents also assume that these policies contribute
to punitive zero tolerance in student discipline
policies (Skiba 2001). The constitutional issue of
freedom of expression is a key component of
opposition to dress code and uniform policies
because policies sometimes fail to acknowledge
cultural, religious, and ethnic dimensions of dress
(LaPoint et al. 2003), for example, prohibition of
hip-hop dress or Muslim headscarves.
Students are frequently opposed to dress code
and uniform policies. Guided by ecological
human development perspectives, DaCosta
(2006) examined the messages conveyed through
school uniform policies. For example, are stu-
dents’ positive identities associated with school
uniforms (e.g., pride and inspiration) or are uni-
forms “. . .markers for who can ‘pass,’ or who can
proceed through the school day without threat of
harassment or disciplinary ‘profiling’?” (p. 50).
Student narratives revealed that the majority of
students in this urban high school were opposed
to the uniform policy that included an alternate
uniform used as punishment. In fact, Han (2011)
found that at the high school level, mandatory
uniform policies increased student problem
behaviors. Two additional studies determined
that students found little benefit in dress code
policies. Firmin et al. (2006) found that students
in two Christian schools reported little progress in
eliminating competition, encouraging appropriate
dress, decreasing distractions in the learning envi-
ronment, and reducing the cost of clothing stu-
dents for school. However, students did believe
that uniform policies encouraged more modest
dress. Sanchez et al. (2012) found that seven and
eighth grade students did not perceive any benefits
in wearing school uniforms.
Dress Codes and Uniforms
To understand high school students’ resistance
to dress code policies, Baxter and Marina (2008)
framed their research using social control theory,
specifically focused on violation of norms and the
reasons behind the violations. In addition to for-
mal and informal interviews, extensive field notes
based on personal observations were the sources
of data. Students violated the dress code as a:
(a) means to challenge authority; (b) way to gain
status by customizing their hair and clothes;
(c) way to celebrate the self in ways essential for
recognition in the subculture; and (d) show of
strength, power, and upward mobility within
their subculture.
There is no guarantee that dress codes will be
an effective deterrent to school violence, but that
is also true of other security measures (e.g., metal
detectors, security guards). Likewise, there is little
evidence that uniforms improve achievement in
school; they are “. . . not a panacea” for educa-
tional reform (Yeung 2009, p. 871). Dress code
policies have inherent weaknesses, for example,
policies may be vague or overbroad, not
completely address the problems they were cre-
ated to solve, and the same issues are subject to
litigation in different jurisdictions (Killen 2000;
Freeburg et al. 2004; Herbon and Workman
2000). When school officials and students spend
their time and resources on legal disputes, they
cannot focus on their primary mission of educa-
tion and learning (Nishigai 2001).
Gaps in Knowledge
Quality research studies most generally are built
on a theoretical foundation or overarching struc-
ture that is used to investigate research questions
and explain findings. Three studies, two using big
data and another using qualitative methods, exam-
ined the impact of school uniforms on multiple
student behaviors and outcomes without a theo-
retical framework. A number of existing theories
could be applied to components of dress code and
uniform research. One gap in knowledge is the
absence of an all-encompassing theory to provide
a context for understanding and explaining the
effects of dress codes and uniforms. Elements of
1089
human development theory, risk-taking theory,
and social norm theory could be combined to
create a theory to guide research regarding dress
codes and uniforms.
Researchers have examined to varying extents
the relationship of dress codes and uniforms to
both thriving and disruptive student behaviors.
There is limited research and, therefore, knowl-
edge gaps in understanding on the relationship of D
student dress with thriving behaviors, such as
academic achievement and proschool attitudes
(Brunsma and Rockquemore 1998; Murray
1997). There is a great deal of empirical data
regarding some behaviors that create risk to
health, safety, and morality in the school environ-
ment (e.g., violence, bullying, drinking, smoking,
and drug abuse). Data about other risks are sparse
(e.g., verbal and visual harassment, teasing).
There are little or no data on visual harassment
using dress as a method of invoking fear and
intimidation – powerful emotions that hinder a
student’s ability to concentrate on academic
achievement (LaPoint et al. 1993).
Regarding thriving behaviors, data can be
gathered to determine the extent to which dress
codes and uniforms increase attendance, self-
esteem, belonging, and school spirit (Brunsma
and Rockquemore 1998; Scales et al. 2000). For
example, Murray (1997) studied the effects of
uniforms on school climate by comparing stu-
dents in a school with a uniform policy to students
in a school without a uniform policy. The two
middle schools were from the same urban area
and comparable in student characteristics such as
racial composition, state categorization, and num-
ber of students receiving free/reduced price lunch.
In nine of ten subscales, students with a uniform
policy rated their school climate more positively
than students without a uniform policy. Murray
concluded that school uniforms do have a positive
effect on student perceptions of school climate.
Regarding disruptive behaviors, data can be
compiled on dress and its relationship to student
problem behaviors such as bullying, coercion,
disruptive behavior, harassment, intimidation,
substance use (alcohol, tobacco, drugs), threats,
verbal abuse, and violence (Holloman 1995;
Holloman et al. 1996; LaPoint et al. 1992, 1993;
1090
O’Neal 1998). For example, in the Columbine
(CO) High School shootings, jocks’ baseball
caps with specific rounded bills implicitly com-
municated threats of impending bullying behavior
(Ogle and Eckman 2002). School officials have a
substantial interest in reducing the number of
innocent students who are intimidated through
such symbols (Murphy 1991). Based on anecdotal
evidence, some administrators believe that dress
codes have been effective in reducing violence in
their schools. Other types of problem behavior
possibly linked to dress can be documented via
anecdotal reports, for example, humiliation, neg-
ative attitudes toward school, peer discrimination,
and implied threats of violence.
A lack of documented evidence may lead to a
conclusion that a dress code policy has been
implemented as a way to instill good taste in
students’ personal appearance. This conclusion
suggests a superficial policy aimed at student
expression and not connected to student behav-
ioral outcomes (Brunsma and Rockquemore
1998). Student expression should be restricted
only when necessary to attain an important pur-
pose (Sarke 1998). When carefully documented
evidence leads to a conclusion that the dress code
policy is aimed at students’ behavior for reasons
not related to the expressive component, then the
policy is permissible if it can endure inspection
under the four-part test of United States v. O’Brien
(Myhra 1999). The O’Brien test requires the
school to prove that the dress code policy is:
(a) within the constitutional power of the school;
(b) that it advances a significant interest of the
school; (c) that the school’s interest is not related
to limiting free expression; and (d) that the limita-
tion of free expression is no greater than necessary
to advance the school’s interest (LaVigne 1999).
Measurement and Measurement Issues
Measurement and the analysis of data are the
foundations of social science research (White
and Breckenridge 2014). Together they are used
to evaluate the impact of dress code and uniform
policies on student behavior. Specific research
questions can be answered by the measurement
Dress Codes and Uniforms
of variables via numeric data (quantitative) and
nonnumeric (qualitative) data. Appropriate
numeric research methods include surveys and
observations. One example of numeric research
is big data sets which are increasingly being used
to understand both thriving and disrupting student
behaviors. Big data features: “. . .multi-sources,
huge volume, and [is] fast changing” (Jin
et al. 2015 p. 63). Appropriate nonnumeric
research methods include ethnography, content
analysis, narrative inquiry, artifact analysis, and
historical sources. Issues related to validity and
reliability are associated with both types of data.
School officials can be proactive in their eval-
uation of the impact of student dress. Regarding
disruptive behaviors, data are necessary to answer
two questions: can a reasonable school official
foresee a disruption and would a reasonable
school official find the disruption to be substantial
and material (Miller 2002). If school officials can
logically predict substantial disruption, they can
prohibit student expression (i.e., particular items
of dress) before any disruption occurs (Sarke
1998). But school officials must provide evidence
that the school’s educational mission is endan-
gered by a foreseeable and perhaps impending
risk of disruption. School records can provide
evidence of past instances of actual or threatened
disruption relating to disputed clothing items
(Miller 2002). When courts apply the substantial
interference test, school districts may be required
to show how regulating student dress will actually
reduce the risk of disruption (LaVigne 1999).
Regarding thriving behaviors, data can provide
evidence suggesting the impact of school dress
codes and uniforms on achievement (Yeung
2009), ease of going to school, confidence, and
self-esteem (Sanchez et al. 2012) and youth
resourcefulness during challenging situations to
maintain their sense of freedom (DaCosta 2006).
Multiple sources of data are needed to provide
sufficient evidence supporting the need for stu-
dent dress codes or uniforms. Observational anal-
ysis should include an awareness of current events
influencing student behavior such as fashion
trends and popular entertainers. For example,
one dress code policy prohibited students from
wearing plaid shirts because of an assumption
Dress Codes and Uniforms
that plaid shirts were a gang symbol. However,
plaid shirts were a fashion trend that year, and it
was impossible to enforce the regulation. Some
dress items can be prohibited because of their
potential to promote unhealthy practices, for
example, alcohol promotional items such as beer
T-shirts (Workman 2003). Evidence of veracity of
observational and anecdotal evidence is mixed but
given the difficulty of measuring effectiveness,
such evidence should not be discounted (Volokh
and Snell 1998). Anecdotal evidence about deter-
rents to school violence supports a ban on items
such as Gothic clothing and Marilyn Manson
T-shirts (Cohen 2000). School officials can show
a connection between certain items of dress and
potential risks to health, safety, or morals by rely-
ing on actual experience (e.g., anecdotal evi-
dence) or on opinions from experts (Lane
et al. 1994). Testimony by an authority can estab-
lish a link between dress code policies and
increased safety, for example, “evidence satisfied
the reasonable relationship standard, including
testimony that the dress code reduced distractions
to learning, increased campus safety, and leveled
socioeconomic barriers” (Zirkel 2000, p. 79).
Newspaper articles that report incidents in
schools can indicate relationships among risks to
health, safety, or morality of the school population
due to particular dress and appearance symbols. In
one school, hooded shirts and cargo pants with
pockets were prohibited because they provided a
hiding place for school contraband, including
weapons and cell phones (Breitman and Barker
2006). In another school, two girls were
reprimanded for wearing Lycra and denim strap-
less dresses that revealed too much cleavage
(Callas 2002). In both situations, students were
required to change to clothes the school provided
or to face being sent home.
School officials may believe certain items of
clothing invite theft and the way to control risk of
theft is to regulate student dress; in response, they
establish dress code policies prohibiting students
from wearing expensive clothing or jewelry.
However, it is insufficient for school officials to
believe that student dress choices contribute to
theft; they must have evidence to show that the
risk of theft is at least partially attributable to
1091
students’ dress. For example, school officials
could compile statistics detailing students
attacking other students for their expensive
clothes or jewelry (Sarke 1998).
In deciding whether dress code policies are
constitutional, courts are guided by tests derived
from Supreme Court decisions. Pure speech may
be restricted only if there is a risk of significant
disruption to learning. Dress may be considered D
speech if the wearer intends to communicate a
particular message, and it is likely others would
understand the message (Killen 2000). Because of
in loco parentis and the status of schools as limited
public forums, school officials are allowed rela-
tively more regulation of speech than officials in
other contexts (Murphy 1991).
Conclusions
If the past is any indication, policies regulating
student dress and appearance will likely encounter
legal challenges. When school dress code policies
are written, the purpose for the regulations should
be expressly stated. For example, “the board
stated that its objective was to maintain order
and decorum, avoid disruptions, maintain and
promote discipline, avoid distractions, prevent
disturbances, contribute to the administration of
the classroom, and promote safety” (Ruggiero
2002, p. 719). Dress code policies can be designed
as part of a school’s social structure to facilitate
student growth into self-actualized adults – a way
to assist adolescents to thrive by providing bound-
aries and expectations for dress. Simultaneously,
positive boundaries and expectations for dress can
counteract commercial messages and potentially
help students develop a positive identity, effective
self-regulation, positive values, and social com-
petencies such as civil behavior.
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Drinking Game Playing: A Prevalent
and Risky Activity Among Youth
Shannon R. Kenney1, Byron L. Zamboanga2,
Justin F. Hummer3 and Joseph W. LaBrie4
1
Department of Psychiatry and Human Behavior,
Alpert Medical School of Brown University,
Providence, RI, USA
2
Department of Psychology, Smith College,
Northampton, MA, USA
3
Department of Psychology, University of
Southern California, Los Angeles, CA, USA
4
Loyola Marymount University, Los Angeles,
CA, USA
Overview
Drinking games (DG) can be defined as a social
drinking activity that consists of rules designed to
facilitate intoxication as participants perform
some type of cognitive and/or motor tasks
(Zamboanga et al. 2013). Given that the overarch-
ing goal of DG is for participants to become
1094 Drinking Game Playing: A Prevalent and Risky Activity Among Youth
intoxicated in a relatively short period of time,
participation typically leads to heavy episodic or
binge drinking (four drinks in a row for females or
five drinks in a row for males) and high blood
alcohol concentrations (BACs), which in turn
increase the risk for negative consequences, such
as blacking out, sexual victimization, and driving
under the influence (DUI) (see Zamboanga
et al. 2014a, 2016b for reviews). Drinking game
involvement is also correlated with excessive
drinking behaviors and other high risk activities
including prepartying, risky sex, unsafe driving,
and drug use (e.g., Borsari et al. 2007, 2013;
Fairlie et al. 2015; Hummer et al. 2013; Johnson
and Stahl 2004; Nagoshi et al. 1994; Simons
et al. 2005a, b; Zamboanga et al. 2010a). Research
suggests that DG participation peaks in late ado-
lescence (Sharmer 2005; Polizzotto et al. 2007)
and that a majority of adolescents matriculate into
college having already participated in DG
(Borsari et al. 2003; Kenney et al. 2010). Despite
the established prevalence and risk associated
with DG playing among adolescents, DG have
not been the focus of harm reduction interventions
or prevention efforts, and research on DG involve-
ment among precollege adolescents is limited
(Zamboanga et al. 2016b).
Introduction
As early as the fifth century BC, ancient Greeks
enjoyed drinking “symposia” in which a “master
of drinking” was designated to predetermine both
the potency and amount of wine to be consumed
as well as impose penalties for violation of game
rules (e.g., failure to recite a passage of poetry or
exhibit the dexterity to aim a drop of wine through
an intricate maze) (Garland 1982). Modern day
DG, however, are played predominantly by ado-
lescents and young adults and have evolved to
include an estimated 500 types of DG, including
Kings, Power Hour, and Quarters, that test
players’ drinking endurance and speed as they
consume large amounts of alcohol in relatively
short spans of time. The increasing popularity of
these hazardous drinking activities leads to esca-
lated risk among youth, including hangovers,
blackouts, DUI, risky sexual behaviors, and alco-
hol dependence (e.g., Borsari et al. 2007; Hummer
et al. 2013; Nagoshi et al. 1994; Zamboanga
et al. 2010b).
Types of Games
Drinking games vary in structure, competitive-
ness, duration, requisite thinking and coordina-
tion, beverage choice, and risk for intoxication
(LaBrie at al. 2013; Zamboanga et al. 2007,
2013). For example, verbal games (e.g., I
Never), in which responses or questions control
consumption, tend to rely on players’ capacity to
share information or remember rules, whereas
media games (e.g., Roxanne), in which words or
actions from television, movies, or music cue
consumption, test players’ perception and listen-
ing skills (Borsari 2004). LaBrie and colleagues
(2013) systematically derived five categories of
DG based on their rules and player behaviors.
Even competition games (e.g., Beer Pong, Flip
Cup), in which players or teams alternate turns,
were found to be the most popular among adoles-
cents and young adults. Because these types of
competitive DG are structured around specific
skill set goals (e.g., throwing a ping pong ball
into a cup of beer from across a ping pong
table), players are incentivized to force opponents
to drink as much as possible while retaining as
much personal visuospatial and motor functioning
as possible, in spite of inebriation. Targeted and
skills games (e.g., Quarters, Jeopardy) require
strategy and involve making others drink or
avoiding drinking oneself, whereas communal
games have no official winner or loser; players
simply agree on some rule-based action, phrase,
or event that determine when and how much to
drink (e.g., Never Have I Ever, Movie DG).
Chance games (e.g., dice and playing card
games) involve simple rules but minimal skill.
Finally, extreme consumption games (e.g., chug-
ging, keg stands), which involve high volume
drinking but are not rule-bound, are associated
with the highest levels of drinking and intoxica-
tion of all DG (LaBrie et al. 2013; Zamboanga
et al. 2007). Regardless of type, however, all DG
Drinking Game Playing: A Prevalent and Risky Activity Among Youth
are governed by reversal of competence or the
notion that the longer the game is played, the
more inebriated and inept players become
(Green and Grider 1990).
As a testament to the perpetuation and evolu-
tion of DG, in early 2014, an online drinking game
known as NekNominate (aka neck and nominate
or neknomination) gained widespread popularity
and attention due to its potentially lethal outcomes
(Moss et al. 2015; Wombacher et al. 2016). In
neknominate, a participant films him or herself
drinking in increasingly extreme circumstances
(e.g., chugging large quantities of high ethanol
content liquor, drinking alcohol out of a toilet),
then nominates others to do the same within 24 h.
Four of the most popular DGs are described as
follows:
Beer Pong (Beirut): Beer Pong is a team-
based game in which players throw a ping pong
ball across a table with the intent of landing the
ball in a cup of beer on the other end of the table.
The game typically consists of two, two-player
teams. Six to ten cups are set up on each side of
the table, typically in a triangle formation. The
goal of the game is to eliminate the other teams’
cups before one’s own cups are eliminated. When
a ball lands in a cup, which is generally filled with
2 to 3 oz of beer, that cup is eliminated and the
defending team must consume all of the beer
inside that cup. Once a team has eliminated all
of the opposing cups (with the opponents having
consumed all the beer in the cups), the losing team
must also consume all the beer remaining in the
winning team’s cups.
Flip Cup (Cup): Flip Cup is also a team-based
drinking game in which two teams stand on oppo-
site sides of a table, facing one another. In front of
each teammate is a plastic cup filled with a stan-
dard amount of beer (generally 2 to 4 oz.). At the
start of the race, the first member of each team
drinks his or her beverage. When finished, the cup
is placed face up at the edge of the table, and the
player who drank it attempts to flip the cup, by
setting it on the edge of the table and flicking or
lifting the bottom until it flips and lands face down
on the table, sitting on its mouth. The player may
not use two hands to help “guide” the cup to flip
over. If he or she is not successful on the first try,
1095
the cup must be reset and re-flipped. Only after the
first teammate is done flipping the cup success-
fully can the next person proceed. Whichever
team finishes drinking and flipping all of their
respective cups is the winner.
Power Hour: With its variant Centurion
(or Century Club), Power Hour is a drinking
event in which every player consumes one shot
of beer every minute for 1 h. Each shot contains D
approximately 1.5 fluid ounces, for a total of 90 fl.
oz. of consumption during the power hour. For
purposes of blood alcohol content, this amount of
beer is roughly equivalent to 7.5 drinks. In the
Centurion variant, beer shots are consumed 1/min
for 100 min, roughly equating to 10 drinks. All
players successfully completing the total number
of shots without retiring are considered winners.
Quarters: Quarters can be played with any
number of players. All players sit around a table
or other hard surface, with a single shallow glass
placed in the middle. The goal is to try to bounce a
quarter off the table and into the glass. If success-
ful, the player selects any other player to have a
drink and receives another turn. If the player fails,
play passes to the next in the circle. If the player
successfully bounces a quarter into the glass three
times in a row, this player may make a rule. As
with other DG, the rule can be anything that
includes drinking as an outcome. For example,
nobody is allowed to say a chosen word, or every-
one must drink before each attempted bounce, or
perhaps no one is allowed to point with his or her
fingers. If any rule is broken during the course of
play, the violator must consume alcohol.
Prevalence
Studies based on high school and matriculating
college student samples show high rates of game
playing among adolescents (Zamboanga et al.
2016b). In a study of 477 first-year college stu-
dents, 54% reported playing a drinking game dur-
ing the last months of high school. Those students
who played a drinking game in their last month of
high school averaged nearly four game playing
events per month and played DG during 44% of
all high school drinking occasions (Kenney
1096 Drinking Game Playing: A Prevalent and Risky Activity Among Youth
et al. 2010). In another study of 1252 students
attending precollege summer orientations, data
compiled from three consecutive years revealed
that 66% of females and 60% of males had played
DG and, of these, approximately one in five
reported weekly and nearly half reported monthly
or biweekly DG playing (Borsari et al. 2003).
Evidence suggests that initiating DG playing dur-
ing high school is predictive of DG participation
in college (Borsari et al. 2003; Johnson
et al. 1998; Kenney et al 2010; Douglas 1987).
Although heavy drinking and DG playing among
college students has often been attributed to new-
found freedom from parental monitoring and
immersion into collegiate social cultures that con-
done and even revere unsupervised underage
drinking (Hingson et al. 2005; O’Malley and
Johnston 2002; Toomey et al. 2007; White
et al 2006; White and Jackson 2004), considerable
evidence suggests that college drinking may pri-
marily be an extension of preestablished high-risk
drinking behaviors, such as DG, that persist or
intensify when students enter collegiate environ-
ments (Baer et al. 1995; Hersh and Hussong 2006;
Leibsohn 1994; Wechsler et al. 1994). Regardless,
DG are thought to act as ritualized drinking con-
texts by which incoming college students are
socialized into heavy drinking peer cultures
(Adams and Nagoshi 1999).
Although the majority of college students
report past month DG participation, younger stu-
dents, particularly first-year students, have the
highest rates of DG involvement (Adams and
Nagoshi 1999. In fact, in a survey of 3830 student
drinkers from 58 US colleges, 73% of first-years
had played a DG in the past month as compared to
38% of sophomores, juniors, and seniors (Engs
and Hanson 1993). In another study of male
and female undergraduates aged 18 to 25 years,
18- and 19-year-olds were five times more
likely to engage in DG than older students
(Sharmer 2005). Although previously considered
a male-dominated activity (Borsari 2004;
Clapp et al. 2000; Engs et al. 1996; Johnson
et al. 1998), recent research shows comparable
rates of DG engagement among male and female
high school and college students (Borsari
et al. 2013; Engs and Hanson 1993; Kenney
et al. 2010; Pedersen and LaBrie 2006). These
findings coincide with trends in college women’s
binge drinking that are increasingly converging
with those of male peers (O’Malley and Johnston
2002; Wechsler et al. 2002; Young et al. 2005).
Although males appear to drink more while par-
ticipating in DG than do females (Johnson and
Sheets 2004), both males and females report
drinking significantly more during DG than dur-
ing other drinking situations (Johnson et al. 1998;
Pedersen and LaBrie 2006).
In regard to race and ethnicity, the vast major-
ity of research shows that DG are more prevalent
among White students compared to other racial-
ethnic groups (Haas et al. 2012; Pedersen and
LaBrie 2006; Kenney et al. 2010; Zamboanga
et al. 2015a, b). Moreover, event-level self-reports
indicate that among students participating in DG,
non-White students, despite lower rates of partic-
ipation overall, experience greater ensuing nega-
tive consequences than White students (Pedersen
and LaBrie 2006). These studies are limited given
that the ethnic minority student samples were
grouped into a single non-White category. In a
recent study, (Zamboanga et al. 2015b) examined
DG behaviors in a large, multisite ethnically
diverse sample of college students. The authors
found that prevalence rates were highest among
White students, followed by Hispanic and Asian
American students who did not differ from one
another but had higher participation rates than
Black students. Whether or not similar patterns
of ethnic and racial differences exist in DG behav-
iors among current high school students and non-
college students is not entirely clear at the present
time. Thus, representative samples with adoles-
cents and young adult populations are needed to
adequately assess the role of racial-ethnic status
and acculturation (i.e., the process of social, psy-
chological, and behavioral adaptation that unfolds
when people from different cultural backgrounds
come in contact with each other; Zamboanga
et al. 2014b), both of which are found to predict
DG participation and risk (e.g., Schwartz
et al. 2014; Zamboanga et al. 2016a).
Research indicates that playing DG represents
a social normative behavior in certain subgroups
of students, namely, high school and collegiate
Drinking Game Playing: A Prevalent and Risky Activity Among Youth
athletes (Borsari et al. 2013; Grossbard
et al. 2007; Hummer et al. 2011; Lisha and
Sussman 2010 for review; cf. Zamboanga
et al. 2008) and fraternity/sorority members
(Sher et al. 2001; West 2001). Not only may
athletes and Greek-affiliated students value the
social and competitive nature of DG, but high
rates of heavy drinking in these populations con-
tribute to higher rates of high risk drinking activ-
ities (e.g., Hummer et al. 2011). In fact, heavy
drinkers have been shown to be nearly seven
times more likely to play DG than students not
classified as heavy drinkers (Sharmer 2005).
Nonetheless, it is important to note that college
students unaffiliated with formal athletics or
Greek houses engage in DG and heavy drinking
and experience negative consequences as a result
of DG (Smith et al. 2005). Residential status
appears to be a strong predictor of DG-related
risk. One study found that of students enrolled in
college, those living away from home (i.e., on
campus) encountered significantly greater drink-
ing opportunities (i.e., gatherings with DG, alco-
hol, and intoxicated peers present) than those
living with parents (White et al. 2008). Surpris-
ingly however, no significant differences emerged
between college and same aged noncollege
attending respondents’ drinking opportunities
(White et al. 2008). Thus, despite lack of direct
data, it appears that DG may be quite common
among noncollege youth.
Even though they consistently represent
unique forms of high risk drinking contexts
(Borsari et al. 2007; Kenney et al. 2010; Zambo-
anga et al. 2010b), DG often occur as a form of
prepartying (aka. front-loading, pregaming or pre-
funking; refer to the prepartying entry for addi-
tional information). Prepartying or pregaming can
be defined as “drinking (which may or may not
involve getting ‘buzzed’ or drunk) alone or with
people before going to an event or gathering
where more alcohol may or may not be con-
sumed.” (Zamboanga and Olthuis 2016, p. 954).
Still, DG have no temporal requirement and can
be played at any point during the course of the
entire drinking occasion. Consistent with Kenney
et al’s (2010) study of incoming college students,
Tomaso et al. (2015) found that high school
1097
students reporting both prepartying and DG in
the past 30 days experienced similar levels of
negative consequences as high schoolers
reporting just DG participation.
However, in a large, multisite study examining
event-specific data among heavier drinking col-
lege students (Hummer et al. 2013), playing DG
led to higher BACs and resulted in more negative
consequences in both prepartying and non- D
prepartying contexts. However, whereas the
heightened risk associated with game playing
when prepartying impacted men and women sim-
ilarly with respect to BACs, the experience of
negative consequences was more pronounced for
female students. Therefore, playing DG while
prepartying seems to be the riskiest combination
for heavier drinking college women, as those who
engage in both drinking behaviors concurrently
have more resultant problems than heavier drink-
ing women who preparty sans games.
In another study of male and female college
athletes (Hummer et al. 2011), 36% reported
typically playing DG while prepartying. Individ-
uals within the prepartying/DG group drank more
and experienced more negative consequences,
both overall and while prepartying, than the
prepartying-only group and the nonprepartying
group. Perhaps most concerning are the specific
types of consequences experienced at a higher rate
by the prepartying/DG group, relative to the other
two groups. These included blacking out, passing
out, waking up in an unexpected place, regrettable
sexual situations, and increased tolerance. Taken
together, these findings indicate that engaging in
DG while prepartying can lead to riskier drinking
outcomes, especially among heavier drinking
groups of college students and women.
Motivations
Among youth, DG are believed to serve multiple
functions; for example, they may offer contexts in
which youth can conform to peer group behavior,
ease stress associated with social interaction, and
foster group camaraderie. Adolescents may
engage in drinking game playing due to a conflu-
ence of potential risk factors associated with the
1098 Drinking Game Playing: A Prevalent and Risky Activity Among Youth
developmental period. These include the
decreased salience of parents and increased
salience of peers, greater exposure to the model-
ing of peer behavior, transition to adulthood and
orientation toward autonomy and non-
conventional behaviors, and emphasis on drink-
ing as a social lubricant associated with fun
(Jessor et al. 1991; Palmqvist et al. 2003;
Palmqvist and Santavirta 2006). High school stu-
dents commonly endorse positive reinforcing
social (e.g., “to be sociable”) and enhancement
(e.g., “because I like the feeling”) motives for
participating in DG (Borsari et al. 2013; Tomaso
et al. 2015; Van Tyne et al. 2012), which are
associated with increased DG participation.
College transitions marked by heavy alcohol
consumption, increased drinking opportunities,
and unprecedented personal stressors (Hingson
et al. 2002; White et al. 2006) are particularly
risk-enhancing for incoming students with prior
high school game playing experience as these
students may be inclined to perceive heavy drink-
ing as a means by which to ease social discomfort
and establish their identity amid unfamiliar peers.
However, considering the normative role that
heavy drinking plays in collegiate cultures, drink-
ing game playing in college may differ fundamen-
tally from precollege drinking game playing.
Considering that 55% of incoming college stu-
dents report playing DG to get drunk and half to
socialize or meet new people (Borsari et al. 2003),
it is not surprising that DG have been embraced by
this population. Self-reports have revealed that
college students most commonly play DG for
social reasons, for instance, to act as a social
lubricant (Borsari 2004; Polizzotto et al. 2007;
Zamboagna et al. 2007). Moreover, perceived
positive expectancy effects (e.g., sociability or
liquid courage) are positively associated with
drinking game participation in both high school
and incoming college student samples (Borsari
et al. 2013; Haas et al. 2012; Nagoshi
et al. 1994; Zamboanga et al. 2005, 2010b,
2012). Players are likely to view getting drunk
positively, take pride in their ability to drink
large quantities, and anticipate approval for
heavy drinking (Green and Grider 1990; Newman
et al. 1991).
Consequences
The rapid intoxication associated with DG makes
self-regulation appreciably more difficult and
negative consequences more likely. Studies have
linked game playing to alcohol-related problems
in high school students (e.g., memory lapses,
passing out, vomiting, and engaging in regrettable
sex; Borsari et al. 2013) as well as college students
(e.g., hangovers, illicit prescription drug use, mar-
ijuana use, tobacco smoking, campus violations,
reliance on alcohol, sexual victimization, DUI,
and car accidents; Borsari et al. 2007; Johnson
and Stahl 2004; Nagoshi et al. 1994; Simons
et al. 2005a, b; Zamboanga et al. 2010a). Unfor-
tunately, engaging in DG during high school
appears to amplify both proximal and prospective
risk. Participating in DG during high school may
predispose adolescents to risky high school
drinking – game players consumed over 5 times
more weekly drinks than nongame players and
64% of game players engaged in binge drinking
during typical drinking occasions – and college
drinking (over and above high school consump-
tion) and consequences (over and above high
school and college consumption) (Kenney
et al. 2010). Not surprisingly, DG participation is
also highly predictive of binge drinking in college
populations. Event-level studies of drinking game
occasions have evidenced that game players, com-
pared to nongame players, experienced an esti-
mated 50% greater likelihood for binge drinking
(Pedersen and LaBrie 2006) and significantly
higher BACs during DG events
(Clapp et al. 2008). Other studies support that
students experience negative consequences (e.g.,
blacking out, passing out, vomiting) as a direct
result of DG participation (e.g., Polizzotto
et al. 2007; Ray et al. 2014; Usdan et al. 2008).
Fueled by high rates of DG involvement, first-
year undergraduates are found to face the greatest
likelihood for adverse outcomes related to DG
(e.g., Adams and Nagoshi 1999; Newman
et al. 1991; Polizzotto et al. 2007; Sharmer
2005). This may be particularly important with
regard to incoming students as risky drinking
may compromise successful negotiation of the
transition to college and lead to problematic
Drinking Game Playing: A Prevalent and Risky Activity Among Youth
drinking trajectories that may persist throughout
college (Task Force of the National Advisory
Council on Alcohol Abuse and Alcoholism
2002; Schulenberg et al. 2001). There is empirical
evidence that relative to their male peers, females
experience more alcohol consequences after
participating in DG, such as increased likelihood
for unprotected, unplanned, or unwanted sexual
intercourse, and date rape or sexual victimization
(Johnson and Stahl 2004; Pedersen and LaBrie
2006). Not surprisingly, simulated lab studies
demonstrate that women achieve higher
BACs than men while playing DG (Cameron
et al. 2011; Correia and Cameron 2010).
Women’s physiological susceptibility to intoxi-
cation and findings that some males use DG to
take sexual advantage of women (Johnson and
Stahl 2004; Newman et al. 1991) point to the
urgent need to explicate this context-specific
risk behavior.
Prevention and Harm Reduction
Despite the established relationship between DG
participation and alcohol misuse and conse-
quences, few studies have examined the effect of
alcohol intervention—with and without DG con-
tent—on DG behaviors. Studies that have exam-
ined BMI and DG-related outcomes have shown
mixed results. While some trials demonstrate that
incoming students randomized to standard
web-based (i.e., AlcoholEdu; Croom et al. 2009)
and brief motivational (Wood et al. 2010) inter-
ventions report lower levels of DG participation
relative to controls, a recent dual-site trial found
reduced DG participation among students partic-
ipating in Alcohol-Wise (Alcohol Education +
eCHECKUP TO GO) at one site but not the
other (Croom et al. 2015). Recently, Fernandez
and colleagues (in press) examined the effect of
DG-specific feedback and discussion in two inde-
pendent trials (Trial 1, N = 198; Trial 2, N = 412)
of college alcohol BMIs, both of which demon-
strated prior efficacy in reducing alcohol-related
problems post-intervention (see Carey et al. 2009
and Borsari et al. 2012). Fernandez et al. found
that in-session DG-related content did not predict
1099
change in DG participation post-intervention.
Nonetheless, the overall mixed results indicate
that more research is needed to explicate the
extent to which DG participation is modifiable
through intervention and what intervention strat-
egies and formats may be most useful. Indeed, if
effective, incorporating information on DG into
multicomponent alcohol interventions may be
seamless and cost-effective (see Larimer and D
Cronce 2007 for review). Researchers have also
called for targeted initiatives, including increased
education about DG (Cameron et al. 2010), inter-
ventions that provide feedback on peer norms and
BACs related to DG (Cameron et al. 2010;
Silvestri et al. 2013), and enhanced supervision
in campus housing (Sharmer 2005). At the high
school level, DG-specific information may sup-
plement school-based educational, parental
awareness, and peer social norms campaigns. At
the college level, DG -specific social norms or
harm-avoidance strategies (i.e., cognitive-
behavioral skills-based, personal feedback-
based, or motivational interventions) may be ben-
eficial. Indeed, college students tend to over-
estimate the occurrence of DG playing among
their peers, and these overestimations are predic-
tive of individual consumption and game playing
rates (Pedersen and LaBrie 2008). Educating stu-
dents about more moderate norms while provid-
ing additional information, such as the risks
associated with game playing, may positively
impact individuals’ decision making about
whether and how often to participate in DG.
Still, the high prevalence and heightened risk
associated with DG playing in adolescent
populations highlights the importance of early
high school or junior high school initiatives
geared to prevent game playing and reduce
harms associated with risky drinking before dan-
gerous patterns may be established. In addition to
harm reduction initiatives focused on DG, pro-
viding opportunities for safer alternative social-
contextual activities may be advantageous by
appealing to youth drawn to DG for social rea-
sons. For example, school-sponsored field trips
or social events preceding athletic games or
dances may offer proxies for socializing and
networking.
1100 Drinking Game Playing: A Prevalent and Risky Activity Among Youth
Methodological Issues and Directions
for Future Research
The majority of research on DG has compared
students’ overall self-reported engagement in
DG with overall alcohol consumption and conse-
quences at the aggregate level. However, event-
level analyses that examine specific DG playing
events with consumption and consequences are
needed to explicate the direct impact of DG
(e.g., Borsari et al. 2007; Clapp et al. 2003, Hum-
mer et al. 2013; Pedersen and LaBrie 2006). For
example, assessing typical durations of game
playing events as well as gauging the differential
impact of drinks consumed before, during, and
after game playing would provide insight into
specific risks associated with this high risk con-
text. Novel assessment methods, such as Ecolog-
ical Momentary Assessment (EMA; Stone and
Shiffman 1994), enable youth to report on feel-
ings and behaviors in real-time and in natural
drinking environments using mobile devices.
This innovative technology may be well suited
for gathering context-specific information related
to DG. Finally, given the limitations of self-report
methods (e.g., memory recall bias) coupled with
the notion that DG involve complex group
dynamics that may not be accurately assessed
using self-report measures (i.e., players may not
always be aware of the social forces that occur
while playing), rigorous, and controlled experi-
mental studies on DG will also greatly advance
our knowledge in this field (see Zamboanga and
Peake 2016)
Further, most of what is known about DG is
restricted to collegiate populations, thus leaving a
void as it relates to younger adolescents and non-
college attending youth (see Zamboanga
et al. 2016 for review). Given the prevalence and
prospective risk associated with DG playing
among precollege adolescents, future research
should further examine early and mid--
adolescents’ motivations for playing DG (e.g.,
social facilitation, peer pressure, competition/
social camaraderie) as well as the peer cultures
in which they are embedded. Research providing
insight into adolescent’s predispositions toward
risky drinking behaviors will help to better define
the role of game playing during this important
developmental period. For instance, qualitative
studies or student focus groups may illuminate
the extent to which socially learned peer group
behavior or individual-level characteristics may
contribute to engagement in these high risk drink-
ing contexts and associated current and prospec-
tive alcohol risks.
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Driving and Drivers
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
For several decades, motor vehicle crashes have
constituted the greatest single public health threat
to adolescents in many countries. Compared to
other age groups, adolescents are substantially
1104
over represented in traffic accidents, including
traffic-related fatalities. In the United States, for
example, adolescent drivers have the highest
crash rate per mile driven of any age group
(Shope and Bingham 2008). In 2004, drivers
aged 16–20 accounted for 13.3% of the drivers
in fatal crashes and 17.9% of the drivers in all
crashes even though they were only 6.3% of the
licensed drivers (Hedlund 2008). The youngest
drivers are at highest risk for crashes, with their
rates of crashing consistently declining with each
year of increasing age per mile traveled. For
example, in 2000, drivers aged 16 years had
nearly three times as many crashes as did by
those of 19 years of age (Williams 2003). These
crashes account for a large proportion of adoles-
cents’ fatalities. In 2004, crashes accounted for
41% of all deaths among teens aged 13–19 years
in the US (Shope and Bingham 2008). These
statistics are important to consider in light of
those showing that other unintentional ▶ injuries
accounted for 15% of all teen deaths, while homi-
cide accounted for 15% and suicide for another
14% (Shope and Bingham 2008). Importantly,
although adolescents can be more resilient than
adults, teens who survive crash related injuries
often experience significant deficits in quality of
life, and they do not recover preinjury function or
quality of life up to 2 years postinjury compared to
national norms (Holbrook et al. 2007). The high
risks that adolescents face, and the highly negative
consequences of those risks rightly have led to
considerable societal interest and concern.
Given the long history of traffic accidents
involving adolescents, several efforts have sought
to improve adolescents’ driving safety. Among the
most popular approaches have been the use of
driver education, more aggressive law enforce-
ment, and efforts to regulate adolescent’s actual
driving. These efforts have increased in popularity,
although not all have been as successful in increas-
ing safety as was hoped. The most common pro-
grams associated with adolescents are those
involving driver education. These programs have
been deemed helpful to the extent that they have
been shown to increase both knowledge and skills;
regrettably, they have not increased the number of
safe drivers as much as expected (Mayhew and
Driving and Drivers
Simpson 2002). Decades of research have con-
cluded that driver education fails to reduce crash
involvement among beginning drivers, and that
they actually can produce adverse outcomes; yet,
the programs still retain tremendous popular appeal
as a means to improve driver safety (Williams and
Ferguson 2004). Among the most notable law
enforcement methods has been those that increased
the national minimum drinking age to 21 and insti-
tuted more strict drunk-driving laws. Unlike other
efforts, these have been shown to be widely suc-
cessful, for example, they have been deemed to
account for a drop in traffic fatalities, down by
62% from 1982 to 2004 (Hedlund 2008). More
recently, there have been efforts to control adoles-
cents’ driving by enacting restrictions on adoles-
cents’ driving. These more intermediate measures
are known as graduated drivers licenses (GDL).
Some of the most common GDL approaches are
those that limit learners’ permits for specified
periods and control them, who can drive with
youth during those times. These latter approaches
have been known to reduce crashes but, as seen
below, they do reveal more limited effects than
anticipated (Simons-Morton et al. 2008). Society,
policy makers, and researchers, then, all recognize
the need to address adolescents’ uneven risks asso-
ciated with their driving, and they have led to the
development of some programs deemed effective.
Despite these efforts, the reality is that adolescents’
driving remains marked by much higher negative
outcomes than those of other age groups.
Many reasons account for the varying success
of efforts aimed to reduce adolescents’ traffic
accidents. Stricter law enforcement regarding
drinking alcohol and driving have been effective;
but it is not clear how else more strict law enforce-
ment approaches can be effective. Despite its pop-
ularity, strict law enforcement may not be as
effective with adolescents, when compared with
other groups, in that it assumes that awareness
leads to behavior change to avoid consequences.
The current understanding of adolescents leads to
the conclusion that they may not make calcula-
tions of costs and benefits in ways that would
increase safety. Adolescents simply do not weigh
benefits and costs the same way that adults do
(e.g., driving passed the speed limit may make
Driving and Drivers
sense when trying to impress peers) (Shope and
Bingham 2008). In addition, classroom instruc-
tions also are not necessarily as effective as would
be expected. Knowledge about a subject does not
necessarily lead adolescents to change behaviors
or attitudes, as evidenced by research highlighting
the limitations of drivers education program
(Williams and Ferguson 2004). Equally impor-
tantly, the graduated drivers licenses may not be
as effective as hoped if they rely on parents, for
parents may not be the most effective models for
safe driving (Simons-Morton et al. 2008).
What may be unusual about the above efforts is
that they developed from highly respected
research about the adolescent period. The study
of adolescence often does not influence policies so
directly and quickly. Regrettably, it appears that
the efforts remain incomplete and limited. The
efforts are limited for at least two reasons. First,
society still has an attachment to having adoles-
cents learn how to drive in their mid teen years.
Second, despite all of the efforts to limit and
control adolescents’ actual driving, the reality is
that these methods remain incomplete to the
extent that they do not take into account the
more complex skills and behaviors that must be
performed in the presence of several risk factor.
The programs have reduced some risk factors, but
the number of risk factors that remain when ado-
lescents are permitted to drive remains high. This
is problematic to the extent that, as the number of
risks increases, so does the chance for accidents.
Some of the reasons that adolescents are more
likely to be involved in crashes have to do with the
nature of adolescence itself. For example, one of
the key factors contributing to an increase in ado-
lescents’ crash risk is passengers. Since cars are an
important mode for socializing, adolescents often
have passengers. Adolescents often travel in motor
vehicles with other adolescents, and given that
adolescents often drive with passengers and drive
less safely than adults, it is not surprising that
adolescents are at greater risk when they drive
together. This greater risk due to driving with
peers appears unique to adolescents; indeed, the
risk has the obverse effect on adults (Williams
2003). In addition, adolescents also are at increased
risk of crashes because they drive more at night and
1105
drive more on weekends (Shope and Bingham
2008). Similarly, adolescents engage in risk behav-
ior related to accidents, such as the drinking of
alcohol, in intermittent ways that place them at
higher risk. Most notably, adolescents may drink
alcohol less than other age groups, but when they
do, they are at greater risk of accidents (Williams
2003). As a last example, adolescents also are less
likely to use seat belts, which increase the risk of D
injury and death (Williams et al. 2003). Adoles-
cents, then, are likely to increase their risk of being
involved in vehicle accidents due to factors that
relate to increased risk and relate to the period of
adolescence. Policies can influence some of these
factors, but the point is that there are so many
factors that place adolescents at risk that reducing
some factors still leaves many others.
That adolescents create other risk factors is
important to highlight, and several studies have
shown links among several factors and adoles-
cents’ driving behavior, crashes, and traffic
offenses. Adolescents are more likely to engage
in common risky driving behaviors. These include
speeding, making illegal lane changes, driving too
closely to other vehicles, failing to yield the right
of way, failing to perceive hidden risks, driving
while drowsy or sleepy, and being more suscepti-
ble to distractions from passengers, phones, eat-
ing, drinking, and a host of other distractions
(Shope and Bingham 2008). In addition, of
course, adolescents are less experienced drivers.
The lack of experience contributes to driving
errors simply because the acquisition of any com-
plex set of skills requires a significant amount of
time. All novice drivers, adolescents included,
necessarily learn from their errors and progress
in driving more safely relies on receiving feed-
back from their driving. These errors and feed-
back are necessary for adolescents and other
learners to automatize the processes involved in
safe driving. Thus, the point is that all drivers need
to drive to learn how to drive safely; there is no
way around the need to develop expertise that
must be time-intensive and involve much practice.
It is important to emphasize that adolescent
novice drivers generally are not like other novice
drivers. Research on brain development makes
this point rather clear. A gap exists between
1106
physical maturity (largely complete by the time
adolescents reach driving age) and mental and
cognitive maturity (incomplete until a decade
later) (Dahl 2008). This gap helps account for
risk-taking behavior and other social-interaction
problems. What this translates into for adolescents
is their need to test their limits and abilities, seek
their identities as individuals, and evolve in their
relationships with peers. In terms of driving, what
this means is that the development of the capacity
to make decisions, which may be just as good as
that of adults, may be less of a factor in high-risk
driving than in other areas of development.
Despite efforts to limit whom adolescents drive
with, the reality is that peers can affect driving by
being drivers and passengers in other cars on the
road and they also may influence driving by being
pedestrians or others not in cars, perhaps in con-
tact via cell phones or text messages.
Although there is a focus on adolescents as a
group at risk, it is important to emphasize that
some adolescents are more at risk than others.
Important individual differences increase the
risk. For example, males are more at risk for traffic
accidents, just as those who are more thrill seekers
are at higher risk (Shope et al. 2003). How ado-
lescents’ parents have served as role models also
matters. How parents drive, and how they social-
ize their adolescents’ driving, strongly influence
adolescents’ driving; adolescents’ driving is sim-
ilar to that of their parents (Taubman-Ben-Ari
et al. 2005). These points are critical to keep in
mind. The limitations of relying on parents, for
example, are enormous. For that reason, it turns
out that the management practices of many par-
ents may not be sufficient to provide the safety
effects that current policy trends have tried to
encourage. Although GDL policies tacitly recog-
nize the importance of parental involvement in
teaching and managing novice teenage drivers,
parents are not systematically prepared to take
on the role (Simons-Morton et al. 2008).
Another important example of the need to con-
sider individual differences among adolescents
comes from research examining ▶ Risk-Taking
and understanding risk. Adolescents may not be
at a particular disadvantage when it comes to
understanding risk; but they may value benefits
Driving and Drivers
differently and not necessarily view risks as poten-
tially relevant to themselves. This is important in
that there appears to be groups of adolescents who
weigh the benefits of risk differently than others.
Harre (2000) offered one of the most important
models to highlight this issue. By combining
notions of perceived risks and perceived benefits,
Harre generated five adolescent risk-approach
“types” arrayed on two dimensions: objective
crash risk (high or low) and perceived crash risk
(high or low). For example, adolescents high on
both dimensions are typical thrill seekers while
those who are habitually cautious drivers are low
on both dimensions. There does seem to be a type
and disposition toward risk and accidents, but it is
important to keep in mind context and its influence.
Even considering context, though, it is reasonable
to accept, for example, that some adolescents may
be temperamentally disposed to accept high risk,
which they accurately judge, because they are
active risk seekers. For adolescents, then, perceived
benefits play an equal and important role in engag-
ing in risk behavior, and the weight given to ben-
efits and risks seems to be different for adolescents
when compared to other groups as well as adoles-
cents compared to one another.
One of the most remarkable points to emerge
in efforts to reduce adolescents’ traffic-related
accidents and their negative effects is that efforts
have sought to benefit from the understanding of
the adolescent period to develop more effective
policies and other social responses. The contin-
ued high rates of traffic accidents reveal that
current efforts remain limited. When compared
to adult drivers, adolescents are at considerable
excess risk of vehicle crashes. This excess risk
continues despite important successes in
addressing adolescents’ abilities to drive more
safely. Researchers have identified many factors
that lend themselves to control, such as driving
with peers, accessing alcohol, and driving at
night. Regrettably, a high number of other fac-
tors, and their combinations together, increase
adolescents’ risk of vehicle accidents. These
studies and statistics reveal truly sobering
results, and they highlight the need to demon-
strate the effectiveness of measures assumed to
curb adolescents’ vehicle accidents.
Drug Sellers and Distributors
References
Dahl, R. D. (2008). Biological, developmental, and
neurobehavioral factors relevant to adolescent driving
risks. American Journal of Preventive Medicine, 35
(3 S), S278–S284.
Harre, N. (2000). Risk evaluation, driving, and adolescents:
A typology. Developmental Review, 20, 206–226.
Hedlund, J. (2008). Teen driving. American Journal of
Preventive Medicine, 35(3 S), S258–S260.
Holbrook, T. L., Hoyt, D. B., Coimbra, R., Potenza, B.,
Sise, M. J., Sack, D. I., et al. (2007). Trauma in adoles-
cents causes long-term marked deficits in quality of
life: adolescent children do not recover preinjury qual-
ity of life or function up to two years postinjury com-
pared to national norms. Journal of Trauma: Injury,
Infection, and Critical Care, 62, 577–583.
Mayhew, D. R., & Simpson, H. M. (2002). The safety
value of driver education and training. Injury Preven-
tion, 8(2), ii3–ii7.
Shope, J. T., & Bingham, C. R. (2008). Teen driving: Motor-
vehicle crashes and factors that contribute. American
Journal of Preventive Medicine, 35(3 S), S261–S271.
Shope, J. T., Raghunathan, T. E., & Patil, S. M. (2003).
Examining trajectories of adolescent risk factors as
predictors of subsequent high-risk driving behavior.
The Journal of Adolescent Health, 32, 214–224.
Simons-Morton, B. G., Ouimet, M. C., & Catalano, R. F.
(2008). Parenting and the young driver problem. Ameri-
can Journal of Preventive Medicine, 35(3 S), S294–S303.
Taubman-Ben-Ari, O., Mikulincer, M., & Gillath, O. (2005).
From parents to children – similarity in parents and
offspring driving styles. Transportation Research Part
F: Traffic Psychology and Behaviour, 8, 19–29.
Williams, A. F. (2003). Teenage drivers: Patterns of risk.
Journal of Safety Research, 34, 5–15.
Williams, A. F., & Ferguson, S. A. (2004). Driver educa-
tion renaissance? Injury Prevention, 10, 4–7.
Williams, A. F., McCartt, A. T., & Geary, L. (2003). Seatbelt
use by high school students. Injury Prevention, 9, 25–28.
Drug Sellers and Distributors
Jemel P. Aguilar
Center for Social Work Research, Austin School
of Social Work, University of Texas at Austin,
Austin, TX, USA
Criminological and social science research indi-
cates that some adolescents engage in the sale or
distribution of illicit substances including mari-
juana, cocaine, crack, and methamphetamine
(Aguilar and Jackson 2009; Atkyns and
1107
Hanneman 1974; Centers and Weist 1998;
Moore 1995). Typically, drug sales occur within
a complex drug economy that transports drugs
from producers to users through interpersonal net-
works that operate based on fragile relationships
(Atkyns and Hanneman 1974; Centers and Weist
1998; Moore 1995). The success of this distribu-
tion system requires a great number of people to
work together against the narcotics officials D
attempting to expose and stop distributors.
Research on adult drug sellers and distributors
and studies of gangs shed light on the drug econ-
omy and the organizational roles within this econ-
omy (Aguilar and Jackson 2009; Dunlap et al.
2004; Moore 1995). This body of knowledge
suggests that drug distributing organizations are
complex, members maintain tenuous relation-
ships, and some organizations have transnational
networks. Law enforcement officials often use the
tenuous relationships within the drug economy to
progress from arrests of street-level sellers to
larger distributors or wholesalers. Unfortunately,
a deeper description of the drug economy
is beyond this discussion; however, several
researchers have described different facets of this
type of system (cf. Adler 1993; Bourgois 2002;
Hoffer 2005; LeBlanc 2004). The basic structure
of drug distribution organizations does provide a
context for the roles adults and youth occupy in
these settings.
Much of what is known about drug sellers in
general and adolescent drug dealers, in particular,
is derived from incarcerated populations or data
gathered from secondary sources (Atkyns and
Hanneman 1974; Moore 1995). In the last
15 years, some researchers published qualitative
studies of adolescent self-identified drug sellers
and this knowledge amplified what researchers
know about adolescents’ involvement in the
drug economy (Centers and Weist 1998; Moore
1995). These studies integrated qualitative tech-
niques that require prolonged engagement, using
community representatives to engage in data col-
lection, and other means to explore active drug
users’ lives and activities. This essay makes uses
this body of research, regardless of how it is
collected, to understand adolescent drug sellers.
Additionally, this essay outlines the ways in
1108
which adolescents enter into and the roles adoles-
cents occupy in the drug economy. Next, the ado-
lescents’ roles are then linked with violence using
Goldstein’s (1985) tripartite model of the drugs-
violence nexus. Goldstein’s model helps to frame
the different initiators and outcomes associated
with drug use or selling. The essay ends with a
discussion of the implications of drug selling
research for adolescent drug treatment and policy.
For the purposes of this essay, drug selling refers
to the marketing of illicit substances, while drug
distribution refers to the activities of individuals
that both sell small amounts of illegal drugs and
provide other sellers with illegal drugs that they
can market for profit (Aguilar and Jackson 2009;
Centers and Weist 1998; Moore 1995). This essay
does not include research describing the market
for prescribed drugs such as Xanax, or Adderall.
Although the findings from the illicit drugs may
apply or shed light on the sale of prescription
drugs, this essay instead focuses on other drugs
involved in the drug market.
Pathways into the Drug Economy
Researchers interested in drug selling and distri-
bution find that some adolescents enter into the
drug economy because of the limited social and
economic opportunities available to them
(Aguilar and Jackson 2009; Anderson 2005; Cen-
ters and Weist 1998; Dembo et al. 1993; Dunlap
et al. 2007; Jacinto et al. 2008; Joseph and Pearson
2002; Moore 1995; Sales and Murphy 2007). In
the last 10 years, researchers and journalists
documented how job flight, the movement of
employment out of the inner city into suburban
areas, is negatively affecting the employment
opportunities of African American men and
young boys. Job flight, coupled with the overrep-
resentation of African American men in the
criminal justice system, is creating almost insur-
mountable barriers to employment for African
American adult men and boys. Thus, with diffi-
culties obtaining gainful and legal employment
many African American youth are entering into
the drug economy as a means to gain an income
(Aguilar and Jackson 2009; Dunlap et al. 2007;
Drug Sellers and Distributors
Dunlap et al. 2004; Jacinto et al. 2008; Joseph and
Pearson 2002). Some researchers describe low-
income, high unemployment neighborhoods as
closed in that few residents are able to develop
the social and economic resources outside the
neighborhood to aid them in escaping from these
areas. For example, Dunlap et al. (2007) studied
the social forces and individual consequences
associated with drug selling in post-Katrina New
Orleans and found that “illegal activities, both
before and after Hurricane Katrina, are increas-
ingly the only viable micro-level methods of
acquiring money” (p. 116). Consequently, with
few resources available to them and the tightening
job market limiting what is available for employ-
ment, adolescents are getting an early and easy
start in the illicit drug market. Thus, some adoles-
cents certainly are entering into the drug economy
for economic or money gain.
Adolescents who join illicit drug markets
for economic gain may access the drug market
through friends or family members already
involved in this economy (Dunlap et al. 2007).
Several researchers are documenting how these
adolescents typically grow up in families and
neighborhoods teeming with drug abuse, selling,
and distribution. These adolescents, however, do
not simply “join up”; instead, they are mentored
into the illicit drug economy in minor, highly
monitored roles. At first, adolescents may act as
go-betweens for drug sellers, a role that asks them
to act as lookouts and warn sellers of a police
presence in the neighborhood, as runners who
transport drugs or money from the distributor to
sellers in the network, or as those who hold the
drugs for a seller working in specific area and
bring the amount needed for sale to the seller
when the buyer and seller are ready. Initially,
new drug sellers will operate their business
under the tutelage of a more experienced drug
seller in that they sell a portion of the senior
drug seller’s supply, keep a percentage of the
profits, and then are able to purchase some addi-
tional drugs for their own use or for sale. As the
relationship between the senior and junior drug
seller grows, the senior drug seller takes on the
role of distributor by obtaining a supply of drugs
from the wholesaler, using a stash house to
Drug Sellers and Distributors
prepare the drug for market, and coordinating the
sale of the drug to lower-level drug sellers. Junior
drug sellers typically are the sales force for the
senior drug sellers and are engaged in the day-to-
day sales and interactions with customers. Senior
distributors also may involve other adolescents
and youth in drug sales through different roles
that are necessary to operate such an enterprise.
Roles in the Illicit Drug Economy
Researchers identified the roles that youth occupy
in the drug economy that go beyond the stereo-
typical street-based seller. These roles are enacted
within a context such as a rave or stash house,
identify the drug sellers’ relationships to their
customers, and position the drug sellers within
the overall drug economy. Essentially, roles in
the drug economy are an important aspect of
socializing someone to their status in the network
and the expectations associated with that status
(Adler 1993; Bourgois 2002; Hoffer 2005;
LeBlanc 2004). Natarajan and Belanger’s (1998)
study of drug distributing organizations identifies
general roles and responsibilities embedded
within drug distribution organizations. These
roles are worth highlighting.
Natarajan and Belanger’s model identifies
three roles: retailer, broker, and distributor. The
retailer role is the one most commonly associated
with the drug economy in that a number of youth
are arrested for drug-related crimes because they
are acting as the street-based vendor for a drug
distributor (Centers and Weist 1998; Moore
1995). Natarajan and Belanger define retailers as
those individuals who sell small quantities of
illicit substances in public settings. Many times,
retailers will obtain their illicit substances from
brokers. Brokers are those individuals who act as
representatives of distributors and provide
retailers with the drugs to sell in the public sphere.
Distributors are those who manage large quanti-
ties of drugs received from traffickers, prepare
drugs by “cutting” or introduce additional com-
ponents to lessen the purity of the drug and
thereby increase the amount available to sale,
and package the drugs for distribution to retailers.
1109
Distributors typically operate out of stash houses.
Stash houses are temporary places where distrib-
utors can prepare large quantities of illicit drugs
for retailers to sell. Stash houses often are secret
locations maintained by drug organizations and
may be run by individuals or family members who
occupy different roles within the drug enterprise.
Natarajan and Belanger’s typology of roles is a
useful framework for understanding the broadly D
defined positions that anyone may occupy on the
selling side of the drug economy.
Additional research studies on adolescent
populations and in drug-using venues have dis-
covered more specific roles and activities that
drug selling youth occupy. For example, the
retailer role has been found to involve many
roles. Several researchers (Jacinto et al. 2008;
Joseph and Pearson 2002; Werb et al. 2008) sug-
gest that adolescent retailers can be grouped into
three types: facilitators, dealers, and user-sellers.
Although adolescents may drift in and out of these
roles, the typology helps further explain some of
the pathways into drug selling, the settings sellers
will access, and some of the associated risky
behaviors that sellers will engage in. Facilitators
are peripherally linked with drug distribution net-
works and use these relationships simply to obtain
drugs (Adler 1993; Bourgois 2002; Feigelman
et al. 1993; Sales and Murphy 2007). Facilitators
typically sell lesser quantities of illicit substances
and their primary customer base is close friends
(Jacinto et al. 2008; Joseph and Pearson 2002).
Jacinto et al.’s (2008) study of ecstasy sellers
indicates that most sellers began using ecstasy
and then started selling the drug to friends within
the first year after use. Most of the sellers they
interviewed did not intend to become drug sellers;
instead, these adolescents described initially
assisting their friends acquire the drug (i.e.,
being the middleperson between a consumer and
seller). Jacinto and her colleagues also found that
adolescents in the “middleperson” role do not
necessary view the drug selling as necessarily
criminal. According to their findings “real
dealers” can be identified by the level of drug
sales because real dealers had to contend with
the associated stigma of the dealer label, drug
distribution was a full-time occupation, and
1110
some facilitators do not make a significant profit
from their selling. Because freelancers invest in
drug selling relationships as a way of maintaining
a convenient supply of illicit substances for their
friends, freelancers’ business practices different
from many other drug sellers in that they are less
likely to create elaborate and formal business
structures and engage in the practice of providing
drug samples and advice for maximizing the
“drug experience” (Jacinto et al. 2008, p. 420).
While many youth present themselves as drug
sellers, some youth selling illicit drugs reject the
identity of drug seller (Aguilar and Jackson 2009;
Joseph and Pearson 2002; Moore 1995). For
example, the respondents in Jacinto et al.’s
(2008) study discussed above rejected the second
type of drug distributor identity, Dealer. Dealers
are adolescents who sell large quantities of illicit
drugs, offer a variety of drug types to their cus-
tomer base (i.e., marijuana, crack, methamphet-
amine, cocaine), and use their income from drug
sales to support themselves (Joseph and Pearson
2002). In other words, their profit margin from
drug sales becomes an important aspect of their
survival. As one of Jacinto et al.’s participants
stated “. . .a dealer is out there pushing. That’s
how they get paid. If that’s your only source of
income and that’s what you do, you’re a dealer”
(p. 432). Thus, using drug distribution to support
oneself is a significant differentiator of small or
large drug sellers.
In contrast to Natarajan and Belanger’s (1998)
typology of drug seller and distributor roles, the
research literature suggests that some adolescent
dealers act as retailers and brokers. For adolescent
drug distributors, moving large quantities of drugs
into the drug economy brings with it some aspects
to their work that does not exist with adolescent
facilitators. Stash houses are one aspect of the
large-scale distributor identity. Stash houses pro-
vide drug distributors a place to keep their drugs
while they are being prepared for sale. Adoles-
cents who sell larger quantities are more deeply
involved in the drug economy in that they are
depending on their drug distribution for their
income, more likely are employing others to dis-
tribute their illicit substances, may sell multiple
substances, and are engaged in several risk
Drug Sellers and Distributors
behaviors (Aguilar and Jackson 2009; Bourgois
2002; Brunelle et al. 2000; Feigelman et al. 1993;
LeBlanc 2004; Li et al. 2001).
The final type of adolescent drug seller is a
drug-addicted adolescent (Joseph and Pearson
2002). These adolescents use in connection with
their selling and attempt to subsidize or cover the
costs of their drug usage by selling. Brunelle
et al.’s (2000) examination of Goldstein’s tripar-
tite model of drug-violence nexus elaborates on
the drug user-seller type. In this study, Brunelle
et al. found that viewing drug-using dealers from
an economic perspective does not quite capture
youth’s motivations to engage in drug selling.
They found that drug-using youth have regular
contact with drug sellers and, through these con-
tacts, may become increasingly involved in the
drug economy to support their drug habits. Earn-
ing money through the drug economy also permits
youth to hide their income from parents and/or
law enforcement in that their earnings are not
officially documented (as in the form of a pay-
check stub) and/or evidence of their spending is
not recorded. Until drug using–selling youth
come to the attention of law enforcement or their
parents, most likely through their crime-related
behaviors, their drug selling can mask their
involvement in selling and drug use and their
drug use can mask their drug selling (Brunelle
et al. 2000). Moreover, drug-addicted drug sellers
are more likely to be accepted by their friendship
networks because the seller peddles their drugs to
friends and their friends are also more likely to be
a part of the illicit drug economy (Flom et al.
2001; Jacinto et al. 2008; Joseph and Pearson
2002). This type of drug seller is under-
researched, most likely because they “fly under
the radar” of both substance abuse services and
law enforcement.
Gangs and Selling Roles
Valdez and Sifaneck’s (2004) research on gangs
and the illicit drug economy suggests a typology
of drug seller and distributor roles in relation to
the gang with which these individuals are affili-
ated. Valdez and Sifaneck outline four different
Drug Sellers and Distributors
types of drug selling gang members: homeboys,
hustlers, slangers, and ballers. Homeboys are
user-seller gang members that are a part of street
gangs and operate their illicit businesses outside
the gang network. Similar to seller-users, home-
boys typically buy illicit drugs for both their own
consumption and sale. Alternatively, hustlers sell
drugs from within the gang network, meaning that
they affiliate their drug sales with their gang even
though the gang’s purpose is not to distribute
drugs. Unlike homeboys, hustlers are well inte-
grated into their gang network, benefit from the
protection of the gang, and use the gang’s social
networks to increase their sales. Slangers are the
third type of gang-related drug sellers (Valdez and
Sifaneck 2004). Slangers are a part of gang net-
works that sell and distribute illicit substances, use
drugs, and return the profits from drug sales back
to the gang network. Akin to the dealer type,
slangers are typically a part of well-organized
networks that traffic large shipments of illicit
drugs for distribution. Similar to slangers, ballers
are a part of well-organized gang units that dis-
tribute illicit substances, except ballers’ gang
units are much larger. Ballers are more likely to
be connected to large distribution networks that
maintain a hierarchy and move large quantities of
illicit drugs in and out of the network. Similar to
the other types of gang-related drug sellers, ballers
benefit from their gang members in that they have
protection from rivals and gain an income from
their drug sales.
Drug Selling Youth and Violence
From a review of the roles that adolescents occupy
in the drug selling economy, it becomes clear that
youth engage in a range of activities that involve
the selling and distribution of illicit substances,
that not all sellers are alike or involved in drug
sales for similar reasons, and that their immersion
in the drug economy differs based on the type of
drug seller. For those adolescents actively
involved in drug selling and distribution net-
works, violence is a part of the practice of selling
illicit drugs. Moreover, some types of adolescent
drug sellers are associated with serious and
1111
violent crime (Aguilar and Jackson 2009;
Bourgois 2002; Brunelle et al. 2000; Feigelman
et al. 1993; LeBlanc 2004; Li et al. 2001). Without
doubt, drug use links to violence.
Paul Goldstein (1985) has outlined a tripartite
model of the drug violence nexus that provides a
conceptual framework for understanding not only
drug use and violence but also drug selling and
violence. Goldstein offers three models that link D
violence and the drugs. These are the pharmaco-
logical model, the economic-compulsive model,
and the systemic model. The pharmacological
model focuses on the biological changes that
occur from using substances or during withdrawal
(Goldstein 1985). The economic-compulsive
model links a person’s aggressive and violent
tendencies with his/her need to obtain money for
a supply of drugs. Several studies indicate that
youth commit serious and violent crimes while
using illicit substances (Bourgois 2002; Brunelle
et al. 2000; LeBlanc 2004). Systemic violence is
the last model posited by Goldstein. Systemic
violence refers to the typically aggressive interac-
tions between people in the drug economy. Unlike
the pharmacological and economic-compulsive
models discussed earlier, the systemic model is
much more difficult to document and study
because individuals in the drug economy are less
likely to report violence committed by or against
them as developing from their participation in the
drug economy. Researchers such as Brunelle et al.
(2000) are applying Goldstein’s framework to
samples of adolescent drug sellers and users. In
Brunelle et al. (2000), the authors found that
youth report using substances to commit crimes
or avoid negative feelings that develop from com-
mitting the crime, or enhance other feelings asso-
ciated with the crime. Moreover, Sales and
Murphy’s (2007) study of ecstasy using drug
sellers indicates that these youth also often will
use drugs while selling.
Implications and Future Directions
Research suggests that substance users will com-
mit violent acts to obtain money needed for fur-
ther drug use. For example, serious and violent
1112
crimes may become a viable option for those user-
sellers who are not able to support their drug use
exclusively by sales. Additionally, journalistic
accounts of youth in the drug economy indicate
that some user-sellers are involved in violent
crimes against other drug sellers (LeBlanc 2004;
Sikes 1997). The violence committed by
adolescent user-sellers also seems to straddle
Goldstein’s pharmacological, economic, and sys-
temic models in that youth may act violently as a
result of the biological changes caused by the
illicit drug, as a way to gain money and additional
drugs, or as part of retaliation against an opposing
drug seller. Further research into the combination
of types of adolescent drug sellers and Goldstein’s
models of the drugs-violence nexus can help
differentiate between adolescent sellers’ motiva-
tions to act violently within the drug economy.
Researchers, practitioners, and policy makers can
use the current knowledge about the different
types of adolescent drug sellers to stagger inter-
ventions for various drug sellers as more youth
enter into the drug marketplace because of
increasingly limited economic opportunities in
the legal market.
Cross-References
▶ Delinquency
References
Adler, P. (1993). Wheeling and dealing: An ethnography of
an upper level drug dealing and smuggling community
(2nd ed.). New York: Columbia University Press.
Aguilar, J. P., & Jackson, A. K. (2009). From the streets to
institutions: Female adolescent drug sellers’ percep-
tions of their power. Affilia: The Journal of Women
and Social Work, 24(4), 369–381.
Anderson, T. L. (2005). Dimensions of women’s power in
the illicit drug economy. Theoretical Criminology, 9(4),
371–400.
Atkyns, R. L., & Hanneman, G. J. (1974). Illicit drug
distribution and dealer communication behavior. Jour-
nal of Health and Social Behavior, 15(1), 36–43.
Bourgois, P. I. (2002). In search of respect: Selling crack in
El Barrio (2nd ed.). New York: Cambridge University
Press.
Brunelle, N., Brochu, S., & Cousineau, M.-M. (2000).
Drug-crime relations among drug-consuming juvenile
Drug Sellers and Distributors
delinquents: A tripartite model and more. Contempo-
rary Drug Problems, 27, 835–866.
Centers, N. L., & Weist, M. D. (1998). Inner city youth and
drug dealing: A review of the problem. Journal of
Youth and Adolescence, 27(3), 395–411.
Dembo, R., Hughes, P., Jackson, L., & Mieczkowski,
T. (1993). Crack cocaine dealing by adolescents in
two public housing projects: A pilot study. Human
Organization, 52(1), 89–96.
Dunlap, E., Sturzenhofecker, G., Sanabria, H., & Johnson,
B. D. (2004). Mothers and daughters: The
intergenerational reproduction of violence and drug
use in home and street life. Journal of Ethnicity in
Substance Abuse, 3(2), 1–23.
Dunlap, E., Johnson, B. D., & Morse, E. (2007). Illicit drug
markets among New Orleans evacuees before and soon
after Hurricane Katrina. Journal of Drug Issues, 37(4),
981–1006.
Feigelman, S., Stanton, B. F., & Ricardo, I. (1993). Per-
ceptions of drug selling and drug use among urban
youths. The Journal of Early Adolescence, 13(3),
267–284.
Flom, P. L., Friedman, S. R., Jose, B., & Curtis, R. (2001).
Peer norms regarding drug use and drug selling among
household youth in a low-income “drug supermarket”
urban neighborhood. Drugs: Education, Prevention, &
Policy, 8(3), 219–232.
Goldstein, P. J. (1985). The drugs/violence nexus:
A tripartite conceptual framework Journal of Drug
Issues, 39, 143–174.
Hoffer, L. D. (2005). Junkie business: The evolution and
operation of a heroin dealing network. Belmont:
Wadsworth.
Jacinto, C., Duterte, M., Sales, P., & Murphy, S. (2008).
“I’m Not a Real Dealer”: The identity process of
ecstasy sellers. Journal of Drug Issues, 38(2), 419–444.
Joseph, J., & Pearson, P. G. (2002). Black youths and
illegal drugs. Journal of Black Studies, 32(4), 422–438.
LeBlanc, N. (2004). Random family: Love, drugs, trouble
and coming of age in the Bronx. New York: Scribner.
Li, X., Stanton, B., Cottrell, L., Burns, J., Pack, R., &
Kaljee, L. (2001). Patterns of initiation of sex and
drug-related activities among urban low-income
African-American adolescents. The Journal of Adoles-
cent Health, 28(1), 46–54.
Moore, S. E. (1995). Adolescent black males’ drug traf-
ficking and addiction: Three theoretical perspectives.
Journal of Black Studies, 26(2), 99–116.
Natarajan, M., & Belanger, M. (1998). Varieties of drug
trafficking organizations: A typology of cases prose-
cuted in New York City. Journal of Drug Issues, 28(4),
1005–1026.
Sales, P., & Murphy, S. (2007). San Francisco’s freelancing
ecstasy dealers: Towards a sociological understanding
of drug markets. Journal of Drug Issues, 37(4),
919–950.
Sikes, G. (1997). 8 ball chicks: A year in the violent world
of girl gangs. New York: Anchor Books.
Valdez, A., & Sifaneck, S. J. (2004). “Getting high and
getting by”: Dimensions of drug selling behaviors
Due Process of Law
among American Mexican gang members in South
Texas. Journal of Research in Crime and Delinquency,
41(1), 82–105.
Werb, D., Kerr, T., Li, K., Montaner, J., & Wood, E. (2008).
Risks surrounding drug trade involvement among
street-involved youth. The American Journal of Drug
and Alcohol Abuse, 34(6), 810–820.
Due Process of Law
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Overview
Due process rests on the belief that the govern-
ment must be fair and respect the rights owed to
individuals. Although the tendency is to focus on
procedural rights (essentially the protections in
place to protect individuals from errors), due
process also involves substantive rights (the
actual rights deemed worth protecting). In the
USA, the Supreme Court has devoted much
attention to these rights, and the rights have
evolved considerably over time. Part of that evo-
lution has involved including adolescents as
individuals worthy of due process rights protec-
tions. That development, however, remains lim-
ited as adolescents’ due process rights are both
limited and also undeveloped. Much of the future
developments in adolescents’ rights likely will
focus on these two domains of due process, mak-
ing them critical to understanding the rights of
adolescents.
Due Process
The principle of due process of law refers to
the government’s need to respect the legal
rights that they owe to individuals according to
legal mandates. The popularly understood com-
ponent of due process involves the need for the
government to follow a prescribed course of law
before it can infringe on individuals’ rights.
Without following those legal mandates, the
1113
government’s action likely violates those rights.
The fundamental concern that “due process of
law” addresses, then, is the nature of those rights.
In this regard, it is much more complex than
might be expected, in that it actually involves
two fundamental components.
The fundamental components are easy to
understand. The more well-known component is
understood as procedural due process. That aspect D
of due process holds the government subservient
to the law that protects individuals from govern-
mental actions (often called state actions). The
focus is on protecting individuals from the gov-
ernment by providing them with the tools they
need to protect themselves from, most notably,
errors that the government would do when they
infringe on peoples’ rights. At its core, it involves
the process by which the government infringes on
peoples’ rights and the protection that people have
from the government.
The less popularly known, but equally
important, component of due process is under-
stood as substantive due process. This aspect
of due process involves limiting laws, includ-
ing legal procedures, so that they are funda-
mentally fair, just, and do not inappropriately
infringe on people’s liberties. This component
of due process, which centers on the general
command that laws must not be unfair,
involves judicial decisions that reach interpre-
tations of what constitutes the needed protec-
tions under substantive due process. It
identifies the types of rights that need protec-
tion in the first place; they are what procedural
due process rights protect.
Both forms of due process serve as impor-
tant sources of protection for adolescents.
They serve, for example, as the basis for ado-
lescents’ right to privacy, including their rights
to relationships, and numerous rights that
guide how social and legal systems respond
to them (e.g., educational systems, child wel-
fare systems, juvenile courts, and criminal
courts) (Levesque 2008, 2016). Given its cen-
trality to the manner the government responds
to adolescents, this entry briefly reviews the
legal sources and nature of due process and
its significance in US law.
1114
The Legal Foundation of Due Process
The legal basis for due process protections stems
from the Fifth Amendment to the US Constitu-
tion. That amendment provides that “no person
shall be. . . deprived of life, liberty, or property,
without due process of law.” The federal courts
originally interpreted the clause as restricting gov-
ernmental procedures used to deprive persons of
life, liberty, and property. That approach centered
on the fairness of proceedings (see Murray’s
Lessee v. Hoboken Land and Improvement
Co. 1855). By the turn of the twentieth century,
however, courts had interpreted the amendment to
include a substantive component. It viewed it as
requiring that the deprivations of rights be
supported by some legitimate justification
(Allgeyer v. Louisiana 1897). This notion that
courts could hold governmental actions unconsti-
tutional, regardless of the validity of the proce-
dures by which they executed those actions, has
since become a firmly rooted principle in consti-
tutional law and a well-accepted part of the sepa-
ration of powers among different governmental
institutions.
In terms of substantive due process, a central
issue that arises is what rights gain the most
protection. Fundamental rights receive the most
protection, meaning that governmental efforts
to limit those rights will lead to considerably
exacting scrutiny to ensure that the government
has a compelling interest to do so and that the
government closely tailored the infringement to
achieving those interests (Korematsu v. United
States 1944). Conversely, governmental actions
that do not affect a fundamental right are
given considerably more leeway and will be
found permissible as long as the regulation
that impairs that interest rationally relates to a
legitimate state interest. This entry is meant to
be quite deferential, and it is so because the
government is not infringing on a right that
should be highly protected (see United States
v. Carolene Products Company 1938). These
interpretive rules mean that courts treat rights
differently, with the most important ones
gaining the strongest judicial protection from
the state itself.
Due Process of Law
As expected, much significance attaches to
whether a right is to be deemed fundamental.
The Supreme Court has taken a narrow view,
with essentially their needing to be explicit or
implicit recognition of the right in the constitu-
tion. The court also generally restricts fundamen-
tal rights to those deemed deeply rooted in the
nation’s history and tradition (see Washington
v. Glucksberg 1997). One of the most remarkable
features of substantive due process is that its con-
tent, which still guides the court today, essentially
was enumerated in a footnote to a case, a now
famous footnote 4 of United States v. Carolene
Products Company (1938). That footnote
highlighted three types of rights under substantive
due process: the first eight amendments in the Bill
of Rights, restrictions on the political process
(e.g., the rights of voting, association, and free
speech); and the rights of “discrete and insular
minorities” (particularly those who lack sufficient
numbers or power to seek redress through the
political process). Among the rights that the
court has recognized as fundamental are those
protecting marriage, marital privacy, use of con-
traception, bodily integrity, and abortion; also
included are the rights to have children and
directing their upbringing (Levesque 2008,
2016). Still, debates continue among scholars
regarding whether fundamental rights should be
limited to those enumerated in the constitution or
could be expanded to embrace rights implied by
more generalized conceptions of liberty (see, e.g.,
Wolf 2002). The debates are of significance in that
they go to the heart of substantive due process,
which is that it limits not only executive and
judicial powers but also legislative actions. Typi-
cally, the power to create laws should remain with
the legislatures; substantive due process gives the
courts considerable power to strike down state and
federal statutes that seek to limit various activities.
Procedural due process rights attract consider-
ably less controversy, although they are not
immune from ongoing debates. The reason proce-
dural rights attract less controversy is that the
constitution explicitly enumerates many of them.
This enumeration is especially the case for crim-
inal prosecutions, as the Bill of Rights offers a
host of explicit procedural right guarantees. These
Due Process of Law
rights mainly have been applied to individual
states in addition to the federal government, a
process known as incorporation that was done
under the power of the Fourteenth Amendment.
As a result, this protection reaches all governmen-
tal actions that can result in an individual’s depri-
vation, whether civil or criminal in nature.
Generally, due process rights aim to give individ-
uals a fair opportunity to affect the result or judg-
ment of statutes, regulations, and enforcement
actions that would deprive individuals of what
generally is described as rights involving life,
liberty, or property. These protections center the
focus of due process on the concept of fundamen-
tal fairness. The Supreme Court often uses lan-
guage borrowed from a 1934 case finding that due
process is violated “if a practice or rule offends
some principle of justice so rooted in the traditions
and conscience of our people as to be ranked as
fundamental” (Snyder v. Massachusetts 1934,
p. 105). In legal proceedings against individuals,
due process involves, for example, adequate
notice, a hearing so that they can be heard, and a
neutral arbiter. These general principles guide
responses to many controversies involving chal-
lenges to state actions.
Although due process rights tend to be less
controversial than substantive due process rights,
considerable room exists for controversy. That
controversy often involves the rigor with which
the requirements of procedural due process
should be applied to a particular deprivation.
The court has formulated a balancing test to
determine the amount of rigor required by the
constitution. That test involves the consideration
of three factors: “first, the private interest that
will be affected by the official action; second,
the risk of an erroneous deprivation of such
interest through the procedures used, and the
probable value, if any, of additional or substitute
procedural safeguards; and, finally, the govern-
ment’s interest, including the function involved
and the fiscal and administrative burdens that the
additional or substitute procedural requirement
would entail” (Eldridge v. Williams 1976,
p. 335). This test eventually would figure prom-
inently in a wide range of cases, including those
dealing with adolescents and their families. For
1115
example, it would relate to adolescents’ rights to
public benefits (e.g., “welfare” and educational
benefits), protections from intrusions in their
relationships (e.g., against the child welfare sys-
tem), and protections from both their parents and
the state (e.g., in cases involving their institution-
alization). This wide range of cases makes it
difficult to underestimate the significance of pro-
cedural due process. D
Conclusion
The right to due process of law serves as a limita-
tion on governments. It has both “procedural”
and “substantive” components. These compo-
nents mean that due process rights impose
unenumerated restrictions on legal procedures
(which involve the manner laws operate or are
enumerated and executed) and also on legal sub-
stance (what laws regulate, such as what they seek
to prohibit). Both components are central to
understanding the nature of rights as well as to
how they can be protected. Both also are central to
understanding and protecting adolescents’ rights.
Cross-References
▶ Equal Protection Laws
References
Allgeyer v. Louisiana. (1897). 165 U.S. 578.
Eldridge v. Williams. (1976). 424 U.S. 319.
Korematsu v. United States. (1944). 323 U.S. 214.
Levesque, R. J. R. (2008). Rethinking child maltreatment
law: Returning to first principles. New York: Springer.
Levesque, R. J. R. (2016). Adolescents, Privacy and the
Law: A Developmental Science Perspective. New
York: Oxford University Press.
Murray’s Lessee v. Hoboken Land & Improvement Co.
(1855). 59 U.S. 272.
Snyder v. Massachusetts. (1934). 291 U.S. 97.
United States v. Carolene Products Company. (1938).
304 U.S. 144.
Washington v. Glucksberg. (1997). 521 U.S. 702.
Wolf, A. B. (2002). Fundamentally flawed: Tradition and
fundamental rights. University of Miami Law Review,
57, 101–156.
1116
Duty to Protect in Law
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Overview
Adolescents suffer many preventable harms.
Among the most prevalent harms that they suffer
are at the hands of family members and others
who care for them. In such instances, concerns
have been raised about the government’s duty to
protect. The Supreme Court of the United States
has addressed this issue by stating the obligations
that governments have under the US Constitution.
The Court has rejected the notion that the govern-
ment has an obligation to protect youth from
private harms, which are harms not caused
directly by the government. This article examines
that leading case by detailing its rationales and
importance.
Protecting Adolescents from Harm
Much debate centers on the extent to which the
government has a duty to protect youth from the
harms they suffer at the hands of family members.
This is the case because there continues to be high
rates of maltreatment, in the hundreds of thou-
sands per year in the USA alone, with a prevailing
sense that much maltreatment goes unreported
(see Levesque 2008). That recognition has led to
the creation of child welfare systems meant to
help protect children from harm, and those sys-
tems include permitting states to intrude aggres-
sively in families and remove children from them
when there is a high risk of harm. Yet, the
Supreme Court clearly has stated that the state
cannot be held responsible, under the Constitu-
tion’s Due Process Clause, for the harms children
suffer from private parties, such as family mem-
bers. The case, DeShaney v. Winnebago County
Department of Social Services (1990), although
not well received by some, has settled the matter
in favor of protecting the state from liability under
Duty to Protect in Law
Constitutional law when youth have been harmed
after having been returned to their family mem-
bers, even when the state knew of the high risk of
harm. This entry reviews this important case and
further highlights key rules regarding the duty to
protect others.
The DeShaney case involved a 4-year-old
child, Joshua, who was severely beaten by his
custodial father. The Winnebago County Depart-
ment of Social Services (“DSS”) and several of its
case workers had received complaints that Joshua
was being abused by his father, and it had taken
various steps to protect him from harm. The child
had been removed from his home but returned to
the father, who had agreed to a variety of condi-
tions that would help reduce the risk of harm to
Joshua. DSS, however, had not removed him from
his father’s custody. Quite tragically, Joshua even-
tually was beaten so severely by his father that he
suffered brain damage resulting in his being
forced to spend the rest of his life confined to a
mental health institution.
Joshua and his mother sued DSS under
42 U.S.C. § 1983. Section 1983 of the Civil
Rights Acts establishes a cause of action for
violations of constitutional rights. Under that
statute, a claim can be made that a right had
been violated by someone who was acting
“under the color of law,” that is, pursuant to
their roles as state actors. Joshua and his mother
alleged that DSS had deprived Joshua of his
liberty interest in bodily integrity, in violation
of the Fourteenth Amendment’s Due Process
Clause, by failing to intervene to protect him
against his father’s violence. The lower courts
all held against Joshua, with all of them essen-
tially confirming that the Due Process Clause of
the Fourteenth Amendment does not impose an
affirmative duty on the part of state and local
governments to protect their citizens from pri-
vate instances of violence. They further had
found that the causal connection between the
state’s (here being DSS) conduct and Joshua’s
injuries simply was too attenuated to establish a
deprivation of constitutional rights actionable
under § 1983. The Supreme Court agreed to
hear the case, and it too held as the lower
courts had.
Duty to Protect in Law
The Supreme Court’s majority opinion flatly
stated that nothing in the language of the Due
Process Clause itself requires a state to protect
the life, liberty, and property of its citizens against
invasion by private actors. Under this view, the
Due Process Clause works to limit state action,
but it does not guarantee certain minimal levels of
safety and security. This means that the Due Pro-
cess Clause cannot be the source of an affirmative
duty on the part of the state to protect these inter-
ests from private invasion. In its reasoning, the
majority noted that the purpose of the Due Process
Clause was to protect citizens from the state, not
to require that the state protect citizens from one
another. The Court did acknowledge that, under
certain limited situations, the state does have an
affirmative duty to act, such that it has the need to
provide adequate care to incarcerated prisoners or
those involuntarily held by the states. By doing so,
the Court confirmed the narrow view that when
the state acts to hold individuals against their will,
the Constitution imposes a duty to ensure their
safety and general well-being, a duty that no lon-
ger exists after the individual is released.
Importantly, the dissenting justices had argued
that the state’s initial action (in which it took
affirmative, protective actions) was of signifi-
cance and that the focus should be on that rather
than on the actions it failed to take to protect. The
argument was that, by intervening, the state had
removed other sources of aid that could have
helped Joshua and others similarly situated.
Because Wisconsin law directed its citizens to
depend on local departments of social services to
protect children from abuse, the dissent argued
that the state had placed Joshua into a special
relationship with the state that required the state
to protect him from harm. The majority was not
persuaded by this line of reasoning.
It is worth highlighting the legal recognition of
exceptions to the rule that individuals or a state
does not have a duty to care. At common law,
individuals did not have a duty to aid others in
distress. Nonfeasance, or inaction, that results in
harm was permissible. Originally, the rule was
absolute in that the failure to take affirmative
steps to prevent harm did not create liability. The
rule, however, has eroded over the years. The
1117
exceptions grew out of the marked distinction
between nonfeasance and misfeasance, with mis-
feasance occurring when, through affirmative
actions, another is rendered more vulnerable to
harm. Leaving someone more vulnerable imposes
a duty to act affirmatively to assist. Placing an
individual in peril creates a “special relationship”
that renders the misfeasor liable for harm suffered
due to his actions and also for his subsequent D
inaction in failing to provide assistance. This rec-
ognition results not only when there is misfeasance
but also when there are certain relationships that
give rise to a duty to aid another in distress. Exam-
ples of special relationships include employer–-
employee relationships, shopkeepers and patrons,
jailors and prisoners, parents and children as well
as school officials and students (see, e.g., Levesque
2002). Thus, many examples support the duty to
care, but those examples tend to rest on the need to
show the existence of a special relationship that
creates the duty to care.
The common law principle relating to special
relationships is what eventually led the Court to
hold that the Fourteenth Amendment imposes a
duty on a state to provide adequate care, including
protection, when the state has assumed the
responsibility for their well-being or otherwise
rendered them more vulnerable to harm (see
Estelle v. Gamble 1976; Youngberg v. Romeo
1982). Unlike the DeShaney case, however, the
instances above that give rise to a state’s duty are
notable for the existence of a complete and total
custodial relationship between the individual and
the state. Whether the Court would impose a spe-
cial relationship in circumstances of less than total
dependence, such as when the state does not have
physical custody but still restricts an individual’s
ability to care for themselves, still remains to
be answered. As the Court in DeShaney (1990,
p. 201) noted:
[w]hile the State may have been aware of the
dangers that Joshua faced in the free world, it
played no part in their creation, nor did it do
anything to render him more vulnerable to them.
That the State once took temporary custody of
Joshua does not alter the analysis, for when it
returned him to his father’s custody, it placed him
in no worse position than that in which he would
have been had it not acted at all.
1118
The Court does not view the state as placing
him in a worse position, nor does the Court view it
as restricting the child’s ability to care for itself or,
in this case, receive care from its parent.
Conclusion
It is difficult to overstate the significance of the
DeShaney case. The case highlights the view that
the Constitution is a negative charter of rights
rather than one that sets affirmative duties. This
means that the Constitution focuses on pro-
tecting individuals from the government, not
from private actors. This approach results in
placing limits on state action rather than trying
to have the state take affirmative steps to ensure
rights. Although the distinctions between nega-
tive and affirmative obligations can become quite
unclear, the general principle affirmed in
DeShaney seeks to clarify the stance that the
government seeks to protect individuals from it
and to limit the government’s role rather than
expand it.
References
DeShaney v. Winnebago County Department of Social
Services. (1990). 489 U.S. 189.
Estelle v. Gamble. (1976). 429 U.S. 97.
Levesque, R. J. R. (2002). Child maltreatment and the law:
Foundations in science, policy and practice. Durham:
Carolina Academic Press.
Levesque, R. J. R. (2008). Rethinking child maltreatment
law: Returning to first principles. New York: Springer.
Youngberg v. Romeo. (1982). 457 U.S. 307.
Dyscalculia
▶ Specific Learning Disorder
Dysgraphia
▶ Specific Learning Disorder
Dyscalculia
Dyslexia
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
The term dyslexia refers to a disability that takes
two forms. It can be a learning disability, known
as developmental dyslexia, unexplainable by def-
icits in general intelligence, motivation or learn-
ing opportunities. It also can take the form of
acquired dyslexia, or alexia, which describes a
specific pattern of reading deficits acquired during
adulthood as a result of brain injuries or diseases.
Generally, however, focus has been on develop-
mental dyslexia. This disability is associated with
numerous types of deficits in domains relating to
language acquisition, writing, and mathematical
abilities, as well as motor coordination, dexterity,
and attention deficits (for a review, see Habib
2000). Generally, however, dyslexia is character-
ized by difficulties with the accurate and/or fluent
recognition of words, as well as poor spelling and
decoding abilities. Dyslexia reveals itself initially
in difficulty learning to read effortlessly or with
understanding, and subsequently by erratic spell-
ing and deficits that affect written as opposed to
spoken language.
Dyslexia arguably is the most common
neurobehavioral disorder affecting children. Dys-
lexia indicates a persistent, chronic condition;
unlike many other conditions, it does not represent
a transient developmental lag. Prevalence rates
range from 5% to 17.5% (Shaywitz and Shaywitz
2005). Dyslexia tends to appear more frequently in
males, with studies reporting ratios ranging from
2:3 to 4:5 (Habib 2000). Researchers have yet to
understand why males are more likely to show
signs of dyslexia, but prevalence studies continue
to note the sex differences.
Dyslexia typically is unexpected given the nor-
mal range of intelligence and other abilities
exhibited by individuals who show dyslexic
symptoms. The disorders associated with dyslexia
often relate to oral-language impairment, espe-
cially subtle impairment in perception and articu-
lation of speech; and these subtle impairments
Dyslexia
currently are viewed as the most likely mechanism
leading to the reading disorders. Indeed, the lead-
ing theory of dyslexia’s causes, the phonological
deficit model, views it as a specific impairment in
the representation, storage, and/or retrieval of
speech sounds (for a review, Ramus et al. 2003).
Importantly, however, it is critical to recognize that
the relationship between oral-language deficits and
dyslexia is far from straightforward, with some
individuals with dyslexia exhibiting no oral-
language impairment and others who read without
difficulty. Dyslexia is a dimensional disorder,
meaning that reading disability and ability occur
along a continuum. This wide range of possible
disorders helps to explain why there continues to
be many theories relating to the causes of dyslexia,
as theories can explain only some but not all pos-
sible features (see Scerri and Schulte-Körne 2010).
Given the wide range of dysfunctions that can
support the manifestations of dyslexia, the most
effective remedial approaches typically involve
extensive, specific, and specialized teaching best
provided by one or more competent professionals.
Depending on the nature of the disability, reading
can become possible, although reading is likely to
be effortful and sometimes accompanied by errors
in comprehension and more or less profound
spelling impairment (Habib 2000). It is this spell-
ing impairment that, during adolescence and
adulthood, tends to persist as the permanent
mark of the developmental disorder. This likely
is the case in that efforts to intervene and treat tend
to not focus on at risk children. The lack of focus
on children at risk is of significance in that at-risk
readers can become both accurate and fluent
readers if they have appropriate instruction; this
is in contrast to older, reading-disabled children
who, with intensive, evidence-based remedial
interventions can markedly improve but not as
fluently as they would have with earlier interven-
tions (for a review, see Alexander and Slinger-
Constant 2004).
Studies report significant familial clustering of
dyslexia. Family history is one of the most impor-
tant risk factors, with research indicating that from
23% to 65% of children who have dyslexia have a
parent who has the disorder (Scarborough 1990).
The probability of an individual being affected
1119
by dyslexia given a sibling is already affected is
estimated at 43–60% (Scerri and Schulte-Körne
2010). Evidence for a genetic origin of dyslexia
has been increasing rapidly. The role of genetics
is not surprising given the role of families. But,
although different forms of dyslexia may occur
within the same families, different genes have
been implicated in different aspects of reading
disorders, with some forms of dyslexia appearing D
more heritable than others, which suggests a role
for environments. Research has identified several
(sometimes controversial) environmental factors
that may link to dyslexia, such as maternal anti-
bodies, immune disorders, fatty-acid deficien-
cies, toxic metals, and exposures to high levels
of prenatal testosterone (Scerri and Schulte-
Körne 2010). These findings have led to the
conclusion that genetic transmission appears
complex and nonexclusive (see Habib 2000;
Pennington 1999).
More recently, research has focused consider-
ably on the neurological bases of developmental
dyslexia. A wide range of studies that have used
postmortem brain specimens and, more recently,
brain imaging suggest differences in the temporo-
parieto-occipital brain regions between dyslexic
and non-impaired readers (for a review, see Habib
2000). For example, functional magnetic reso-
nance imaging has been helpful in beginning to
distinguish among types of reading disabilities
(Shaywitz and Shaywitz 2005). These lines of
research indicate that dyslexia involves a disrup-
tion of left hemisphere posterior brain systems.
This area of research further suggests that disrup-
tions in the posterior reading systems result in
attempts to compensate by shifting to other, ancil-
lary systems. For example, it is not uncommon for
children to engage the right-hemisphere sites that
allow poor readers to use other perceptual pro-
cesses to compensate for poor phonologic skills.
This shift helps explain why some may develop
accuracy in reading words but remain slow, non-
automatic readers (Shaywitz and Shaywitz 2005).
Cross-References
▶ Specific Learning Disorder
1120
References
Alexander, A. W., & Slinger-Constant, A.-M. (2004). Cur-
rent status of treatments for dyslexia: Critical review.
Journal of Child Neurology, 19, 744–758.
Habib, M. (2000). The neurological basis of developmen-
tal dyslexia: An overview and working hypothesis.
Brain, 123, 2373–2399.
Pennington, B. F. (1999). Toward an integrated under-
standing of dyslexia: Genetic, neurological, and cogni-
tive mechanisms. Development and Psychopathology,
11, 629–654.
Ramus, F. S., Rosen, S., Dakin, S., Day, B., Castellote, J.,
White, S., et al. (2003). Theories of developmental
dyslexia: Insights from a multiple case study of dys-
lexic adults. Brain, 126, 841–865.
Scarborough, H. S. (1990). Very early language deficits in
dyslexic children. Child Development, 61, 1728–1743.
Scerri, T. S., & Schulte-Körne, G. (2010). Genetics of
developmental dyslexia. European Child & Adolescent
Psychiatry, 19, 179–197.
Shaywitz, S. E., & Shaywitz, B. A. (2005). Dyslexia
(specific reading disability). Biological Psychiatry, 57,
1301–1309.
Dysphoria
Roger J. R. Levesque
Indiana University, Bloomington, IN, USA
Dysphoria can be defined as a self-report of feel-
ings of depression in an individual (Kistner et al.
1999). Similar types of feelings could be
described as dejection, disaffection, dysthymia,
unhappiness, dissatisfaction with one’s life or
self (or part of one’s self), or generally low self-
esteem. Importantly, dysphoria refers only to a
condition of mood. It can be experienced as part
of typical development as well as atypcial devel-
opment. Dysphoria is a component of several psy-
chiatric disorders, including anxiety disorders and
mood disorders as well as gender identity disor-
der, which is sometimes called gender dysphoria
(see, e.g., Cohen-Kettenis and Pfäfflin 2010).
The study of dysphoria during the adolescent
period tends to focus on depressive symptoms and
the role peers play in their experience. Adolescents
exhibit a tendency to experience feelings of
Dysphoria
depression, especially during middle adolescence
(Kistner et al. 1999). If adolescents believe that
their peers are hesitant to accept them, whether
this is actually the case or not, this type of experi-
ence and perception can lead to an increased risk of
that individual also feeling dysphoric (Kistner et al.
1999). One’s self-perception concerning peer
acceptance is actually a crucial determining factor
in determining whether youth develop dysphoria in
later years; and this phenomenon can take place
even if a particular youth’s peers actually do accept
them (Demir and Urberg 2004). The key element in
feelings of dysphoria is self-perception, as dyspho-
ria itself often is comprised of a self-report of
depression. During adolescence, there is an inten-
sified emphasis on peer acceptance or rejection;
this component of an adolescent’s experience can
effectively establish and sustain that person’s sense
of self-worth. Hence, it proves unsurprising that
such perceptions could have a lingering impact on
an adult’s potential to develop dysphoria that can
lead to more severe symptoms. Even during
adolescence, the presence of high levels of self-
devaluative dysphoric experiences increase the
liability for persistence of a first-episode of major
depressive disorder (Park et al. 2005).
Cross-References
▶ Depressive Symptoms
References
Cohen-Kettenis, P. T., & Pfäfflin, F. (2010). The DSM
diagnostic criteria for gender identity disorder in ado-
lescents and adults. Archives of Sexual Behavior, 39,
499–513.
Demir, M., & Urberg, K. A. (2004). Friendship and adjust-
ment among adolescents. Journal of Experimental
Child Psychology, 88, 68–82.
Kistner, J., Balthazor, M., Risi, S., & Burton, C. (1999).
Predicting dysphoria in adolescence from actual and
perceived peer acceptance in childhood. Journal of
Clinical Child Psychology, 28, 94–104.
Park, R. J., Goodyear, I. M., & Teasdale, J. D. (2005). Self-
devaluative dysphoric experience and the prediction of
persistent first-episode major depressive disorder in
adolescents. Psychological Medicine, 35, 539–548.