Administrative Appointments

  • Director, Program in Psychiatry & The Law (2010 - Present)
  • Founding Member & Director, Pegasus Physycians at Stanford (2008 - Present)

Honors & Awards

  • Fellow, American Psychiatric Association (1992)
  • One of 327 Best Mental Health Experts, Good Housekeeping (1994)
  • Goldberger Award, American Medical Association (1996)
  • Dlin/Fischer Award for Significant Achievement in Clinical Research, American Academy of Psychosomatic Medicine (1990)
  • Outstanding Mentor Award, American Academy of Child and Adolescent Psychiatry (1990-3 , 1995-6, 1998-9, 2004)
  • Fellow, American Academy of Psychosomatic Medicine (1990)
  • Fellow, American Academy of Child and Adolescent Psychiatry (1987)
  • Distinguished Fellow, American Psychiatric Association (2003)
  • Lifetime Distinguished Fellow, American Psychiatric Association (2010)

Professional Education

  • Dr. med. univ. (M.D.), University of Vienna, Austria, Medicine (1972)

Community and International Work

  • Mental Health in Unaccompanied Minor Refugees, Vienna, Austria


    Psychopathology and its Treatment

    Partnering Organization(s)

    Medical University of Vienna

    Populations Served




    Ongoing Project


    Opportunities for Student Involvement


Current Research and Scholarly Interests

Dr. Steiner's predominant interest is the application of Humanistic principles to the practice of Medicine and Psychiatry.

Dr Steiner is the director and a founding member of the PEGASUS PHYSICIAN WRITERS at Stanford, a working group of over 100 Stanford physicians who also write creatively. The group meets monthly and dscusses writing proposals, poetry, novels and trade books in progress. Most members of the group have an extensive publication record. The group is open to physicians who write creatively, including medical students, trainees and undergraduates exploring medicine as a career. We ask prospective members to send a current CV and writing sample. They also should indicate which specific project they are currently working on. The group can be reached by e mailing Dr. Steiner at Stanford or via his private website at:

Dr. Steiner directs Stanford's Program in Psychiatry & The Law. He is an expert in Forensic Psychiatry, aiming to bring Medicine to crime and criminals, as well as their victims and their families. He is particularly interested in freedom of will, culpability and its relationship to psychopathology.

Dr. Steiner's empirical research is based on developmental approaches to psychopathology which emphasize the conjoint study of normative and non-normative phenomena, and the complex interaction of biological, psychological and social variables in the etiology, pathogenesis, diagnosis and treatment of mental disorders.He has published extensively on the details of this model and has applied it to the study of normal and abnormal aggression, responses to stress and traumatic events, and the mental processes helping people adjust to adversity across the life span.

All Publications

  • Defense mechanism is predicted by attachment and mediates the maladaptive influence of insecure attachment on adolescent mental health CURRENT PSYCHOLOGY Laczkovics, C., Fonzo, G., Bendixsen, B., Shpigel, E., Lee, I., Skala, K., Prunas, A., Gross, J., Steiner, H., Huemer, J. 2020; 39 (4): 1388–96
  • Michael Angel. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry Steiner, H. 2017; 41 (6): 768

    View details for PubMedID 29019154

  • Eating Disorders Fast Facts, ISBN 1903734916 Steiner, H., Flament, Martine 2010
  • The Handbook of Developmental Psychiatry World Scientific and Imperial College Press, ISBN 978-981-4324-81-6 Steiner, H. 2010
  • Handbook of Mental Health Interventions in Children and Adolescents: An Integrated Developmental Approach San Francisco, Jossey/Bass/Wiley, ISBN 078796154X Hans Steiner, M.D., (editor) 2004

    View details for Web of Science ID A1977DR72900004

    View details for PubMedID 331232

  • Psychopathology in adolescents with TLE and FLE. European journal of paediatric neurology Huemer, J., Plattner, B., Planer, N., Steiner, H., Feucht, M. 2016; 20 (6): 880-887


    To describe the rates and types of psychiatric disorders among adolescents with chronic symptomatic epilepsies and to evaluate syndrome-specific differences between temporal lobe (TLE) and frontal lobe (FLE) epilepsies.A cross-sectional single-center study design applying the Youth Self Report (YSR) to investigate psychopathological symptoms and the Weinberger Adjustment Inventory (WAI) to investigate personality dimensions was used. Consecutive adolescents between 14 and 18 years of age with drug-resistant symptomatic TLE and FLE were investigated during pre-surgical evaluation prior to epilepsy surgery. Data from twenty-eight patients (19 with TLE and 9 with FLE) were analyzed for this report.Compared with the test norm, higher prevalence rates and a wider range of psychopathological symptoms were seen in patients with TLE. This result was not seen in patients with FLE. Concerning personality dimensions, significantly higher values of repressive defensiveness and significantly lower values of positive emotion and confidence were found in patients with TLE. In contrast, significantly lower levels of distress and significantly higher levels of repressive defensiveness and denial of distress were seen in patients with FLE. Comparing TLE with FLE, a significantly higher mean score for distress, and a significantly lower mean score for positive emotion and denial of distress were found in patients with TLE.In summary, psychiatric comorbidity was frequently found in this sample of youths with chronic drug-resistant localization-related epilepsies. Although results have to be interpreted with caution because of the small sample size, psychiatric symptomatology was significantly different between TLE and FLE. Our results show that continuous and syndrome-specific psychiatric monitoring is essential in young patients with epilepsy.

    View details for DOI 10.1016/j.ejpn.2016.07.011

    View details for PubMedID 27474513

  • Child and adolescent psychiatry patients coming of age: a retrospective longitudinal study of inpatient treatment in Tyrol. BMC psychiatry Fuchs, M., Kemmler, G., Steiner, H., Marksteiner, J., Haring, C., Miller, C., Hausmann, A., Sevecke, K. 2016; 16: 225


    Mental illness is a common phenomenon at all ages. Various independent studies have shown that psychopathology is often expressed on a continuum from youth to adulthood. The aim of our study was to demonstrate a) the frequency of admission of former child and adolescent psychiatry inpatients (CAP-IP) to adult inpatient mental health facilities, and b) a potential longitudinal diagnostic shift. This is the first Austrian study designed to shed light on these issues.Nearly 1000 inpatient cases at a specialized child and adolescent care center were analyzed. These cases were then tracked using data matching with registry data from adult psychiatric institutions. Overall, our observational period was 23 years.26 % of our sample of former CAP-IP used psychiatric inpatient mental health services as adults, thus indicating chronicity or reoccurrence. In line with previous literature, there were patients who stayed in the same diagnostic category as well as patients with a diagnostic shift from childhood to adulthood.Childhood and adolescence is a very important period for early intervention and prevention of mental illness. Our findings support the notion of the continuity of psychopathology from youth into adulthood.

    View details for DOI 10.1186/s12888-016-0910-x

    View details for PubMedID 27391233

    View details for PubMedCentralID PMC4938986

  • Oppositional COMT Val158Met effects on resting state functional connectivity in adolescents and adults. Brain structure & function Meyer, B. M., Huemer, J., Rabl, U., Boubela, R. N., Kalcher, K., Berger, A., Banaschewski, T., Barker, G., Bokde, A., Büchel, C., Conrod, P., Desrivières, S., Flor, H., Frouin, V., Gallinat, J., Garavan, H., Heinz, A., Ittermann, B., Jia, T., Lathrop, M., Martinot, J., Nees, F., Rietschel, M., Smolka, M. N., Bartova, L., Popovic, A., Scharinger, C., Sitte, H. H., Steiner, H., Friedrich, M. H., Kasper, S., Perkmann, T., Praschak-Rieder, N., Haslacher, H., Esterbauer, H., Moser, E., Schumann, G., Pezawas, L. 2016; 221 (1): 103-114


    Prefrontal dopamine levels are relatively increased in adolescence compared to adulthood. Genetic variation of COMT (COMT Val158Met) results in lower enzymatic activity and higher dopamine availability in Met carriers. Given the dramatic changes of synaptic dopamine during adolescence, it has been suggested that effects of COMT Val158Met genotypes might have oppositional effects in adolescents and adults. The present study aims to identify such oppositional COMT Val158Met effects in adolescents and adults in prefrontal brain networks at rest. Resting state functional connectivity data were collected from cross-sectional and multicenter study sites involving 106 healthy young adults (mean age 24 ± 2.6 years), gender matched to 106 randomly chosen 14-year-olds. We selected the anterior medial prefrontal cortex (amPFC) as seed due to its important role as nexus of the executive control and default mode network. We observed a significant age-dependent reversal of COMT Val158Met effects on resting state functional connectivity between amPFC and ventrolateral as well as dorsolateral prefrontal cortex, and parahippocampal gyrus. Val homozygous adults exhibited increased and adolescents decreased connectivity compared to Met homozygotes for all reported regions. Network analyses underscored the importance of the parahippocampal gyrus as mediator of observed effects. Results of this study demonstrate that adolescent and adult resting state networks are dose-dependently and diametrically affected by COMT genotypes following a hypothetical model of dopamine function that follows an inverted U-shaped curve. This study might provide cues for the understanding of disease onset or dopaminergic treatment mechanisms in major neuropsychiatric disorders such as schizophrenia and attention deficit hyperactivity disorder.

    View details for DOI 10.1007/s00429-014-0895-5

    View details for PubMedID 25319752

    View details for PubMedCentralID PMC4667398

  • Emotional expressiveness and avoidance in narratives of unaccompanied refugee minors. European journal of psychotraumatology Huemer, J., Nelson, K., Karnik, N., Völkl-Kernstock, S., Seidel, S., Ebner, N., Ryst, E., Friedrich, M., Shaw, R. J., Realubit, C., Steiner, H., Skala, K. 2016; 7: 29163-?


    The aim of this study was to examine a cohort of unaccompanied refugee minors (URMs) by means of psycholinguistic methods in order to obtain a more subtle picture of their degree of traumatization.Twenty-eight participants were included in the Stress-Inducing Speech Task (SIST) consisting of a free association (FA) and a stress (STR) condition. Narratives were examined by means of (1) quantitative parameters (word count); (2) psycholinguistic variables (temporal junctures, TJs), narrative structure, referential activity (RA)-a measure of emotional expressivity; and (3) content analysis ratings.Word count was significantly lower than in age-matched norms. In the FA condition, TJs were lower, but in the STR condition, rates were comparable. RA was significantly higher in both conditions. Content analysis ratings showed that the experiences described by these youths were potentially traumatic in nature.This pattern of narrative shows a mixture of fulfilling the task demand, while containing an emotionally charged narrative. Narrative structure was absent in the FA condition, but preserved in the STR condition, as URMs struggled with the description of non-normative events. This indicates that these youths have not yet emotionally dealt with and fully integrated their trauma experiences.

    View details for DOI 10.3402/ejpt.v7.29163

    View details for PubMedID 26955827

    View details for PubMedCentralID PMC4783431

  • Adolescent Defense Style as Correlate of Problem Behavior. Zeitschrift fu¨r Kinder- und Jugendpsychiatrie und Psychotherapie Huemer, J., Shaw, R. J., Prunas, A., Hall, R., Gross, J., Steiner, H. 2015; 43 (5): 345-350


    Adolescent problem behaviors are often the visible results of intrapsychic distress. Defensive reactions are the unconscious means of managing intrapsychic distress. This cross-sectional study examines the strength of defensive style as measured by self-report on the Response Evaluation Measure (REM-71) relative to age, sex, and SES, as a correlate of internalizing and externalizing problem behaviors, as assessed by the Youth Self Report (YSR).A sample of 1,487 students from two suburban high schools completed self-report measures of defense style, self-esteem, and internalizing and externalizing problem behaviors. Demographic variables (age, sex, and SES) were included as covariates.Mature and immature defense style correlated as expected with problem behaviors. Demographic variables contributed minimally to the variance in the outcome variable.Defense style, as assessed by the REM-71, is a significant correlate of clinically elevated internalizing and externalizing problem behaviors in youth as in adults. This study adds to the convergent validity of the REM-71.

    View details for DOI 10.1024/1422-4917/a000368

    View details for PubMedID 26373385

  • Defensive functioning and psychopathology: a study with the REM-71 COMPREHENSIVE PSYCHIATRY Prunas, A., Preti, E., Huemer, J., Shaw, R. J., Steiner, H. 2014; 55 (7): 1696-1702


    The aim of the present study is to explore the association between defensive functioning (as assessed through the REM-71) and psychiatric symptoms in a large sample from the community, and the moderating role of age and gender on that association. Furthermore, we explored the concurrent validity of REM-71 as compared with "caseness" (SCL-90-R).The REM-71 was administered together with SCL-90-R to a community sample of 1,060 Italian high-school and university students (mean age=19.01±3.85 years; 66.7% females).Factor 1 defenses were by far the primary contributors to the predictor synthetic variable (i.e. association between defenses and psychopathology). Gender proved to moderate the association between immature defenses and symptoms. Using ROC analysis, we derived a cut-off score for Factor 1 defenses.Our results support the adoption of the REM-71 as a useful instrument for the assessment of defensive array and psychopathological liability in adolescents and adults.

    View details for DOI 10.1016/j.comppsych.2014.06.008

    View details for Web of Science ID 000342121800032

  • Defensive functioning and psychopathology: a study with the REM-71. Comprehensive psychiatry Prunas, A., Preti, E., Huemer, J., Shaw, R. J., Steiner, H. 2014; 55 (7): 1696-1702


    The aim of the present study is to explore the association between defensive functioning (as assessed through the REM-71) and psychiatric symptoms in a large sample from the community, and the moderating role of age and gender on that association. Furthermore, we explored the concurrent validity of REM-71 as compared with "caseness" (SCL-90-R).The REM-71 was administered together with SCL-90-R to a community sample of 1,060 Italian high-school and university students (mean age=19.01±3.85 years; 66.7% females).Factor 1 defenses were by far the primary contributors to the predictor synthetic variable (i.e. association between defenses and psychopathology). Gender proved to moderate the association between immature defenses and symptoms. Using ROC analysis, we derived a cut-off score for Factor 1 defenses.Our results support the adoption of the REM-71 as a useful instrument for the assessment of defensive array and psychopathological liability in adolescents and adults.

    View details for DOI 10.1016/j.comppsych.2014.06.008

    View details for PubMedID 25070477

  • Incarcerated youth with personality disorders: Prevalence, comorbidity and convergent validity PERSONALITY AND MENTAL HEALTH Kaszynski, K., Kallis, D. L., Karnik, N., Soller, M., Hunter, S., Haapanen, R., Blair, J., Steiner, H. 2014; 8 (1): 42-51


    The aims of this study were to examine the prevalence and comorbidities of personality disorders among incarcerated juveniles and to investigate the validity of these results.A sample of 790 incarcerated youth (650 boys and 140 girls; mean age = 16.8 years) completed an assessment of Axis II diagnoses (Structured Interview for DSM-IV Personality). Subjects also completed secondary questionnaires assessing anger-irritability (Youth Self-Report (YSR)), aggression (YSR), delinquency (Massachusetts Youth Screening Instrument-2), and distress and restraint (Weinberger Adjustment Inventory).Personality disorders can be found among incarcerated youth at high rates. Many meet the criteria for more than one personality disorder. Those with personality disorders have significant elevations of anger-irritability, aggression, delinquency, and distress and reduced restraint compared with incarcerated youth without a personality disorder.Results indicate that personality disorders can be found in incarcerated youth at high rates. These findings further our understanding of chronic psychiatric illness and possibly criminal recidivism in this at-risk population. Addition of personality measures in the assessment of delinquents may assist in the development of more effective interventions. Furthermore, the supportive convergent validity of these findings in a population younger than 18 years may indicate a need to reassess the current rationale for the diagnosis of Axis II disorders.

    View details for DOI 10.1002/pmh.1241

    View details for Web of Science ID 000331450200005

    View details for PubMedID 24532554

  • Responses to conflict, family loss and flight: posttraumatic stress disorder among unaccompanied refugee minors from Africa. Neuropsychiatrie Völkl-Kernstock, S., Karnik, N., Mitterer-Asadi, M., Granditsch, E., Steiner, H., Friedrich, M. H., Huemer, J. 2014; 28 (1): 6-11


    To investigate African unaccompanied refugee minors (URMs) living in Austria for posttraumatic stress disorder (PTSD) prevalence and related symptoms, comorbidity, demographics and coping strategies."UCLA PTSD Index and inventories" and "Scales for Children Afflicted by War and Persecution (SCWP)" were used to assess 41 African URMs.The study revealed lower PTSD rates than measured among URMs in previous studies. Girls were more likely to develop PTSD. PTSD was significantly correlated with single war-related traumatic events. The depression score for the sample was above the clinical cut-off value.Trauma-specific psychopathology was less severe than reported in other studies. These findings could be explained by concepts of resilience. Other implications, such as response bias, are discussed.

    View details for DOI 10.1007/s40211-013-0094-2

    View details for PubMedID 24500800

  • Personality and Psychopathology in African Unaccompanied Refugee Minors: Repression, Resilience and Vulnerability CHILD PSYCHIATRY & HUMAN DEVELOPMENT Huemer, J., Voelkl-Kernstock, S., Karnik, N., Denny, K. G., Granditsch, E., Mitterer, M., Humphreys, K., Plattner, B., Friedrich, M., Shaw, R. J., Steiner, H. 2013; 44 (1): 39-50


    Examining personality and psychopathological symptoms among unaccompanied refugee minors (URMs), we measured intra-individual dimensions (repression and correlates thereof) usually associated with resilience. Forty-one URMs completed the Weinberger Adjustment Inventory (WAI), assessing personality, and the Youth Self-Report (YSR), describing current symptoms. URMs endorsed high levels of Repressive Defensiveness, Denial of Distress, and Restraint; unexpectedly, URMs reported high Distress and reduced Happiness (WAI, p's < 0.05). Although YSR symptoms were below clinical cut points, there were notable correlations between Distress and Attention Problems, Self-destructive, and Aggressive Behavior (all on the YSR), correcting for multiple comparisons (p's < 0.004). URMs exposed to non-normative stressors reported non-symptomatic outcomes, and high levels of personality dimensions correlating with resilience. However, URMs also endorsed high Distress and low Happiness, calling their resilience into question. Positive correlations between WAI Distress and YSR symptom subscales suggest that URMs harbor vulnerabilities of clinical and forensic significance.

    View details for DOI 10.1007/s10578-012-0308-z

    View details for Web of Science ID 000314065000003

    View details for PubMedID 22661148

  • Psychopathology and offense types in detained male juveniles PSYCHIATRY RESEARCH Plattner, B., Giger, J., Bachmann, F., Bruehwiler, K., Steiner, H., Steinhausen, H., Bessler, C., Aebi, M. 2012; 198 (2): 285-290


    A substantial proportion of violent crime is committed by juveniles. In detained juveniles, high rates of psychopathology have been found. The objective of this study was to determine psychopathology associated with offense characteristics in detained male adolescents. The Mini International Neuropsychiatric Interview was used to assess juvenile detainees. The final sample included 275 males (mean age=16.45, S.D.=1.27 years). Multivariate logistic regressions yielded significant associations between psychopathology and specific offense types: The presence of substance use disorders (without alcohol) (SUD) was found to predict drug-related crimes, and the presence of alcohol use disorders (AUD) without further SUD were a predictor of violent crime, especially in older juveniles. The absence of anxiety disorder, especially in younger juveniles, was found to be relevant for the prediction of robbery. The results of the study suggest that the use and abuse of legal and illegal substances might be a trigger for serious violent and drug-related crimes in juveniles. In particular, the presence of AUD is presumed to have a pivotal role in the development of impulsive aggression. These findings are important when considering the serious social impact of violent behaviors in adolescents.

    View details for DOI 10.1016/j.psychres.2012.02.006

    View details for Web of Science ID 000311987000019

    View details for PubMedID 22445705

  • Symptomatic Response to Divalproex in Subtypes of Conduct Disorder CHILD PSYCHIATRY & HUMAN DEVELOPMENT Padhy, R., Saxena, K., Remsing, L., Huemer, J., Plattner, B., Steiner, H. 2011; 42 (5): 584-593


    To investigate response to Divalproex sodium (DVPX) with respect to Reactive/Affective/Defensive/Impulsive (RADI) and Proactive/Instrumental/Premeditated (PIP) aggression among adolescent males with conduct disorder (CD), using results from a randomized, double-blind, placebo-controlled trial. It was hypothesized that DVPX response among participants with RADI aggression would be greater than among those with PIP aggression. Fifty-eight ethnically diverse males with severe CD were assigned to High Distress (HDCD) or Low Distress (LDCD) Conduct Disorder, corresponding with RADI and PIP aggression, respectively. Following a 1-week washout, all subjects were randomized to a high dose (up to 1,500 mg/day) or low dose (up to 250 mg/day) of DVPX. Baseline and endpoint assessments included Clinical Global Impression (CGI), Achenbach Self Report (YSR), and Weinberger Adjustment Inventory (WAI-62). Response to DVPX was significantly higher in the HDCD group (64%) than in the LDCD group (22%) in the high-dose treatment group (p = 0.03). Mean weekly WAI-62 distress scores declined significantly among the HDCD subjects than among LDCD subjects in the high-dose group. These results support the utility of mood stabilizing agents such as DVPX in treating patients with disorders characterized by the RADI pattern of aggression, including those with severe CD.

    View details for DOI 10.1007/s10578-011-0234-5

    View details for Web of Science ID 000294959500006

    View details for PubMedID 21706221

  • Psychopathology in African Unaccompanied Refugee Minors in Austria CHILD PSYCHIATRY & HUMAN DEVELOPMENT Huemer, J., Karnik, N., Voelkl-Kernstock, S., Granditsch, E., Plattner, B., Friedrich, M., Steiner, H. 2011; 42 (3): 307-319


    We assessed the prevalence of a range of psychopathology among African unaccompanied refugee minors (URMs) in Austria. Additionally, the predictive value of war exposure on PTSD symptoms was examined. Forty-one URMs were assessed with the Mini-International Neuropsychiatric Interview for children and adolescents, the Youth Self-Report, the UCLA PTSD Reaction Index and Facts About You. As expected, 56% of youth had at least one diagnosis by structured clinical interview. The most common diagnoses were adjustment disorder, PTSD and dysthymia. War affliction marginally predicted (p = 0.065) PTSD controlling for age and gender. URMs had high levels of psychopathology compared to norms. Their PTSD rates were somewhat lower than found in previous studies. We discuss methodological and substantive reasons for this finding. Future studies need to examine URMs across the entire diagnostic spectrum and employ multi-method designs to yield valid results. The psychopathology in URMs has clinical and forensic implications.

    View details for DOI 10.1007/s10578-011-0219-4

    View details for Web of Science ID 000290027700004

    View details for PubMedID 21293919

  • Psychosocial background in incarcerated adolescents from Austria, Turkey and former Yugoslavia PSYCHIATRY RESEARCH Bauer, S. M., Steiner, H., Feucht, M., Stompe, T., Karnik, N., Kasper, S., Plattner, B. 2011; 185 (1-2): 193-199


    Adolescents with a migration background account for a substantial proportion of juveniles in custody. Psychosocial adversities pose a significant risk for criminal behaviour. So far, the nature of psychosocial adversities experienced by migrant youth is understudied. The aim of this study was to explore differences in psychosocial background in three ethnic groups (Turkish, former-Yugoslavian and Austrian) of detained juveniles in Austria. A semi-structured interview (Multidimensional Clinical Screening Inventory for delinquent juveniles, MCSI) was used to assess psychosocial background (e.g., trauma, family background, forensic and psychiatric family history, school history, psychiatric treatment received and criminal history) in juveniles entering an Austrian pre-trial detention facility. Of the 370 eligible participants, the final study sample consisted of 278 juveniles. The ethnic distribution was as follows: 55.4% Austrian (mean age 16.88 years, S.D.=1.52), 14% Turkish (mean age 16.28 years, S.D.=1.23), 30.6% former-Yugoslavian (mean age 16.47 years, S.D.=1.41). In the Austrian sample, family dysfunction was significantly more prevalent than in the Turkish or former-Yugoslavian samples. Mental health services were significantly less used by juveniles with migration background. Turkish juveniles had a significantly poorer school performance than Austrians. Juveniles from former-Yugoslavia had significantly less often attended schools offering secondary education. The results suggest that detained juveniles with migration background are poorly integrated into the educational and mental health system of the host society. Family systems, even if substantially dysfunctional, seem to be perceived as more stable by migrant youth than by Austrian youth.

    View details for DOI 10.1016/j.psychres.2010.04.052

    View details for Web of Science ID 000287113000033

    View details for PubMedID 20627325

  • Overt and Covert Aggression in College Women with Bulimia Nervosa ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE Huemer, J., Sagar, A., Alquero, K., Denny, K., Shaw, R. J., Steiner, H. 2011; 39 (6): 409-415


    This study examines the prevalence of overt and covert aggression in women with bulimia nervosa (BN) as well as the relationship between the severity of BN and the frequency of aggressive acts.20 female college students with BN and 20 control subjects completed self-report measures of aggressive behavior and eating disorder pathology. They also completed the Juvenile Health and Wellness Survey-76 to assess general risk taking and indices of sexual behavior and mental health.BN subjects reported higher levels of both overt and covert aggression (p < .001). Overt aggression tended to be more premeditated, while the self-report of covert aggression behavior was more impulsive. Levels of aggressive behavior were significantly correlated with severity of BN (p < .01). Subjects with BN reported higher levels of risk-taking and sexual behaviors.Aggression is an important clinical issue in BN. Subtypes of aggression suggest different pathways for overt and covert aggressive acts with impulsive covert aggression being more closely related to the binge-purge cycle. Awareness of subtypes of aggression in BN may have important clinical and treatment implications.

    View details for DOI 10.1024/1422-4917/a000139

    View details for Web of Science ID 000296582300005

    View details for PubMedID 22031013

  • Psychopathology, trauma and delinquency: subtypes of aggression and their relevance for understanding young offenders. Child and adolescent psychiatry and mental health Steiner, H., Silverman, M., Karnik, N. S., Huemer, J., Plattner, B., Clark, C. E., Blair, J. R., Haapanen, R. 2011; 5: 21-?


    To examine the implications of an ontology of aggressive behavior which divides aggression into reactive, affective, defensive, impulsive (RADI) or "emotionally hot"; and planned, instrumental, predatory (PIP) or "emotionally cold." Recent epidemiological, criminological, clinical and neuroscience studies converge to support a connection between emotional and trauma related psychopathology and disturbances in the emotions, self-regulation and aggressive behavior which has important implications for diagnosis and treatment, especially for delinquent populations.Selective review of preclinical and clinical studies in normal, clinical and delinquent populations.In delinquent populations we observe an increase in psychopathology, and especially trauma related psychopathology which impacts emotions and self-regulation in a manner that hotly emotionally charged acts of aggression become more likely. The identification of these disturbances can be supported by findings in cognitive neuroscience. These hot aggressive acts can be delineated from planned or emotionally cold aggression.Our findings support a typology of diagnostic labels for disruptive behaviors, such as conduct disorder and oppositional defiant disorder, as it appears that these acts of hot emotional aggression are a legitimate target for psychopharmacological and other trauma specific interventions. The identification of this subtype of disruptive behavior disorders leads to more specific clinical interventions which in turn promise to improve hitherto unimpressive treatment outcomes of delinquents and patients with disruptive behavior.

    View details for DOI 10.1186/1753-2000-5-21

    View details for PubMedID 21714905

    View details for PubMedCentralID PMC3141659

  • Posttraumatic Stress Disorder in Children and Adolescents: A Review of Psychopharmacological Treatment CHILD PSYCHIATRY & HUMAN DEVELOPMENT Huemer, J., Erhart, F., Steiner, H. 2010; 41 (6): 624-640


    PTSD in children and adolescents differs from the adult disease. Therapeutic approaches involve both psychotherapy and psychopharmacotherapy.The current paper aims at reviewing studies on psychopharmacological treatment of childhood and adolescent PTSD. Additionally, developmental frameworks for PTSD diagnosis and research along with an experimental model of quenching and kindling in the context of stress exposure are presented. We conducted an extensive literature search of reviews on psychopharmacotherapy as well as studies on psychopharmacological treatment for PTSD among children and adolescents. We used the database PubMed and focused on the time period of the last 10 years up to January 2009. Pertinent earlier papers were also included.There are a limited number of studies specifically assessing the psychopharmacological treatment of PTSD in children and adolescents. The vast majority of them lack verification in RCTs. Only the use of imipramine, divalproex sodium and sertraline were already evaluated in RCTs. Future studies should take into account developmental approaches to the diagnosis and treatment of PTSD in children and adolescents. In this context, different underlying neurobiological patterns, which are reflected in distinct clinical symptomatology, require a precise investigation and a symptom-orientated psychopharmacological approach.

    View details for DOI 10.1007/s10578-010-0192-3

    View details for Web of Science ID 000282783300004

    View details for PubMedID 20567898

  • Adaptive styles in elite collegiate athletes: The role of activation and self-regulation PERSONALITY AND MENTAL HEALTH Steiner, H., Denny, K., Stemmle, P. 2010; 4 (3): 163-171

    View details for DOI 10.1002/pmh.120

    View details for Web of Science ID 000283105400001

  • Divalproex Sodium -ER in Outpatients with Disruptive Behavior Disorders: A Three Month Open Label Study CHILD PSYCHIATRY & HUMAN DEVELOPMENT Saxena, K., Mora, L., Torres, E., Hall, R., Delizonna, L., Torres, A., Steiner, H. 2010; 41 (3): 274-284


    This aim of this clinical trial was to study the effects of divalproex sodium (DVPX) in reducing Reactive/Affective/ Defensive/ Impulsive Aggression (RADI) in youth with Disruptive Behavior Disorders (DBD) in an outpatient clinic over a period of 3 months. We recruited forty participants with Oppositional Defiant Disorder or Conduct Disorder. Twenty participants received 12 weeks of openly titrated DVPX, whereas twenty participants served as a comparison control group. Primary efficacy measures were the Clinical Global Improvement-Severity (CGI-S) and CGI-C (Change) scales; secondary efficacy measures included standardized measures of aggression. Based on the CGI-S and CGI-C ratings, the DVPX group showed significant improvement by the last observation. Attrition rates were notably high, which is not surprising given the clinical population studied. This study provides further support for the efficacy of DVPX in decreasing RADI aggression in the context of DBD. These results are particularly noteworthy because the sociotherapeutic structures supporting patients in previous trials were not present.

    View details for DOI 10.1007/s10578-009-0167-4

    View details for Web of Science ID 000275426100003

    View details for PubMedID 20043204

  • Prevalence Differences of Psychiatric Disorders among Youth after Nine Months or more of Incarceration by Race/Ethnicity and Age JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Karnik, N. S., Soller, M. V., Redlich, A., Silverman, M. A., Kraemer, H. C., Haapanen, R., Steiner, H. 2010; 21 (1): 237-250


    Despite high rates of psychiatric morbidity among young offenders, few studies look closely at prevalence rates in terms of race/ethnicity or developmental stage. Seven hundred and ninety (790) incarcerated young people with a mean age of 18+/-1.2 years were examined. The racial/ethnic distribution was White (17%), African American (28%), Hispanic (47%) and Other (8%). White males had greater than average levels of psychosis; African American males showed lower than average alcohol dependence rates but higher levels of marijuana dependence. White females were more likely than Hispanic and African American females to have attention deficit-hyperactivity disorder and substance and stimulant dependence. Race/ethnicity and age differences can be useful when creating culturally-informed and developmentally appropriate interventions for incarcerated young people.

    View details for Web of Science ID 000274700800016

    View details for PubMedID 20173266

  • Adaptive styles in elite collegiate athletes: The role of activation and self-regulation" Personality and Mental Health Steiner, H., Denny, Katie, Stemmle, Pascale 2010; online
  • Listening for Avoidance: Narrative Form and Defensiveness in Adolescent Memories CHILD PSYCHIATRY & HUMAN DEVELOPMENT Nelson, K. L., Bein, E., Huemer, J., Ryst, E., Steiner, H. 2009; 40 (4): 561-573


    We describe a linguistic clue to speakers' states of mind that has utility for psychotherapists and counselors, and summarize the theoretical and empirical support for using this clue in clinical practice. Specifically, we posit that the degree to which people relate stressful episodes from their lives as a chronological sequence of events is negatively associated with the extent to which they self-protectively avoid experiencing negative affect. We review relevant discussions and findings from linguistics and psychology, and then present a new study that replicates previous research. In this study of the relationship between defensive avoidance and the narrative structure of stressful memories in non-clinical adolescents, 168 high school students spoke for 10 min into a tape recorder about "your most stressful life event." Transcribed interviews were analyzed for narrative immersion, the extent to which the past is retold in chronological order, using a method adopted from Labov and Waletzky. A negative association was found between narrative immersion and avoidance (as operationalized by scores on the Marlowe Crowne Social Desirability Scale). Listening for narrative immersion in the speech of clients discussing past stressful times may therefore represent a useful tool in exploring defensive avoidance of stressful episodic memories.

    View details for DOI 10.1007/s10578-009-0144-y

    View details for Web of Science ID 000269883500006

    View details for PubMedID 19452274

  • Integrated Treatment of Aggression in the Context of ADHD in Children Refractory to Stimulant Monotherapy: A Window Into the Future of Child Psychopharmacology AMERICAN JOURNAL OF PSYCHIATRY Steiner, H., Karnik, N. S. 2009; 166 (12): 1315-1317
  • Comparison of Short-Term Psychological Outcomes of Respiratory Failure Treated by Either Invasive or Non-Invasive Ventilation PSYCHOSOMATICS Shaw, R. J., Harvey, J. E., Bernard, R., Gunary, R., Tiley, M., Steiner, H. 2009; 50 (6): 586-591


    There is now widespread recognition of the development of symptoms of posttraumatic stress disorder (PTSD) in individuals subjected to treatment in the hospital intensive care unit (ICU).The authors sought to investigate traumatic aspects of the ICU hospitalization experience.A group of 20 adult pulmonary patients requiring ventilation in the ICU were compared with 20 patients treated without ventilation. Subjects completed a semistructured interview about their hospital experience and were given self-report measures to assess PTSD and coping style.Subjects requiring invasive ventilation were significantly more likely to endorse symptoms of PTSD. There was a strong correlation between symptoms of PTSD and recall of memories of traumatic medical events. Symptoms of PTSD were positively associated with habitual experiences of distress and negatively associated with the use of denial of distress.Specific traumatic aspects of a patient's treatment, in this case the experience of intubation and mechanical ventilation, may be an additive risk factor for the development of PTSD.

    View details for Web of Science ID 000272488900006

    View details for PubMedID 19996229

  • Sex-specific predictors of criminal recidivism in a representative sample of incarcerated youth COMPREHENSIVE PSYCHIATRY Plattner, B., Steiner, H., The, S. S., Kraemer, H. C., Bauer, S. M., Kindler, J., Friedrich, M. H., Kasper, S., Feucht, M. 2009; 50 (5): 400-407


    The objective of the study was to identify sex-specific psychopathologic predictors of criminal recidivism among a representative sample of incarcerated youths.In this prospective longitudinal study, the Mini-International Psychiatric Interview for children and adolescents was used to assess psychopathology in juveniles entering an Austrian pretrial detention facility between March 2003 and January 2005. From the beginning of the study until January 2006, data on criminal history were obtained from the Integrierte Vollzugsverwaltung, a database containing criminal information of every individual incarcerated in Austria. Of the 370 eligible participants, the final study sample comprised 328 juveniles (56 girls and 272 boys, age range = 14-21 years, mean = 16.7).Reincarceration rates within the specified follow-up period were 52.6% for the boys and 37.5% for the girls. Using Cox forward stepwise regression and Kaplan-Meier analyses, age at first incarceration (B = -.296, Wald statistic = 17.11, P < .001) and oppositional defiant disorder (B = .751, Wald statistic = 19.25, P < .001) were identified as significant predictors for reoffending in boys. In girls, generalized anxiety disorder (B = 1.97, Wald statistic = 13.71, P < .001) was found to be a predictor for reoffending, whereas dysthymia (B = -1.44, Wald statistic = 4.02, P = .045) was found to serve as protective factor.Our study confirms high rates of reoffending after release from correctional facilities in both sexes. It further defines sex-specific psychopathologic risk factors for relapse in incarcerated juveniles. According to our results, in boys, oppositional defiant disorder and early age at first incarceration are predictive of reincarceration. In girls, anxiety disorder was found to be a risk factor for future offending, whereas dysthymia was found to have a protective influence. Consequently, rehabilitation programs should be sex specific.

    View details for DOI 10.1016/j.comppsych.2008.09.014

    View details for Web of Science ID 000269251100002

    View details for PubMedID 19683609

  • The Italian version of the Response Evaluation Measure-71 COMPREHENSIVE PSYCHIATRY Prunas, A., Madeddu, F., Pozzoli, S., Gatti, C., Shaw, R. J., Steiner, H. 2009; 50 (4): 369-377


    The aim of the present study was to analyze the psychometric properties of the Italian version of the Response Evaluation Measure (REM-71), a 71-item self-report measure previously developed for the assessment of defenses in adults and adolescents. The authors also examined the differences in the use of defenses based on sex and age (early adolescence, late adolescence, and early adulthood), and the association between defenses, psychosocial health, and psychologic distress in a large community sample.The Italian version of REM-71 was obtained through back-translation and administered to 1648 (1020 female subjects, mean age = 19.5 years, SD = +/-5.77) community subjects, aged between 13 and 68 years, voluntarily recruited among high school and university students in Milan, Italy, and the surrounding area. All subjects completed a self-report measure to assess demographic variables and satisfaction with life. A subsample (n = 1197) completed the Italian version of the Symptom Checklist-90-Revised to assess symptoms of psychologic distress.Results were highly consistent with those obtained in the original English version of the REM-71 and included satisfactory internal consistency of the measure. Factor analyses yielded 2 principal factors that showed overall stability across age and sex subgroups. Factor 1 and factor 2 defenses were significantly correlated, in line with theoretical expectations, with positive and negative aspects of various domains of life.Results provide further support for the structure and validity of the REM-71 as a useful instrument for the assessment of defenses in adolescents and adults and suggest no major cross-cultural differences in the organization of these defenses.

    View details for DOI 10.1016/j.comppsych.2008.09.010

    View details for Web of Science ID 000266820100011

    View details for PubMedID 19486736

  • Prevalence of and Gender Differences in Psychiatric Disorders Among Juvenile Delinquents Incarcerated for Nine Months PSYCHIATRIC SERVICES Karnik, N. S., Soller, M., Redlich, A., Silverman, M., Kraemer, H. C., Haapanen, R., Steiner, H. 2009; 60 (6): 838-841


    This study examined prevalence rates of psychiatric disorders among young offenders after they were incarcerated for nine months.A total of 790 youths were surveyed, including a significant proportion of females (N=140, 18%), nine months after incarceration. The Structured Clinical Interview for DSM-IV with portions of the Diagnostic Interview for Children and Adolescents and the Structured Interview for DSM-IV Personality were used.Even when conduct disorder and oppositional defiant disorder were excluded, 88% of males and 92% of females had a psychiatric disorder (including substance use disorder); more than 80% of offenders met criteria for some type of substance use disorder. Gender differences were found for anxiety disorders (males 26%, females 55%, p<.01), marijuana dependence (males 32%, females 24%, p=.04), marijuana abuse (males 19%, females 11%, p=.04), and stimulant dependence (males 25%, females 44%, p<.01).Despite nine months of incarceration, young offenders continued to show high levels of psychiatric and substance use disorders.

    View details for Web of Science ID 000266493800017

    View details for PubMedID 19487357

  • External and Internal Factors Influencing Happiness in Elite Collegiate Athletes CHILD PSYCHIATRY & HUMAN DEVELOPMENT Denny, K. G., Steiner, H. 2009; 40 (1): 55-72


    When under conditions of high demand and allostatic load, are happiness and satisfaction in four domains (family, friends, academics, recreation) influenced more by external or internal factors? Do student-athletes who lead exceedingly complicated lives report happiness as a function of athletic achievement or internal disposition? Stanford student-athletes (N=140) were studied with a standardized questionnaire which examined internal factors ((1) locus of control, (2) mindfulness, (3) self-restraint, and (4) self-esteem) to see whether they better account for happiness than external factors (playing time, scholarship). As predicted, internal factors were more powerful correlates of happiness when holding constant demographics. Regression models differed for different aspects of happiness, but the main postulated result of internal versus external was maintained throughout. These findings have implications for how well athletes cope with adversity which, in turn, could shed light on the development of traits that may provide a buffer against adversity and build resilience.

    View details for DOI 10.1007/s10578-008-0111-z

    View details for Web of Science ID 000262490300005

    View details for PubMedID 18626767

  • Habitual Response to Stress in Recovering Adolescent Anorexic Patients CHILD PSYCHIATRY & HUMAN DEVELOPMENT Miller, S. P., Erickson, S. J., Branom, C., Steiner, H. 2009; 40 (1): 43-54


    Although previous research has investigated the stress response in acutely anorexic patients, there is currently little research addressing this response in recovering adolescent anorexic girls. Therefore, this study investigated partially and fully weight-restored anorexic adolescent girls' psychological and physiological response to a standardized stressor.We measured the heart rate and affect of 17 adolescent recovering anorexic patients and 40 healthy age-matched controls during two conditions of the Stress Induced Speech Task (SIST): Free Association and Stress Task. Recovering patients were either partially or fully weight-restored.Compared to the controls, the recovering anorexic girls reported greater overall habitual psychological distress and higher levels of negative affect during the standardized stressor. However, recovering patients did not show a muted heart rate response during the stressor. Neither recovering anorexics nor controls demonstrated a correspondence between heart rate and positive or negative affect.Although the physiological stress response of recovering adolescent anorexic patients was similar to controls, the psychological response of partially and fully weight-restored anorexic adolescents appears similar to that of acutely anorexic adolescents. Treatment implications are discussed in terms of the persistence of negative affect and treatment resistance.

    View details for DOI 10.1007/s10578-008-0112-y

    View details for Web of Science ID 000262490300004

    View details for PubMedID 18618238

  • Unaccompanied refugee children LANCET Huemer, J., Karnik, N., Steiner, H. 2009; 373 (9664): 612-614

    View details for Web of Science ID 000263563500008

    View details for PubMedID 19231617

  • Mental health issues in unaccompanied refugee minors. Child and adolescent psychiatry and mental health Huemer, J., Karnik, N. S., Voelkl-Kernstock, S., Granditsch, E., Dervic, K., Friedrich, M. H., Steiner, H. 2009; 3 (1): 13-?


    Previous studies about unaccompanied refugee minors (URMs) showed that they are a highly vulnerable group who have greater psychiatric morbidity than the general population. This review focuses on mental health issues among URMs. Articles in databases PsycINFO, Medline and PubMed from 1998 to 2008 addressing this topic were reviewed. The literature had a considerable emphasis on the assessment of PTSD symptoms. Results revealed higher levels of PTSD symptoms in comparison to the norm populations and accompanied refugee minors. In several studies, age and female gender predicted or influenced PTSD symptoms. The existing literature only permits limited conclusions on this very hard to reach population. Future research should include the analysis of long-term outcomes, stress management and a more thorough analysis of the whole range of psychopathology. Additionally, the development of culturally sensitive norms and standardized measures for diverse ethnic groups is of great importance.

    View details for DOI 10.1186/1753-2000-3-13

    View details for PubMedID 19341468

  • Defence mechanisms in schizophrenia PERSONALITY AND MENTAL HEALTH Shaw, R. J., Geurse, M. K., Steiner, H. 2008; 2 (4): 240-248

    View details for DOI 10.1002/pmh.47

    View details for Web of Science ID 000207692700004

  • Posttraumatic stress disorder following traumatic injury: Narratives as unconscious indicators of psychopathology BULLETIN OF THE MENNINGER CLINIC Hashemi, B., Shaw, R. J., Hong, D. S., Hall, R., Nelson, K., Steiner, H. 2008; 72 (3): 179-190


    Current conventional assessment methodologies used to diagnose posttraumatic stress disorder (PTSD) rely heavily on symptom counts obtained from clinical interviews or self-report questionnaires. Such measures may underestimate the impact of traumatic events, particularly in individuals who deny or repress emotional distress. This case report illustrates the use of two methods of narrative analysis to assess unconscious representations of PTSD. Linguistic analysis and a computerized analysis of referential activity were able to capture unconscious aspects of the traumatic experience.

    View details for PubMedID 18990054

  • Personality correlates of physiological response to stress among incarcerated juveniles ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE Karnik, N. S., Popma, A., Blair, J., Khanzode, L., Miller, S. P., Steiner, H. 2008; 36 (3): 185-190


    To examine the relationship between personality type and physiological response to stress among juvenile delinquents.Delinquent males (N = 42, mean age 16.5, SD = 1) recruited from a convenience sample at local juvenile detention facility were compared to a male control sample from a local high school (N = 79; mean age 16.1, SD = 0.8). All participants completed the Weinberger Adjustment Inventory and a Stress-Inducing Speech Task during both of which heart rate was measured.Compared to controls, delinquent youths showed significantly lower heart rates under both free association and stress conditions (p < 0.05) and a lower rate of increase during stressful stimuli (p < 0.05). Among delinquents, those with a non-reactive personality type appeared to show consistently lower levels of physiological arousal as measured by heart rate.Delinquents consistently had lower overall levels of arousal as measured by heart rate. In delinquent boys, we also found a persistently low arousal group with a non-reactive psychological pattern. This combination may be a forerunner of future psychopathy or a product of the developmental trajectory that leads to and results from psychopathic behavior.

    View details for DOI 10.1024/1422-4917.36.3.185

    View details for Web of Science ID 000256407000005

    View details for PubMedID 18622978

    View details for PubMedCentralID PMC3104598

  • Narration and vividness as measures of event-specificity in autobiographical memory DISCOURSE PROCESSES Nelson, K. L., Moskovitz, D. J., Steiner, H. 2008; 45 (2): 195-209
  • Evidence for Interventions for Young Offenders. Child and adolescent mental health Karnik, N. S., Steiner, H. 2007; 12 (4): 154-159


    Young offenders are an issue of global concern. Despite a greater understanding of the aetiology of conduct disorder and juvenile delinquency, the research on treatments and the use of evidence-based methods of interventions has not kept pace. This review critically and selectively examined interventions for young offenders, and organises them based on levels of care. The challenge is to intervene using empirical strategies that are implemented based on our emerging understanding of aggression.

    View details for DOI 10.1111/j.1475-3588.2007.00460.x

    View details for PubMedID 32811014

  • Suicidality, psychopathology, and gender in incarcerated adolescents in Austria JOURNAL OF CLINICAL PSYCHIATRY Plattner, B., The, S. S., Kraemer, H. C., Williams, R. P., Bauer, S. M., Kindler, J., Feucht, M., Friedrich, M. H., Steiner, H. 2007; 68 (10): 1593-1600


    Delinquent juveniles are at extreme risk for suicide with death rates 4 times higher than in the general population. Whereas psychopathologic risk factors for suicidal behavior in nonforensic adolescent populations are well defined, psychopathologies associated with suicidality in delinquent juveniles are not yet clear. The objective of this study was to determine gender-specific psychopathologic profiles associated with suicidality in detained juveniles.The Massachusetts Youth Screening Instrument-Second Version, the Youth Self-Report, and the Mini-International Neuropsychiatric Interview for children and adolescents were used to investigate juveniles in an Austrian pre-trial detention facility. The study sample consisted of all juveniles entering the system between March 2003 and January 2005. Of the 370 eligible participants, 319 completed the study (53 girls and 266 boys; age range, 14 to 21 years; mean = 16.67, SD = 1.45 years).We found significantly higher prevalence rates of both current (p < .01) and lifetime (p < .001) suicidality in girls than in boys. Suicidal boys exhibited more psychopathology and a wider range of psychopathology compared to nonsuicidal boys. For suicidal girls, psychopathologies appeared more circumscribed (all relevant p values < .04). Using signal detection methods, major depressive disorder, attention-deficit/hyperactivity disorder, and social phobia identified boys at highest risk of suicidality, while a diagnosis of posttraumatic stress disorder identified girls at highest risk.Suicidality levels are high in delinquent adolescents, especially in girls. Psychopathologic risk factors seem to be gender specific in this population. Not only depression, but also psychopathologies that usually do not arouse strong suspicion for an association with suicidal behavior, i.e., social phobia and ADHD in boys and PTSD in girls, might increase suicide risk. Further research in other countries is needed to replicate our results with respect to sociocultural influences.

    View details for Web of Science ID 000250620700019

    View details for PubMedID 17960977

  • Divalproex sodium for the treatment of PTSD and conduct disordered youth: A pilot randomized controlled clinical trial CHILD PSYCHIATRY & HUMAN DEVELOPMENT Steiner, H., Saxena, K. S., Carrion, V., Khanzode, L. A., Silverman, M., Chang, K. 2007; 38 (3): 183-193


    We examined the efficacy of divalproex sodium (DVP) for the treatment of PTSD in conduct disorder, utilizing a previous study in which 71 youth were enrolled in a randomized controlled clinical trial. Twelve had PTSD. Subjects (all males, mean age 16, SD 1.0) were randomized into high and low dose conditions. Clinical Global Impression (CGI) ratings for core PTSD symptoms (Intrusion, avoidance and hyper arousal) were primary outcome measures, weekly slopes of impulsivity secondary ones. Intent-to-treat analyses showed significant positive associations between receiving high dose of DVP CGI's. Parallel analyses comparing outcome by drug level achieved strengthened the results.

    View details for DOI 10.1007/s10578-007-0055-8

    View details for PubMedID 17570057

  • State and trait emotions in delinquent adolescents CHILD PSYCHIATRY & HUMAN DEVELOPMENT Plattner, B., Karnik, N., Jo, B., Hall, R. E., Schallauer, A., Carrion, V., Feucht, M., Steiner, H. 2007; 38 (2): 155-169


    To examine the structure of emotions and affective dysregulation in juvenile delinquents.Fifty-six juvenile delinquents from a local juvenile hall and 169 subjects from a local high school were recruited for this study. All participants completed psychometric testing for trait emotions followed by measurements of state emotions under two conditions (free association and stress condition). Finally, delinquent participants completed a detailed assessment of past trauma using the Childhood Trauma Interview (CTI).Delinquents exhibit significantly higher levels of negative state and trait emotions when compared to a high school sample. In the delinquent sample chronicity of physical trauma affects the longstanding variable of trait emotionality and severity of trauma, specifically emotional abuse and witnessing violence, shapes negative emotional outcomes in state emotionality. In addition, delinquents appear to experience a wider range of emotions than the comparison sample and were more likely to experience a confluence of state emotions of sadness and anger under stressed conditions.Adolescent delinquents appear to have a different experience of negative emotions than comparison adolescents. The experience of emotions appears to differ in state and trait conditions. These emotions may be related to childhood experiences of trauma.

    View details for Web of Science ID 000247265400006

    View details for PubMedID 17417724

  • Relationship between defenses, personality, and affect during a stress task in normal adolescents CHILD PSYCHIATRY & HUMAN DEVELOPMENT Steiner, H., Erickson, S. J., MacLean, P., Medic, S., Plattner, B., Koopman, C. 2007; 38 (2): 107-119


    Although there are extensive data on the relationship between personality and stress reactivity in adults, there is little comparable empirical research with adolescents. This study examines the simultaneous relationships between long term functioning (personality, defenses) and observed stress reactivity (affect) in adolescents.High school students (N = 169; mean age 16; 73 girls) were asked to participate in two conditions of the Stress Induced Speech Task (SIST): Free Association and Stressful Situation. Immature and mature defenses, distress and restraint personality dimensions, and negative and positive affect were examined.Greater reported use of immature defenses was significantly associated with negative affect, whereas greater reported use of mature defenses was significantly associated with greater positive affect. Although personality style was also a significant predictor of negative affect across two out of three conditions, defenses were better overall predictors of affect than were personality dimensions. Gender was also a significant predictor of negative affect, wherein girls reported more negative affect than boys.Defenses and personality style predict affective response during a moderately stressful task. Immature defenses and, to a lesser extent, the distress personality dimension predict mobilization of negative affect, whereas mature defenses predict the reporting of positive affect. These results relate to processes central to psychotherapy: defensive responding, personality style, and affective reactivity during the recounting of stressful events.

    View details for DOI 10.1007/s10578-007-0046-9

    View details for Web of Science ID 000247265400003

    View details for PubMedID 17356922

  • Juvenile myoclonic epilepsy: A benign disorder? Personality traits and psychiatric symptoms EPILEPSY & BEHAVIOR Plattner, B., Pahs, G., Kindler, J., Williams, R. P., Hall, R. E., Mayer, H., Steiner, H., Feucht, M. 2007; 10 (4): 560-564


    Since the clinical observations published by Janz in 1957, the presence of personality irregularities in patients with juvenile myoclonic epilepsy (JME) has been described repeatedly, but never quantified using standardized assessments. The aim of the present study was to investigate whether juveniles with a short history of JME exhibit psychopathological symptoms and/or personality irregularities.We used standardized assessments, the Youth Self Report (YSR) and the Weinberger Adjustment Inventory (WAI).Of 38 patients who fulfilled the study entry criteria, 25 agreed to participate and completed all surveys. On the YSR, our sample exhibited twice the amount of psychiatric symptoms than age-matched norms. Furthermore, psychopathological symptoms increased with duration of JME. According to WAI results, JME significantly affected self-restraint: patients with longer disease duration showed less self-control.Adolescents with JME present not only with neurological abnormalities but also with significant psychopathology and personality irregularities. Our data suggest that psychological and behavioral changes are dynamic processes dependent on the progression of the disease.

    View details for DOI 10.1016/j.yebeh.2007.03.008

    View details for Web of Science ID 000247216900007

    View details for PubMedID 17466599

  • Consensus report on impulsive aggression as a symptom across diagnostic categories in child psychiatry: Implications for medication studies JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Jensen, P. S., Youngstrom, E. A., Steiner, H., Findling, R. L., Meyer, R. E., Malone, R. P., Carlson, G. A., Coccaro, E. F., Aman, M. G., Blair, J., Dougherty, D., Ferris, C., Flynn, L., Green, E., Hoagwood, K., Hutchinson, J., Laughren, T., Leve, L. D., Novins, D. K., Vitiello, B. 2007; 46 (3): 309-322


    To determine whether impulsive aggression (IA) is a meaningful clinical construct and to ascertain whether it is sufficiently similar across diagnostic categories, such that parallel studies across disorders might constitute appropriate evidence for pursuing indications. If so, how should IA be assessed, pharmacological studies designed, and ethical issues addressed?Experts from key stakeholder communities, including academic clinicians, researchers, practicing clinicians, U.S. Food and Drug Administration, National Institute of Mental Health, industry sponsors, and patient and family advocates, met for a 2-day consensus conference on November 4 and 5, 2004. After evaluating summary presentations on current research evidence, participants were assigned to three workgroups, examined core issues, and generated consensus guidelines in their areas. Workgroup recommendations were discussed by the whole group to reach consensus, and then further iterated and condensed into this report postconference by the authors.Conference participants agreed that IA is a substantial public health and clinical concern, constitutes a key therapeutic target across multiple disorders, and can be measured with sufficient precision that pharmacological studies are warranted. Additional areas of consensus concerned types of measures, optimal study designs, and ethical imperatives.Derived from scientific evidence and clinical experience, these consensus-driven recommendations can guide the design of future studies.

    View details for DOI 10.1097/CHI.0b013e31802f1454

    View details for Web of Science ID 000244428800006

    View details for PubMedID 17314717

  • Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Anonymous 2007; 46 (1): 126-141


    Oppositional defiant disorder (ODD) is a common clinical problem in children and adolescents. Oppositionality and associated types of aggressive behavior are among the most common referral problems in child psychiatry. Grouped among the disruptive behavior disorders, ODD is frequently comorbid with other psychiatric conditions and often precedes the development of conduct disorder (CD), substance abuse, and severely delinquent behavior. Youth with ODD may also have specific CD behaviors, such as aggression. Although compared with CD there exists a smaller and less sophisticated empirical database for ODD, this parameter draws upon the existing ODD and CD literature to make recommendations regarding diagnosis and treatment of ODD. The etiology of ODD is complex and its development is based on a cumulative risk/protective factor model that combines biological, psychological, and social factors. Recommended treatment is multimodal and extensive, involving individual and family psychotherapeutic approaches, medication, and sociotherapy. Methodologically sound controlled clinical trials are lacking.

    View details for DOI 10.1097/

    View details for Web of Science ID 000243146600021

    View details for PubMedID 17195736

  • An application of DSM-IV's outline for cultural fonnulation: Understanding conduct disorder in Latino adolescents AGGRESSION AND VIOLENT BEHAVIOR Shaffer, T. G., Steiner, H. 2006; 11 (6): 655-663
  • Early maturation as a risk factor for aggression and delinquency in adolescent girls: a review INTERNATIONAL JOURNAL OF CLINICAL PRACTICE Celio, M., Karnik, N. S., Steiner, H. 2006; 60 (10): 1254-1262


    Early physical maturation has long been considered a risk factor for the development of delinquent girls. The basis of this relationship has not been fully explored or understood. This review summarises the current literature and research on early physical maturation in adolescent females and places it within a developmental perspective. The process of early physical maturation is also placed within a biopsychosocial model so that risk and protective factors arising from the biological, social, family, education and peer environments can be ascertained. A complex model of maturation and environmental-social interaction is constructed and currently supported by research, but it is clear that a great deal of further work is necessary to fully understand this process.

    View details for Web of Science ID 000240404300022

    View details for PubMedID 16930146

  • Ethnic variation of self-reported psychopathology among incarcerated youth COMMUNITY MENTAL HEALTH JOURNAL Karnik, N. S., Jones, P. A., Campanaro, A. E., Haapanen, R., Steiner, H. 2006; 42 (5): 477-486


    Research on ethnic minority populations has shown them to be undertreated, underdiagnosed and perceived as more psychopathological in comparison to the Caucasian population. This study aimed to assess ethnic variation of self-perceived psychopathology in a population of incarcerated youths. The Youth Self-Report (YSR) was completed by 5964 incarcerated adolescents (95% male; mean age = 16.5) in the California Youth Authority (CYA) system. Overall, ethnic minorities (African-Americans and Hispanics) self-report lower levels of psychiatric problems than Caucasians. These differences were more pronounced in males than females. Further research is needed to better ascertain the reasons for these differences.

    View details for DOI 10.1007/s10597-006-9056-5

    View details for Web of Science ID 000241716700004

    View details for PubMedID 16897411

  • Efficacy profiles of psychopharmacology: Divalproex sodium in conduct disorder CHILD PSYCHIATRY & HUMAN DEVELOPMENT Khanzode, L. A., Saxena, K., Kraemer, H., Chang, K., Steiner, H. 2006; 37 (1): 55-64


    Little is known about how deeply medication treatment penetrates different levels of the mind/brain system. Psychopathology consists of relatively simple constructs (e.g., anger, irritability), or complex ones (e.g., responsibility). This study examines the efficacy of a specific compound, divalproex sodium (DVPX), on the various levels of psychopathology, utilizing a previous study in which 71 youth with conduct disorder were enrolled in a randomized controlled 7-week clinical trial. We examined weekly slopes of "emotional cognitions" of varying degrees of complexity obtained by Weinberger Adjustment Inventory (WAI), measuring more basic states, such as anger, depression, happiness and anxiety, and complex states, such as impulse control, consideration of others, responsibility and self-esteem. Intent-to-treat analyses showed significant associations between assignment to the active treatment and improvement in depression and impulse control. This is a rare clinical trial, which provides preliminary evidence for the different profiles of efficacy of medication treatment.

    View details for DOI 10.1007/s10578-006-0019-4

    View details for PubMedID 16927177

  • Hypothalamus pituitary adrenal axis and autonomic activity during stress in delinquent male adolescents and controls PSYCHONEUROENDOCRINOLOGY Popma, A., Jansen, L. M., Vermeiren, R., Steiner, H., Raine, A., Van Goozen, S. H., van Engeland, H., Doreleijers, T. A. 2006; 31 (8): 948-957


    Patterns of low autonomic arousal have consistently been related to delinquency and disruptive behavior disorders (DBD) in children and adolescents. Findings on another stress regulating mechanism, the hypothalamic pituitary adrenal (HPA) axis, have been inconsistent, which may partly be due to not considering specific stress reactivity measures. Therefore, the aim of the present study was to investigate the relationship between disruptive behavior in male adolescents and their HPA and autonomic reactivity to a standard public speaking task (PST).Responsivity to the PST of cortisol, heart rate (HR), skin conductance level (SCL) and self-reported negative feelings was measured, and compared between 12and14-year-old boys who attended a delinquency diversion program (DP), with and without DBD (DP+, n=22 and DP-, n=49, resectively), and matched normal controls (NC, n=30). DBD diagnoses were based on a structured psychiatric interview.The DP+ group, but not the DP- group, showed a significantly decreased cortisol and HR response during the PST as compared with the NC group. No significant effects were found for SCL. All subjects connoted the task negatively.The results indicate that low cortisol and HR responsivity to stress may be a neurobiological marker for delinquent boys with DBD, but not for those without DBD. Directions for future research and clinical implications are discussed.

    View details for DOI 10.1016/j.psyneuen.2006.05.005

    View details for Web of Science ID 000240302300005

    View details for PubMedID 16831519

  • Treatment of aggression with risperidone in children and adolescents with bipolar disorder: a case series BIPOLAR DISORDERS Saxena, K., Chang, K., Steiner, H. 2006; 8 (4): 405-410


    To evaluate the effectiveness and safety of risperidone in children and adolescents with bipolar disorder characterized by aggression and mania, despite treatment with mood stabilizers.A retrospective chart review of patients seen in an outpatient pediatric mood disorders clinic over an 18-month period was performed. Data were extracted from charts of patients who had a diagnosis of bipolar disorder with aggression that was uncontrolled on a mood stabilizer; as a result, these patients had risperidone added to their regimen.Four boys (aged 7-15 years) and two girls (aged 8 and 14 years) were treated with risperidone (mean dosage, 0.85 mg/day) for 3-16 months. Aggressive behavior improved in all patients after risperidone was started and remained improved for the duration of follow-up. Other symptoms of mania also improved. Risperidone was generally well tolerated. Sedation and akathisia were reported in one patient.The addition of risperidone to a mood stabilizer may improve aggression and other symptoms of mania in pediatric patients with bipolar disorder who do not respond adequately to a mood stabilizer alone. The long-term efficacy and safety of this regimen should be evaluated in a controlled clinical trial.

    View details for PubMedID 16879141

  • Assessing defense structure in school-age children using the response evaluation measure-71-youth version (REM-Y-71) CHILD PSYCHIATRY & HUMAN DEVELOPMENT Araujo, K. B., Medic, S., Yasnovsky, J., Steiner, H. 2006; 36 (4): 427-436


    This study used the Response Evaluation Measure-Youth (REM-Y-71), a self-report measure of 21 defense reactions, among school-age children. Participants were elementary and middle school students (n = 290; grades 3-8; age range: 8-15; mean = 11.73). Factor analysis revealed a 2-factor defense structure consistent with structure among high school and adult samples. The composite REM-Y defense scores for each factor were significant predictors of social desirability, using the Children's Defensiveness Scale (CDS); anxiety, using the State-Trait Anxiety Inventory for Children (STAIC); and psychosocial functioning. This study represents the first cross-sectional empirical analysis of overall defense structure and use among children and early adolescents.

    View details for DOI 10.1007/s10578-006-0013-x

    View details for Web of Science ID 000239459700006

    View details for PubMedID 16794865

  • Divalproex sodium reduces overall aggression in youth at high risk for bipolar disorder 50th Annual Meeting of the American-Academy-of-Child-and-Adolescent-Psychiatry Saxena, K., Howe, M., Simeonova, D., Steiner, H., Chang, K. MARY ANN LIEBERT INC. 2006: 252–59


    The psychopharmacology of aggression in youth is relatively unexplored, even though such maladaptive aggression manifests across many different diagnoses.This study was a 12-week, open-label trial with divalproex sodium (DVPX) in 24 bipolar offspring 6-18 years of age (mean age = 11.3 years; 17 boys) with mixed diagnoses of major depression, cyclothymia, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). The Overt Aggression Scale (OAS) was used to measure aggression in 4-week intervals. We measured serum gamma-butyric acid (GABA) and glutamate levels at baseline and week 12.Seventy-one percent of evaluable subjects were considered responders to DVPX treatment by the OAS. There was a significant correlation between the Young Mania Rating Scale (YMRS) and OAS scores at week 0 (p = 0.036) and week 12 (p = 0.025). Serum DVPX level did not correlate with treatment response.These youths who are at high risk for bipolar disorder experienced an overall decrease in aggressive behavior in response to DVPX. Age or gender did not predict a positive response to DVPX. This study is the first report of treatment efficacy of a mood stabilizer for aggression in youth at high risk for bipolar disorder.

    View details for PubMedID 16768633

  • Juvenile maladaptive aggression: A review of prevention, treatment, and service configuration and a proposed research agenda JOURNAL OF CLINICAL PSYCHIATRY Connor, D. F., Carlson, G. A., Chang, K. D., Daniolos, P. T., Ferziger, R., Findling, R. L., Hutchinson, J. G., Malone, R. P., Halperin, J. M., Plattner, B., Post, R. M., Reynolds, D. L., Rogers, K. M., Saxena, K., Steiner, H. 2006; 67 (5): 808-820


    To review prevention programs, psychosocial and psychopharmacologic treatments, and service delivery configurations for children and adolescents with maladaptive aggression. To propose a research agenda for disorders of aggression in child and adolescent psychiatry.Recent empirical studies were reviewed using searches of MEDLINE and PsycINFO (text terms: aggression, antisocial, violence, conduct, oppositional, psychosocial treatment, psychopharmacology, and prevention), relevant books, review articles, and bibliographies.Articles met the following criteria: published in an English-language, peer-reviewed journal between 1980 and 2005, included a focus on individuals < 18 years old, and included an outcome measure of relevant significance.Results of 154 randomized, controlled psychosocial treatment trials, 20 controlled psychopharmacology studies, 4 open-label medication studies, and 2 psychopharmacology meta-analyses were reviewed.Prevention programs show promise for reducing future aggression in at-risk populations. Empirical support is available for the effectiveness of multifocused psychosocial treatments in reducing aggression in children and adolescents. Atypical antipsychotics, lithium, divalproex sodium, and stimulants for conduct problems associated with attention-deficit/hyperactivity disorder have empirical support for reducing aggression in selected patient populations.Therapeutic nihilism in the treatment of aggressive children and adolescents with conduct problems is no longer warranted. Multifocused psychosocial interventions given early in life to at-risk children have the most support for effectiveness. However, treatments for children who routinely present to the child psychiatrist with already well-established disorders of aggression are neither robust nor well-established. Further research into maladaptive aggression in referred children and adolescents within and across psychiatric diagnoses is important for the field of child and adolescent psychiatry.

    View details for Web of Science ID 000238171700016

    View details for PubMedID 16841631

  • Psychopharmacologic treatment in juvenile offenders CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA Soller, M. V., Karnik, N. S., Steiner, H. 2006; 15 (2): 477-?


    This article first reviews ways to assess children in the justice system who may benefit from psychopharmacologic treatments. Second, it summarizes the emerging understanding of the nature of aggression and violence and the utility of using the schema of reactive ("hot") and proactive ("cold") aggression as a way to consider pharmacologic options. Third, it summarizes the current published studies on the treatment of conduct disorder, which roughly corresponds to the population of children in the juvenile justice system. Finally, it examines the ways that different classes of medications might be considered when approaching juvenile delinquents and the ways that psychopharmacology could be used as part of an overall treatment plan.

    View details for DOI 10.1016/j.chc.2005.12.003

    View details for Web of Science ID 000236523900013

    View details for PubMedID 16527667

  • Disruptive behaviors: conduct and oppositional disorders in adolescents. Adolescent medicine clinics Karnik, N. S., McMullin, M. A., Steiner, H. 2006; 17 (1): 97-114


    CD and ODD present unique challenges in both the diagnostic and treatment arenas. The complex network of causes leading to disruptive disorders makes it necessary to structure treatment in a multifaceted manner. The earlier that adolescents are identified as exhibiting disruptive behavior disorders, the better the opportunity to intervene. While early-onset CD is very difficult to treat effectively, the disorder is far more difficult to correct if left untreated and can ultimately lead to ASPD in adulthood. When physicians are presented with behavioral complaints, they must fully assess the adolescent to determine what, if any, referrals and treatments are needed.

    View details for PubMedID 16473295

  • Baseline predictors of response to divalproex in conduct disorder JOURNAL OF CLINICAL PSYCHIATRY Saxena, K., Silverman, M. A., Chang, K., Khanzode, L., Steiner, H. 2005; 66 (12): 1541-1548


    Successful treatment of conduct disorder remains difficult. On the basis of a positive response to divalproex among adolescent boys with conduct disorder, we conducted an analysis of the impact of baseline comorbid diagnoses and personality factors on the likelihood of treatment response to divalproex.Seventy-one adolescent boys with conduct disorder (DSM-IV) and a history of at least 1 offense against persons were randomly assigned to receive high- or low-dose divalproex for 7 weeks. Evaluations included best estimate diagnoses, the Clinical Global Impressions-Severity of Illness scale (CGI-S) and CGI-Improvement scale (CGI-I), the 62-item Weinberger Adjustment Inventory (WAI-62) assessment of distress and restraint, the Response Evaluation Measure assessment of immature and mature defenses, and the Achenbach Youth Self-Report assessment of overall psychopathology. All were conducted at study entry and exit, and the WAI-62 was conducted weekly throughout the 7-week study period. Treatment response was defined as a rating of much improved or very much improved on the CGI-I. Data were collected from June 1997 to April 1998.Fifty-eight subjects completed the study and were eligible for inclusion in the analysis. Plasma divalproex level (p = .003) and immature defenses (p = .004) were significant positive predictors of treatment response, while restraint (p = .01) and level and range of psychopathology (p = .04) were significant predictors of nonresponse. Comorbidities or distress (p = .06) were not significantly associated with treatment outcome.Predictors of response to divalproex treatment for conduct disorder were identified, despite the small sample size in this study. The pattern of positive and negative predictors of response to divalproex, an antikindling agent, tends to support a model of kindling-reinforced reactive/affective/defensive/impulsive aggression among adolescent boys with conduct disorder. Additional studies are needed to identify more subtle predictors of treatment response and to clarify the mechanisms contributing to the development of conduct disorder.

    View details for PubMedID 16401155

  • Heart rate correlates of attachment status in young mothers and their infants JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Zelenko, M., Kraemer, H., Huffman, L., Gschwendt, M., Pageler, N., Steiner, H. 2005; 44 (5): 470-476


    To explore heart rate (HR) correlates of attachment behavior in young mothers and their infants to generate specific hypotheses and to provide pilot data on which studies to test those hypotheses might be based.Using the strange situation procedure, patterns of attachment were assessed in 41 low-income adolescent mothers and their infants. During the procedure, the HRs of the infants and mothers were recorded. The HR changes were analyzed and infant attachment group differences were examined.Infants in all attachment groups demonstrated a similar HR response. There were, however, notably different behavioral reactions in the insecure groups: relatively increased behavioral distress in the insecure/resistant infants and relatively decreased behavioral distress in insecure-avoidant infants. Mothers of insecure-resistant infants demonstrated elevated HRs during reunions and the insecure/resistant dyads demonstrated lower consistency between HR changes in infant and mother than the secure dyads.The results suggest the discrepancy between attachment-related behavioral reactions and HR response in insecurely attached infants. Maternal and dyadic HR changes vary between the attachment groups.

    View details for DOI 10.1097/01.chi.0000157325.10232.b1

    View details for PubMedID 15843769

  • Divalproex sodium in the treatment of pediatric psychiatric disorders. Expert review of neurotherapeutics Rana, M., Khanzode, L., Karnik, N., Saxena, K., Chang, K., Steiner, H. 2005; 5 (2): 165-176


    Divalproex sodium is an anticonvulsant that is used extensively in adults with indications for epilepsy, acute mania and migraine prophylaxis. It has been used in children and adolescents as a first-line agent for mania in bipolar disorder. Its efficacy as a mood stabilizer has been established, and there have been studies outlining its efficacy as an agent effective in the treatment of conduct disorder, disruptive behavior disorders, aggression and explosive disorder. Longer-acting formulations are now available that cause less gastrointestinal side effects and can also be taken once a day, thus potentially increasing adherence, an important factor in this patient population. Future directions would include developing a more potent valproic acid formulation with fewer side effects, completing randomized controlled trials to establish the efficacy of divalproex sodium in various other pediatric psychiatric disorders, establishing the relative efficacy of the compound in head-to-head comparisons with other mood stabilizers, examining systematically the value of the compound in multimodal pediatric psychiatric treatment packages, and complete effectiveness trials that demonstrate the short- and long-term effectiveness of the compound in the real world of clinicians. In this drug profile, divalproex sodium and its uses in the pediatric population for psychiatric conditions are reviewed.

    View details for PubMedID 15853487

  • Use of antipsychotics in children and adolescents Symposium on Developmental Neurobiology and Psychiatry - Challenges and Best Practices for Studies in Children and Adolescents Findling, R. L., Steiner, H., Weller, E. B. PHYSICIANS POSTGRADUATE PRESS. 2005: 29–40


    The comparable efficacy and improved safety of the atypical antipsychotics compared with the traditional antipsychotic agents in the treatment of schizophrenia and other disorders in adults have prompted the use of these agents in children and adolescents. The atypical antipsychotics are increasingly being used in children and adolescents with a variety of different psychiatric diagnoses, including schizophrenia, bipolar disorder, autism/pervasive developmental disorders, conduct disorder, depression, anxiety disorders, tic disorders, delirium, and eating disorders. Unfortunately, clinical use of these agents in pediatric patients has far exceeded the limited evidence from randomized controlled trials. This article reviews the available evidence from the published literature on the use of the atypical antipsychotics in children and adolescents with schizophrenia, bipolar disorder, and maladaptive aggression associated with autism/pervasive developmental disorders and conduct disorder/disruptive behavior disorders.

    View details for Web of Science ID 000232011600005

    View details for PubMedID 16124839

  • Psychopharmacologic treatment of agression in children and adolescents PEDIATRIC ANNALS Ruths, S., Steiner, H. 2004; 33 (5): 318-327


    Knowledge regarding psychopharmacology is increasingly based on clinical trials and rational algorithms. Medications are increasingly regarded as useful adjuncts in the treatment of maladaptive aggression, whether it appears as a target symptom or as a complication of a whole range of psychopathology. Properly integrated into a treatment package that uses psychotherapies and environmental manipulation, medications can provide relief from one of the most destructive forms of psychopathology. Still, more controlled clinical trials are needed, especially those comparing active interventions and those testing the synergistic and antagonistic effects of different treatment modalities.

    View details for Web of Science ID 000221414200006

    View details for PubMedID 15162638

  • Relationships of dissociation and childhood abuse and neglect with heart rate in delinquent adolescents JOURNAL OF TRAUMATIC STRESS Koopman, C., Carrion, V., Butler, L. D., Sudhakar, S., Palmer, L., Steiner, H. 2004; 17 (1): 47-54


    This study examined the relationship of dissociative symptoms, abuse and neglect, and gender to mean heart rate (HR) in two types of interviews. Participants were 25 female and 16 male delinquent adolescents. Dissociative symptoms and abuse and neglect were assessed by structured interviews. Participants were randomized to one of two conditions, to describe either their most stressful life experience or their free association thoughts. Greater dissociative symptoms were associated with lower mean HR, whereas abuse and neglect, being a girl, and participating in the free association task were associated with higher mean HR. The finding that high levels of dissociative symptoms may be related to a suppression of autonomic physiological responses to stress support Bremner's conceptualization (J. D. Bremner, 1999) that dissociative symptoms comprise one of two subtypes of the acute stress response, differing physiologically as well as subjectively from a predominantly hyperarousal or intrusive symptom response.

    View details for PubMedID 15027793

  • Pathways to dissociation: Intrafamilial versus extrafamilial trauma in juvenile delinquents JOURNAL OF NERVOUS AND MENTAL DISEASE Plattner, B., Silvermann, M. A., Redlich, A. D., Carrion, V. G., Feucht, M., Friedrich, M. H., Steiner, H. 2003; 191 (12): 781-788


    Dissociation is postulated to occur as a function of particular types of child abuse or chronic abuse. Additionally, there is an ongoing controversy examining the perpetrator's relationship to the victim in the development of dissociation. In this study, reports of traumatic events experienced both in the family environment and in the community were used to examine the relationship between dissociative disorder as defined by DSM-IV (pathological dissociation), and dissociation as a defense mechanism. The first objective was to identify whether the site of the trauma or the quantity of trauma correlated more significantly with symptoms of dissociation. The second objective was to explore a potential correlation between topics that participants choose to disclose during a standardized Stress Inducing Speech Task (SIST), and symptoms of dissociation. The third objective was to examine the relationship between the age of occurrence, the duration of trauma, and symptoms of dissociation. Fifty-two delinquent juveniles completed measures (including the SCID-D, REM-71, CTQ, CTI, SIST) assessing traumatic experiences, psychopathological dissociation, and dissociation as defense mechanism. Blind raters scored the SIST for intrafamilial and extrafamilial trauma. The perpetrator's relationship to the victim, site of the trauma, quantity of the trauma, age of occurrence, and duration of the trauma were analyzed by descriptive statistics and Pearson partial correlations. Significant correlations were found between symptoms of pathological dissociation and intrafamilial trauma. Significant correlations were not found between extrafamilial trauma and pathological dissociation and dissociation as defense mechanism. All these correlations held constant the chronicity of traumas reported. The results obtained in this study through blind and independent assessment suggest that special trauma characteristics (i.e., childhood trauma perpetrated by a family member) rather than sheer cumulative effects of trauma may have greater implications for the development of pathological dissociation. The relationships to dissociation as a defense were much weaker.

    View details for DOI 10.1097/01.nmd.0000105372.88982.54

    View details for Web of Science ID 000187438200003

    View details for PubMedID 14671454

  • Studies of offspring of parents with bipolar disorder AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS Chang, K., Steiner, H., Ketter, T. 2003; 123C (1): 26-35


    Children and adolescents who are the biological offspring of individuals with bipolar disorder (BD) (bipolar offspring) represent a population rich in potential for revealing important aspects in the development of BD. Multiple cross-sectional assessments of psychopathology in bipolar offspring have confirmed high incidences of BD, as well as mood and behavioral disorders, and other psychopathology in this population. Longitudinal studies of offspring have begun to shed light on precursors of BD development. Other assessments of bipolar offspring have included dimensional reports of psychiatric and psychosocial functioning, temperament assessments, and descriptions of family environments and parenting styles. Neurobiological studies in bipolar offspring are just beginning to yield findings that may be related to the underlying neuropathophysiology of BD. The future holds promise for longitudinal studies of bipolar offspring incorporating all of these facets, including genetic analyses, to further elucidate the factors involved in the evolution of BD.

    View details for DOI 10.1002/ajmg.c.20011

    View details for PubMedID 14601034

  • Temperament characteristics of child and adolescent bipolar offspring JOURNAL OF AFFECTIVE DISORDERS Chang, K. D., Blasey, C. M., Ketter, T. A., Steiner, H. 2003; 77 (1): 11-19


    We wished to characterize temperament of children at high risk for bipolar disorder (BD).We collected data from the Dimensions of Temperament-Revised (DOTS-R) from 53 biological offspring of at least one parent with BD.Overall, our cohort differed from population means for the DOTS-R, having decreased Activity Level-General scores, and increased Approach, and Rhythmicity-Sleep scores. Offspring with psychiatric disorders differed from those without in having decreased Flexibility, Mood, and Task Orientation scores. Temperament profiles for diagnostic categories of BD and attention-deficit/hyperactivity disorder were performed in a descriptive manner.Self- or parent-report of temperament was used rather than clinical observation. Temperament characterization was cross-sectional and retrospective rather than prospective and may overlap with clinical diagnoses.Assessment of temperament may be useful in characterizing bipolar offspring. Decreased flexibility and task orientation, and presence of negative moods may be correlated with development of psychopathology.

    View details for DOI 10.1016/S0165-0327(02)00105-2

    View details for PubMedID 14550931

  • High school student athletes: Associations between intensity of participation and health factors CLINICAL PEDIATRICS Pyle, R. P., McQuivey, R. W., Brassington, G. S., Steiner, H. 2003; 42 (8): 697-701


    This paper addresses and compares the impact of organized, more intensive sports participation with lower intensity participation among high school student-athletes. Subjects included 770 high school students who reported being active in organized school sports. Mental health, physical health, and coping skills were assessed as indicated by factor scores derived from the Juvenile Wellness and Health Survey (JWHS-76). Results indicate that compared to students who were less active, competitive sports participation was associated with fewer mental health problems, fewer total risks, and fewer eating and dietary problems for both girls and boys. These results provide initial support for the association between youth participation in competitive sports and mental health.

    View details for Web of Science ID 000185904700005

    View details for PubMedID 14601918

  • Divalproex sodium for the treatment of conduct disorder: A randomized controlled clinical trial JOURNAL OF CLINICAL PSYCHIATRY Steiner, H., Petersen, M. L., Saxena, K., Ford, S., Matthews, Z. 2003; 64 (10): 1183-1191


    New treatments for conduct disorder are sorely needed. We aimed to test the efficacy of divalproex sodium for the treatment of conduct disorder.Seventy-one youths with conduct disorder according to DSM-IV criteria were enrolled in a randomized, controlled, 7-week clinical trial. Subjects were all adolescent males with at least 1 crime conviction. Subjects were randomized into high- and low-dose conditions and were openly managed by a clinical team. Subjects and independent outcome raters were blinded to condition. Clinical Global Impressions-Severity of Illness (CGI-S) and CGI-Improvement (CGI-I) ratings, Weinberger Adjustment Inventory ratings, and staff ratings of behavioral privilege were used to assess outcome.Intent-to-treat analyses showed significant associations between assignment to the high-dose condition and ratings on the CGI-S (p =.02) and CGI-I (p =.0008). Self-reported weekly impulse control was significantly better in the high-dose condition (p <.05), and association between improvement in self-restraint and treatment condition was of borderline statistical significance (p <.06). Parallel analyses comparing outcome by blood drug level achieved strengthened the results, as expected.This preliminary study in a most difficult population suggests a role for divalproex sodium in the treatment of conduct disorder. Divalproex sodium improved self-reported impulse control and self-restraint, variables shown to be predictive of criminal recidivism. Studies are needed of longer-term impact and side-effect profiles. This is one of few controlled psychopharmacologic studies of conduct disorder.

    View details for Web of Science ID 000186327500007

    View details for PubMedID 14658966

  • Predicting adolescents' global functioning from personality typologies CHILD PSYCHIATRY & HUMAN DEVELOPMENT Erickson, S. J., Steiner, H. 2003; 34 (1): 63-80


    This study examined the utility of three personality typologies in predicting global functioning in a non-clinic sample of adolescents. Participants were 140 students from middle class suburban public high schools (74 girls; mean age = 16.0 +/- 1.2; 70.7% Caucasian, 11.4% African American, 7.1% Asian, 7.1% Hispanic, and 3.6% other) who completed psychometrically sound standardized measures of personality. They were combined into three four quadrant personality typologies. Global Assessment of Functioning (GAF) ratings were based on clinical interviews utilizing DSM criteria and were obtained by raters blind to self-report results. All three systems overlapped modestly but significantly. Each model detected significant GAF differences among quadrants. There was no gender difference in representation among the quadrants of the three systems. Results suggest that compared with unitary dimensions of personality, typologies concurrently utilizing two dimensions of personality functioning better capture individual differences on a complex psychological construct such as global functioning. Further research is warranted to examine the utility of these typological systems in predicting global functioning across a variety of clinical and nonclinical adolescent populations, and to determine how other aspects of global functioning may influence or interact with personality typologies.

    View details for Web of Science ID 000185367800005

    View details for PubMedID 14518624

  • Divalproex monotherapy in the treatment of bipolar offspring with mood and behavioral disorders and at least mild affective symptoms 41st Annual Meeting of the New-Clinical-Drug-Evaluation-Unit Chang, K. D., Dienes, K., Blasey, C., Adleman, N., Ketter, T., Steiner, H. PHYSICIANS POSTGRADUATE PRESS. 2003: 936–42


    Offspring of parents with bipolar disorder, by virtue of their high-risk status for developing bipolar disorder, merit an investigation of the efficacy of treatment with mood stabilizers. Behavioral and mood difficulties in this population may represent prodromal forms of bipolar disorder. We studied the efficacy of divalproex in treating child and adolescent bipolar offspring with mood or behavioral disorders who did not yet meet criteria for bipolar I or II disorder.We studied 24 children aged 6-18 years (mean = 11.3 years; 17 boys/7 girls) with at least 1 biological parent with bipolar disorder. Participants were diagnosed by the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia with at least 1 of the following DSM-IV disorders: major depressive disorder, dysthymic disorder, cyclothymic disorder, or attention-deficit/hyperactivity disorder. Subjects all had at least moderate affective symptoms (28-item Hamilton Rating Scale for Depression or Young Mania Rating Scale score > 12). After a 2-week washout period, subjects were treated with divalproex for 12 weeks, titrated to achieve serum levels of 50-120 micro g/mL (mean final dose = 821 mg/day; mean final serum level = 79.0 micro g/mL).One subject discontinued after 2 weeks due to continuation of symptoms. Of the remaining 23 subjects, 18 (78%) were considered responders by primary outcome criteria ("very much improved" or "much improved" on the Clinical Global Impressions-Improvement scale). Divalproex was well tolerated with no discontinuations due to adverse effects.Bipolar offspring with mood or behavioral disorders and at least mild affective symptoms may respond to divalproex treatment. Our study was limited by the open treatment, lack of a placebo group, and the heterogeneous nature of the sample. Controlled studies are warranted in the use of divalproex in symptomatic bipolar offspring.

    View details for Web of Science ID 000184920400012

    View details for PubMedID 12927009

  • A cluster-analytic investigation of MMPI profiles of serious male and female juvenile offenders JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Espelage, D. L., Cauffman, E., Broidy, L., Piquero, A. R., Mazerolle, P., Steiner, H. 2003; 42 (7): 770-777


    To use cluster analysis to identify psychological profiles and related mental health symptoms among male and female juvenile offenders.Juvenile offenders (N = 141) incarcerated in the California Youth Authority completed the Minnesota Multiphasic Personality Inventory (MMPI) and the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2).MMPI cluster analysis revealed four distinct profiles: two for male and two for female juvenile offenders. Among males, we identified one Normative cluster with no clinically elevated scores. A second male cluster, labeled Disorganized, exhibited clinical elevations on scales 8 (Schizophrenia), 6 (Paranoia), 4 (Psychopathic Deviate), and 7 (Psychasthenia). Among females, two clinically elevated profiles emerged. One Impulsive-Antisocial cluster consisted of clinical elevations on scale 4 (Psychopathic Deviate), which has been consistently associated with delinquent and antisocial behavior. The second cluster, labeled Irritable-Isolated, produced elevations on MMPI scales 4 (Psychopathic Deviate), 8 (Schizophrenia), 6 (Paranoia), and 7 (Psychasthenia). There were no significant sex, ethnicity, or offense differences across clusters, but the clusters exhibit distinct psychiatric profiles (MMPI) and mental health symptoms (MAYSI-2).The findings indicate that not only do female offenders have more acute mental health symptoms and psychological disturbances than male offenders, they exhibit qualitatively distinct psychiatric profiles. Results reinforce the need for assessment of mental health symptoms for male and female juvenile offenders as well as sex-appropriate treatments.

    View details for DOI 10.1097/01.CHI.0000046877.27264.F6

    View details for Web of Science ID 000183750800007

    View details for PubMedID 12819436

  • Defenses in school age children: Children's versus parents' report CHILD PSYCHIATRY & HUMAN DEVELOPMENT Yasnovsky, J., Araujo, K., King, M., Mason, M., Pavelski, R., Shaw, R., Steiner, H. 2003; 33 (4): 307-323


    We tested a questionnaire assessing defenses in school age children and compared the results with their mothers' reports of the same. Thirty-four children (56% male, mean age 8.5) completed the Response Evaluation Measure for Youth (REM-Y) twice over three weeks. Simultaneously, mothers completed the parent version of this measure (REM-P) about their children. In these questionnaires, factor 1 defenses (less adaptive; broken down into intrapersonal and interpersonal defenses) are assessed separately from factor 2, or more adaptive, defenses. Only lower level, interpersonal defenses, such as acting out, were recognized by mothers in their children. The children's intrapersonal defenses, along with factor 2 reactions, were reported less by mothers than by children.

    View details for Web of Science ID 000182440200004

    View details for PubMedID 12723903

  • The stress response in anorexia nervosa CHILD PSYCHIATRY & HUMAN DEVELOPMENT Miller, S. P., Redlich, A. D., Steiner, H. 2003; 33 (4): 295-306


    Patients with eating disorders have been found to have problems with Interoceptive Awareness. This study seeks to examine this issue in an experimental paradigm. In the present study, we investigated the hypothesis that, in addition to lowering a body's autonomic stress response, a state of starvation also lowers the psychological stress response. Results indicated that those with anorexia nervosa showed a muted physiology, but they did not show a complete denial of negative emotion. No relation was seen, however, between their affective and physiological responses to a stress task, which contrasted results found for the controls.

    View details for Web of Science ID 000182440200003

    View details for PubMedID 12723902

  • Bipolar offspring: A window into bipolar disorder evolution Conference on Pediatric Bipolar Disorder Chang, K., Steiner, H., Dienes, K., Adleman, N., Ketter, T. ELSEVIER SCIENCE INC. 2003: 945–51


    Children of parents with bipolar disorder (bipolar offspring) represent a rich cohort for study with potential for illumination of prodromal forms of bipolar disorder. Due to their high-risk nature, bipolar offspring may present phenomenological, temperamental, and biological clues to early presentations of bipolar disorder. This article reviews the evidence for establishing bipolar offspring as a high-risk cohort, the studies which point to possible prodromal states in bipolar offspring, biological findings in bipolar offspring which may be indicators of even higher risk for bipolar disorder, initial attempts at early intervention in prodromal pediatric bipolar disorder, and implications for future research.

    View details for DOI 10.1016/S0006-3223(03)00061-1

    View details for PubMedID 12788239

  • Dissociative symptoms in posttraumatic stress disorder: diagnosis and treatment CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA Steiner, H., Carrion, V., Plattner, B., Koopman, C. 2003; 12 (2): 231-?


    This article explores the complex relationship between dissociation and psychiatric trauma. Dissociation is described as a defense reaction, a risk factor for the development of posttraumatic stress disorder, and as a set of syndromal disturbances. The authors discuss various models proposed for the relationship between these. They outline developmental considerations in diagnosis and treatment and end by discussing further needed research.

    View details for DOI 10.1016/S1056-4993(02)00103-7

    View details for PubMedID 12725010

  • Psychopharmacologic strategies for the treatment of aggression in juveniles CNS SPECTRUMS Steiner, H., Saxena, K., Chang, K. 2003; 8 (4): 298-308


    Maladaptive aggression in youth is one of the most common and troublesome reasons for referrals to child psychiatrists. It has a complex relationship with psychopathology. There are several syndromes, which are primary disturbances of clustered maladaptive aggression, most notably oppositional defiant disorder and conduct disorder. However, problems with aggression also appear in a wide range of other disturbances, such as bipolar disorder, posttraumatic stress disorder, and mood disorders. Additionally, aggression is normative, serves an adaptive purpose and can be situationally induced. These complexities need to be carefully addressed before targeting maladaptive aggression psychopharmacologically. We summarize the literature on the psychopharmacology of maladaptive aggression in youth, focusing on disorders without cognitive impairment. We delineate the subtypes of aggression which are most likely to respond to medication (reactive-affective-defensive-impulsive in their acute and chronic form) and conclude with a discussion of specific medication strategies which are supported by controlled clinical trials and clinical experience.

    View details for PubMedID 12679744

  • The College Health Related Information Survey (CHRIS-73): A screen for college student athletes CHILD PSYCHIATRY & HUMAN DEVELOPMENT Steiner, H., Pyle, R. P., Brassington, G. S., Matheson, G., King, M. 2003; 34 (2): 97-109


    To assess the reliability and discriminate validity of a new screening instrument for college student athletes.518 Stanford University students completed the proposed instrument (College Health Related Information Survey-CHRIS-73), which was based on the Juvenile Wellness and Health Survey (JWHS-76) but re-designed to assess mental health domains relevant to college athletes.Factor analysis yielded four factors: mental health problems, eating problems, risk behaviors, and performance pressure. Factors were internally consistent, reasonably independent, and clearly discriminated between athletes and non-athletes, and males and females.This study supports the CHRIS-73 as a useful screen for assessing mental health problems among college student athletes.

    View details for Web of Science ID 000186797300002

    View details for PubMedID 14617944

  • Risk and protective factors for juvenile eating disorders. European child & adolescent psychiatry Steiner, H., Kwan, W., Shaffer, T. G., Walker, S., Miller, S., Sagar, A., Lock, J. 2003; 12: I38-6


    Eating disorders are prevalent and complicated disorders which are difficult to treat. Unicausal and main effects models are not likely to do justice to the complexity of psychopathology encountered, as one considers etiology and pathogenesis. Risk and protection can arise out of several domains: biological, psychological and social. Risk and protective factors aggregate in specific developmental phases and interact to produce adverse outcomes. Temperamental factors, eating dysregulation, attachment, deficient self regulation and sociocultural ideals of health and beauty all contribute to pathogenesis. Applying the insights of developmental psychopathology to these disorders has considerable potential to lead to early and preventive interventions. Reviewing the current literature from this perspective and updating a similar discussion from 8 years ago, we witness a continued accumulation of quality empirical data. Compared to previous reviews, the field's attention has shifted to psychosocial/cultural domains relevant to eating, away from biological risk. In the aggregate, these data make possible the increasing differentiation of eating disorders from other psychopathology, and the specific pathways in which anorexia and bulimia may develop. Understanding of risk and vulnerability still outweighs our knowledge of protective factors and resilience. While an ideal study would be longitudinal, such studies are still extremely difficult to conduct and costly, thus, forcing us to further our understanding from lagged designs, cross-sectional data and case control studies. While these have many limitations, they do seem to produce an increasingly coherent account of the development of these disorders and prepare us for more targeted and longitudinal study of high risk populations.

    View details for PubMedID 12567214

  • Pre-adjudicative and adjudicative competence in juveniles and young adults Annual Conference of the American-Psychology-Law-Society Redlich, A. D., SILVERMAN, M., Steiner, H. JOHN WILEY & SONS LTD. 2003: 393–410


    There are several different types of legal competence, such as competence to waive Miranda rights, competence to confess, and competence to stand trial. Although it can be surmised that many of the underlying factors that influence the different legal competencies are similar, little research has been conducted to empirically test this hypothesis. In the present study, juveniles' and young adults' understanding and appreciation of their Miranda rights and their ability to stand trial were measured. Age, suggestibility, average grades in school, and frequency of previous police involvement were also examined as possible factors that influence both types of legal knowledge. Results indicated that Miranda competence and adjudicative competence are indeed strongly related, especially for juveniles. Also, age and suggestibility were found to predict Miranda competence, whereas suggestibility and average school grades predicted competence to stand trial. Patterns of findings often diverged for juveniles and young adults. Implications for legal policy are discussed.

    View details for DOI 10.1002/bsl.543

    View details for Web of Science ID 000183945800008

    View details for PubMedID 12808697

  • Characterization of children of bipolar parents by parent report CBCL JOURNAL OF PSYCHIATRIC RESEARCH Dienes, K. A., Chang, K. D., Blasey, C. M., Adleman, N. E., Steiner, H. 2002; 36 (5): 337-345


    In past research the Child Behavior Checklist (CBCL) has differentiated among various diagnostic categories for children and adolescents. However, research has not been conducted on whether the CBCL differentiates among diagnostic categories for children at high risk for development of psychopathology. This study compares four diagnostic groups [bipolar disorder (BD), attention/deficit-hyperactivity disorder (ADHD), Depressed/Anxious and No Diagnosis] within a cohort of 58 children of bipolar parents to determine whether their CBCL scores will replicate the scores of children not at high risk for bipolar disorder. The cohort of children of bipolar parents received elevated scores on the CBCL scales in comparison with non-clinical populations. In addition, the CBCL distinguished between children of bipolar parents with and without clinical disorders. Finally the BD group differed from the ADHD group only on the Aggressive Behaviors, Withdrawn and Anxious/Depressed subscales of the CBCL. Therefore the CBCL did not discriminate between the BD and ADHD groups as it had in previous studies of children with BD and unspecified family history. It is possible that this discrepancy is due to a group of children of bipolar parents with ADHD who are currently prodromal for bipolar disorder and therefore received higher scores on the CBCL based on prodromal symptomatology. A longitudinal follow-up of this cohort is necessary to ascertain whether this is the case.

    View details for Web of Science ID 000178254700009

    View details for PubMedID 12127602

  • Coping styles as correlates of health in high school students JOURNAL OF ADOLESCENT HEALTH Steiner, H., Erickson, S. J., Hernandez, N. L., Pavelski, R. 2002; 30 (5): 326-335


    To study a large, population-based sample of adolescents with the goal of expanding our knowledge base about the relationship of coping and health outcomes.We examined 1769 nonclinical, high school students (48% girls, mean age 16 years, predominantly white) using one class period to establish a link between coping styles, health problems, and health risk behaviors. Instruments employed included the Coping Response Inventory - Youth form (abbreviated version) and the Juvenile Wellness and Health Survey. ANCOVAs were used to test the main effects of coping typology, gender, and their interaction on the five health domains.Findings were consistent with previous research and showed that approach coping correlated negatively with indicators of health problems and health risk behaviors, while avoidance coping correlated positively with these domains. The presence of both forms of coping mitigated the negative effects of avoidance coping.As early as mid-adolescence, habitual coping styles appear to be associated with significant health outcomes. In screening nonclinical samples the clinician can rely on habitual coping styles as indicators of potential health problems.

    View details for Web of Science ID 000175406700006

    View details for PubMedID 11996781

  • Boys' and girls' responses to stress: Affect and heart rate during a speech task JOURNAL OF ADOLESCENT HEALTH Steiner, H., Ryst, E., Berkowitz, J., Gschwendt, M. A., Koopman, C. 2002; 30 (4): 14-21


    To examine gender differences in heart rate and reports of negative and positive affect among adolescents during a speech task.Subjects were 133 adolescents, 73 girls and 60 boys, ages 14-18 years. Subjects were randomly assigned to speak for 10 minutes and asked either to free associate or to describe the most stressful event in their lives. Their heart rate was assessed at baseline and at 5 and 10 minutes after the task began. Self-ratings of negative and positive affect were assessed at baseline and at 10 minutes after the beginning of the task. Data were analyzed by Student's t-tests for independent samples, analyses of covariance, and Spearman rank-order correlation coefficients.Girls rated their negative affect significantly higher at baseline in comparison to boys. In addition, girls had a higher baseline heart rate. However, boys' increase in heart rate 5 minutes into the speech task was significantly greater than that of girls. Also, the free association task elicited significantly greater increases in heart rate compared to a task in which the adolescent described his or her most stressful life event. However, the stressful event task elicited greater negative and less positive affect. Significant relationships between change in heart rate and ratings of post-task affect were found among girls but not among boys, suggesting that the girls' ratings of their affect are more congruent with their physiological reactions to a stressful speech task.These results suggest that gender and task differences must be considered in assessing adolescents' stress.

    View details for Web of Science ID 000174924300003

    View details for PubMedID 11943570

  • Violence exposure, posttraumatic stress, and personality in juvenile delinquents JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Ruchkin, V. V., Schwab-Stone, M., Koposov, R., Vermeiren, R., Steiner, H. 2002; 41 (3): 322-329


    To assess posttraumatic stress and its relationship to comorbid psychopathology, violence exposure, and personality traits in Russian male juvenile delinquents.Posttraumatic stress and comorbid psychopathology were assessed by a semistructured psychiatric interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version) in 370 delinquent youths during winter-spring of 1999. In addition, violence exposure, personality, and psychopathology were assessed by self-reports.Most delinquents reported some degree of posttraumatic stress: 156 subjects (42%) fulfilled partial criteria and 87 (25%) fulfilled full DSM-IV criteria for posttraumatic stress disorder (PTSD). Violence-related experiences (witnessing and victimization) were the most common types of trauma. Higher levels of posttraumatic stress were accompanied by higher rates of comorbid psychopathology, with the most striking differences occurring between the groups with full versus partial PTSD criteria. Violence exposure was related to temperamental behavior activation (novelty seeking), whereas PTSD symptom scores were predominantly related to behavior inhibition and poor coping (high harm avoidance and low self-directedness).Similar to findings from American samples, Russian juvenile delinquents represent a severely traumatized population, mainly due to high levels of violence exposure. Those with full PTSD are the most severely traumatized and have highest rates of psychopathology, as compared to those with no or partial PTSD, and they require the most clinical attention and rehabilitation. Both exposure to violence and levels of posttraumatic stress are related to personality traits, which influence degree of exposure and individual perception of stress. The latter should be considered in individualized approaches to rehabilitation.

    View details for Web of Science ID 000174118400012

    View details for PubMedID 11886027

  • Acute stress disorder following ventilation PSYCHOSOMATICS Shaw, R. J., Robinson, T. E., Steiner, H. 2002; 43 (1): 74-76

    View details for Web of Science ID 000174337000014

    View details for PubMedID 11927764

  • The Child Abuse Potential inventory and pregnancy outcome in expectant adolescent mothers CHILD ABUSE & NEGLECT Zelenko, M. A., Huffman, L. C., Brown, B. W., Daniels, K., Lock, J., Kennedy, Q., Steiner, H. 2001; 25 (11): 1481-1495


    The study explores the prenatal Child Abuse Potential (pCAP) scores derived from the Child Abuse Potential Inventory administered to expectant adolescent mothers. The aim of the study was to assess the association of the pCAP scores with maternal negative prenatal behaviors, and evaluate the contribution of the pCAP scores to neonatal morbidity.The pCAP scores, demographic data, and self-report on prenatal behaviors were obtained during the second half of the pregnancy in a sample of 45 poor single adolescent mothers. A pediatrician blind to the prenatal data reviewed the neonatal records to assess neonatal morbidity. Maternal prenatal records were reviewed for obstetric risk assessment by an obstetrician who was blind to the rest of the data. The relations among the pCAP scores, prenatal behaviors, and neonatal morbidity were analyzed.In the prenatal period, the pCAP scores were positively correlated with self-reported prenatal smoking and substance use. The multiple linear regression analysis showed that the pCAP scores significantly contributed to neonatal morbidity independently of obstetric risk factors.The Child Abuse Potential scores obtained during pregnancy in poor single adolescent mothers reflect domains of maternal functioning that are associated with negative prenatal behaviors and appear to be important for predicting neonatal morbidity. Further studies are warranted to validate the prenatal use of the Child Abuse Potential Inventory.

    View details for PubMedID 11766012

  • Poor adolescent expectant mothers: Can we assess their potential for child abuse? JOURNAL OF ADOLESCENT HEALTH Zelenko, M. A., Huffman, L., Lock, J., Kennedy, Q., Steiner, H. 2001; 29 (4): 271-278


    To explore the correlates of high scores on the Child Abuse Potential Inventory in adolescent expectant mothers.Child Abuse Potential scores and data on demographics, pregnancy desire, history of maltreatment, psychological functioning, and perceived social support were obtained by self-report and semi-structured interview. The sample consisted of 50 poor single adolescents recruited from prenatal clinics during the second half of the pregnancy. The relationships among the variables were assessed using Pearson product-moment correlation and multiple regression strategies.Higher Child Abuse Potential scores were associated with higher maternal psychological distress, maternal history of psychiatric diagnosis, and lack of perceived support by the father of the baby. Older pregnant teenagers were more likely to report childhood history of maltreatment, higher psychological distress, and perceived and expected less support by the maternal mother. Expectant mothers who were raised by a single parent were more likely to have a history of childhood maltreatment, less likely to live with the father of the baby during their pregnancy and to expect less support from him.Child Abuse Potential scores, obtained during pregnancy in a sample of poor single adolescents provide a marker of maternal prenatal functioning and perceived social support. Further studies are warranted to validate prenatal use of the Child Abuse Potential Inventory (CAPI), which may help identify populations at particularly high risk for child abuse during pregnancy and inform strategies for early preventive interventions. Adolescent education on family planning, child rearing, and social support programs should address the importance of the fathers' role.

    View details for PubMedID 11587911

  • Substance abuse and criminal recidivism: A prospective study of adolescents CHILD PSYCHIATRY & HUMAN DEVELOPMENT Wilson, J. J., Rojas, N., Haapanen, R., Duxbury, E., Steiner, H. 2001; 31 (4): 297-312


    Studies of substance abuse among delinquents have shown mixed results on criminal recidivism. The present study evaluates personality traits associated with substance abuse and recidivism among delinquent boys, and prospectively determines the extent to which these factors are predictive of criminal recidivism. 134 incarcerated boys (x = 15.9 +/- 1.1) completed the Weinberger Adjustment Inventory and the Substance Abuse Screening Inventory. Youth were prospectively followed for up to 4.5 years following release. Among incarcerated delinquents, personality traits are predictive of a positive substance abuse screen and recidivism. A trend indicating a possible interaction between personality and treatment is observed. If these findings are replicated, personality traits may play a role in predicting substance abuse as well as individual delinquent responses to treatment.

    View details for Web of Science ID 000166878000003

    View details for PubMedID 11227989

  • Family environment of children and adolescents with bipolar parents BIPOLAR DISORDERS Chang, K. D., Blasey, C., Ketter, T. A., Steiner, H. 2001; 3 (2): 73-78


    The effect of family environment on the development of bipolar disorder (BD) in children is not known. We sought to characterize families with children at high risk for developing BD in order to better understand the contributions of family environment to the development of childhood BD.We collected demographic data and parental ratings on the Family Environment Scale (FES) for 56 children (aged 6-18 years) from 36 families with at least one biological parent with BD. The cohort had previously been psychiatrically diagnosed according to semistructured interviews.Statistical comparisons with normative data indicated that parents' ratings were significantly lower on the FES Cohesion and Organization scales and were significantly higher on the FES Conflict scale. Multivariate analyses of variance indicated that families with both parents having a mood disorder had no significantly different FES scores than families with only one parent with a mood disorder (BD). Diagnostic data indicated that while 54% of the children in the sample had an Axis I disorder and 14% had BD, FES scores did not differ significantly for subjects with or without an Axis I disorder, or with or without BD.Families with a bipolar parent differ from the average family in having less cohesion and organization, and more conflict. Despite this difference, it does not appear that the environment alone of families with a bipolar parent determines the outcome of psychopathology in the children, or that the psychopathology of the children determines the family environment.

    View details for PubMedID 11333066

  • Associated health risks of adolescents with disordered eating: How different are they from their peers? Results from a high school survey CHILD PSYCHIATRY & HUMAN DEVELOPMENT Lock, J., Reisel, B., Steiner, H. 2001; 31 (3): 249-265


    In this study, we compare health risks of adolescents with disordered eating to those of their peers without disordered eating. A self-report health survey from a community sample of 1769 high school students was used to compare emotional, medical, and social behaviors of these two groups. Risk data for disordered eating students was compared within and across genders. Adolescents with disordered eating are at increased risk for emotional and physical health problems compared to their peers. Overall health risks for boys and girls with disordered eating are quite similar. However, boys with disordered eating develop associated health risk profiles that differentiate them from male peers by having increased mental health, sexual and physical abuse, and general health problems. Girls with disordered eating have associated health risks for substance use and sexual risk-taking that distinguished them from their female peers.

    View details for Web of Science ID 000166288700006

    View details for PubMedID 11196014

  • Trauma and personality correlates in long term pediatric cancer survivors CHILD PSYCHIATRY & HUMAN DEVELOPMENT Erickson, S. J., Steiner, H. 2001; 31 (3): 195-213


    To explore the relationship between PTSD and trauma-spectrum symptoms, including personality and functional correlates, in long term pediatric cancer survivors (N = 40), we assessed these constructs with a structured interview for PTSD, a clinical interview, and self-report questionnaires. Thirty-five out of 40 participants (88%) currently met at least one trauma symptom at a functionally significant level. These survivors demonstrate high levels of restraint and low levels of distress, representative of a repressive adaptive style. After more than 5 years since treatment completion, the relatively high levels of current trauma-spectrum symptoms may reflect the long-term deleterious impact of childhood cancer.

    View details for Web of Science ID 000166288700003

    View details for PubMedID 11196011

  • The response evaluation measure (REM-71): A new instrument for the measurement of defenses in adults and adolescents AMERICAN JOURNAL OF PSYCHIATRY Steiner, H., Araujo, K. B., Koopman, C. 2001; 158 (3): 467-473


    There is widespread agreement that the concept of defense is useful, but large-scale studies with representative cohorts are lacking. Self-report measures capturing conscious derivatives of defense can facilitate such studies. The authors report the design and initial performance of a new self-report measure of specific defenses.A 71-item questionnaire based on a developmental model of defenses was created, pilot tested, and refined. The item pool was given to two independent clinical researchers for the classification of items (concordance=98.5%). The instrument was then administered to 1,875 nonclinical subjects drawn from two suburban high schools and from a public waiting area of a local airport (1,038 female subjects; mean age=21.0 years, SD=11.9, range=13-89), who were also assessed with a simple screening measure covering demographic variables and satisfaction with life.The internal consistency of the questionnaire items was good. Two factors emerged from a factor analysis of the items, paralleling Vaillant's theoretical model. Most defenses made unique, significant contributions to these factors. Defenses and factors related in the expected direction with scores on life satisfaction in various domains.The Response Evaluation Measure is a brief, coherent, and potentially useful screening instrument for the assessment of defenses in adults and adolescents.

    View details for Web of Science ID 000167323000020

    View details for PubMedID 11229990

  • Linguistic analysis to assess medically related posttraumatic stress symptoms PSYCHOSOMATICS Shaw, R. J., Harvey, J. E., Nelson, K. L., Gunary, R., Kruk, H., Steiner, H. 2001; 42 (1): 35-40


    The authors examined the presence of posttraumatic stress symptoms (PTSS) in 20 patients requiring ventilation after acute respiratory distress. The subjects completed a semistructured interview about their ventilation experience that was subject to content and linguistic analysis. Subjects also completed two self-report measures to assess PTSS and socioemotional adjustment. Subjects who endorsed PTSS were more likely to use a narrative style suggesting emotional involvement in their recall of the stressful event. The authors indicate that the presence of PTSS is a common consequence of traumatic medical experiences and that denial of distress may be an adaptive short-term coping strategy.

    View details for Web of Science ID 000166369100006

    View details for PubMedID 11161119

  • Perinatal complications and child abuse in a poverty sample CHILD ABUSE & NEGLECT Zelenko, M., Lock, J., Kraemer, H. C., Steiner, H. 2000; 24 (7): 939-950


    Perinatal medical illness has been associated with child maltreatment. Using a Child Protective Service (CPS) report as the defining event, this study explores to what extent perinatal morbidity is a risk factor for maltreatment.Medical charts of 206 children ages 0-3 years were reviewed. Data regarding birth history were collected and analyzed in three groups of children: children whose medical record indicated a report to CPS based on prenatal findings (Early Maternal Inadequacy group [EMI]), children whose medical record indicated a report to CPS based only on postnatal findings (Child Maltreatment group [CM]), and a control group without CPS report (NM).Compared to the CM and the NM groups, children in the EMI group showed significantly lower birth weight and higher neonatal morbidity as measured by Apgar scores, frequency of oxygen requirement and intubation at birth, frequency of admission to Neonatal Intensive Care unit, and frequency of neonatal medical problems. There was no significant difference between the CM and the NM groups in birth weight, gestational age, and other measures of morbidity.The results of the study suggest that perinatal complications are associated with prenatal maltreatment. Previously reported strong associations between neonatal morbidity and child abuse are more likely a result of antecedent prenatal maternal behaviors (early maternal inadequacy). Early maternal inadequacy, a clinically and demographically distinct phenomenon, is important due to serious health, development and financial implications and deserves further exploration.

    View details for Web of Science ID 000087428700006

    View details for PubMedID 10905418

  • Trauma spectrum adaptation - Somatic symptoms in long-term pediatric cancer survivors PSYCHOSOMATICS Erickson, S. J., Steiner, H. 2000; 41 (4): 339-346


    The authors assessed somatic symptoms and the degree of association among somatic symptoms, global adjustment, trauma symptoms, and personality characteristics in long-term pediatric cancer survivors. Forty cancer survivors completed self-report questionnaires and clinical interviews. Participants' level of somatic symptoms fell between nonclinic and psychiatric populations. Somatic symptom scores correlated with general adjustment in the negative direction and with posttraumatic stress disorder (PTSD) scores in the positive direction. The majority of participants met at least partial current PTSD criteria. Because these survivors demonstrate a repressive adaptive style but endorse somatic symptoms, the latter may represent a method for detecting trauma-related distress in this population.

    View details for Web of Science ID 000087918600008

    View details for PubMedID 10906356

  • Psychiatric phenomenology of child and adolescent bipolar offspring JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Chang, K. K., Steiner, H., Ketter, T. A. 2000; 39 (4): 453-460


    To establish prodromal signs of and risk factors for childhood bipolar disorder (BD) by characterizing youths at high risk for BD.Structured diagnostic interviews were performed on 60 biological offspring of at least one parent with BD. Demographics, family histories, and parental history of childhood disruptive behavioral disorders were also assessed.Fifty-one percent of bipolar offspring had a psychiatric disorder, most commonly attention-deficit/hyperactivity disorder (ADHD), major depression or dysthymia, and BD. BD in offspring tended to be associated with earlier parental symptom onset when compared with offspring without a psychiatric diagnosis. Bipolar parents with a history of childhood ADHD were more likely to have children with BD, but not ADHD. Offspring with bilineal risk had increased severity of depressed and irritable mood, lack of mood reactivity, and rejection sensitivity, while severity of grandiosity, euphoric mood, and decreased need for sleep were not preferentially associated with such offspring.Bipolar offspring have high levels of psychopathology. Parental history of early-onset BD and/or childhood ADHD may increase the risk that their offspring will develop BD. Prodromal symptoms of childhood BD may include more subtle presentations of mood regulation difficulties and less presence of classic manic symptoms.

    View details for PubMedID 10761347

  • Adolescents and sports: Risk or benefit? CLINICAL PEDIATRICS Steiner, H., McQuivey, R. W., Pavelski, R., Pitts, T., Kraemer, H. 2000; 39 (3): 161-166


    In order to begin to compensate for a lack of data on the effects of athletic participation in the development of adolescent mental health patterns, as well as to assess general health of the adolescent population, the Juvenile Wellness and Health Inventory (JWHS-76) was administered to 1,769 high school students. Our results indicate that sports participation is associated with self-reported lower total risk scores, mental and physical health benefits, and an increased risk of injury. This suggests a positive role for organized sports participation in youth populations. Prospective studies are needed to assess the impact of different sports, mounting performance pressure, and transition into collegiate levels of participation.

    View details for Web of Science ID 000085957600004

    View details for PubMedID 10752009

  • Trauma and dissociation in delinquent adolescents JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Carrion, V. G., Steiner, H. 2000; 39 (3): 353-359


    To assess history of trauma and dissociation in a group of juvenile delinquents and to assess how adolescents would respond to a structured interview for dissociative symptoms.Sixty-four adolescents in juvenile probation hall participated in 2 investigational sessions in 1996-1997. For session 1 they answered the Childhood Trauma Questionnaire (CTQ), the Response Evaluation Measure for Youth-71 (REMY-71), and the Weinberger Adjustment Inventory. For session 2 they were given the Childhood Trauma Interview (CTI) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D).In this sample 28.3% met criteria for a dissociative disorder and 96.8% endorsed a history of traumatic events. There were significant positive correlations between CTI and CTQ trauma scores and SCID-D and REMY-71 dissociative symptoms. All dissociative symptoms were endorsed, but depersonalization was the most common experience. There was a lack of congruence between the different methods of assessing dissociation.This study provides support for an early link between history of trauma and dissociation. Adolescents were able to answer questions from a structured interview assessing dissociation.

    View details for Web of Science ID 000085580800018

    View details for PubMedID 10714056

  • Body dissatisfaction and dieting in young children INTERNATIONAL JOURNAL OF EATING DISORDERS Schur, E. A., Sanders, M., Steiner, H. 2000; 27 (1): 74-82


    To develop a broader understanding of young children's knowledge and beliefs about dieting and body dissatisfaction.Sixty-two third through sixth-grade boys and girls completed audiotaped interviews and questionnaires regarding eating behavior, attitudes toward dieting, and body dissatisfaction.Fifty percent of all children wanted to weigh less and 16% reported attempting weight loss. Children were well informed about dieting and were most likely to believe that dieting meant changing food choices and exercising as opposed to restricting intake. Their primary source of information was the family. Seventy-seven percent of children mentioned hearing about dieting from a family member, usually a parent.Young children are knowledgeable about dieting and the concept of dieting does not necessarily mean caloric restriction to them. These data suggest that the family can play a powerful role in countering the development of eating concerns and body dissatisfaction in children.

    View details for Web of Science ID 000084531300008

    View details for PubMedID 10590451

  • Adolescent defense style and life stressors CHILD PSYCHIATRY & HUMAN DEVELOPMENT Araujo, K., Ryst, E., Steiner, H. 1999; 30 (1): 19-28


    This study examines the relationship between stressful life events and defense mechanisms. Eighty seven female adolescent patients completed the Adolescent Family Inventory of Life Events and Changes (A-FILE) assessing stressors in six domains of family life, and the Defense Style Questionnaire (DSQ) assessing 19 defense mechanisms grouped into Immature, Prosocial, and Mature clusters. Increasing stressors are significantly positively correlated with a more immature defense style. Results support the hypothesis that there is an iterative relationship between immature defenses and life stressors. These findings are compatible with a regression model of defense functioning and complement our previous results linking defenses to temperament.

    View details for Web of Science ID 000082942800002

    View details for PubMedID 10533290

  • Violence and related psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry Steiner, H., Stone, L. A. 1999; 38 (3): 232-234

    View details for PubMedID 10087682

  • Violent behavior in children and youth: Preventive intervention from a psychiatric perspective JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Rae-Grant, N., McConville, B. J., Fleck, S., Kennedy, J. S., Vaughan, W. T., Steiner, H., Bernard, V., Deci, P., MacMillan, H., Makini, G., Offord, D. R., Silverman, M. M., Thomas, L. 1999; 38 (3): 235-241
  • Personality traits in juvenile delinquents: Relation to criminal behavior and recidivism JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Steiner, H., Cauffman, E., Duxbury, E. 1999; 38 (3): 256-262


    To examine the relation between personality traits and criminal behavior and to determine whether such factors are predictive of future recidivism.A sample of 481 incarcerated males (mean age = 16 years) completed questionnaires assessing distress and restraint relating to personality characteristics. In addition, official criminological data were gathered from subjects' records. A subsample of 148 juveniles was followed up to 4.5 years after release and examined for rearrests and time out of prison since last incarceration.Results indicate a significant association between self-reported levels of distress and restraint and prior criminal behavior as well as behavior during incarceration. Furthermore, of the sample surveyed, 67% were rearrested. Personality traits measured during incarceration were predictive of recidivism rates, above and beyond the effects of such criminological factors as age and number of prior offenses.The results support the view that juvenile delinquents are a heterogeneous population in terms of personality features. These traits have discriminant and predictive validity. Adding personality measures to the assessment of delinquents may further our understanding of how personality influences criminal activity and future recidivism. We may be able to use this understanding to target specific domains of functioning to develop more effective intervention strategies.

    View details for Web of Science ID 000078832100012

    View details for PubMedID 10087686

  • Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: Results from a community-based survey JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Lock, J., Steiner, H. 1999; 38 (3): 297-304


    Health problems of gay, lesbian, and bisexual (GLB) youth are reported as differing from those of heterosexual youth. Increased depression, suicide, substance use, homelessness, and school dropout have been reported. Most studies of GLB youth use clinical or convenience samples. The authors conducted a community school-based health survey that included an opportunity to self-identify as GLB.An anonymous self-report health care questionnaire was used during a community-based survey in 2 high schools in an upper middle class district.Significantly increased health risks for self-identified GLB youth were found in mental health, sexual risk-taking, and general health risks compared with self-identified heterosexuals, but not in health domains associated with substance abuse, homelessness, or truancy.Self-identified GLB youth in community settings are at greater risk for mental health, sexual risk-taking, and poorer general health maintenance than their heterosexual peers.

    View details for Web of Science ID 000078832100018

    View details for PubMedID 10087691

  • Sertraline in children and adolescents with obsessive-compulsive disorder - A multicenter randomized controlled trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION March, J. S., Biederman, J., Wolkow, R., Safferman, A., Mardekian, J., Cook, E. H., Cutler, N. R., Dominguez, R., Ferguson, J., Muller, B., Riesenberg, R., Rosenthal, M., Sallee, F. R., Wagner, K. D. 1998; 280 (20): 1752-1756


    The serotonin reuptake inhibitors are the treatment of choice for patients with obsessive-compulsive disorder; however, empirical support for this assertion has been weaker for children and adolescents than for adults.To evaluate the safety and efficacy of the selective serotonin reuptake inhibitor sertraline hydrochloride in children and adolescents with obsessive-compulsive disorder.Randomized, double-blind, placebo-controlled trial.One hundred eighty-seven patients: 107 children aged 6 to 12 years and 80 adolescents aged 13 to 17 years randomized to receive either sertraline (53 children, 39 adolescents) or placebo (54 children, 41 adolescents).Twelve US academic and community clinics with experience conducting randomized controlled trials.Sertraline hydrochloride was titrated to a maximum of 200 mg/d during the first 4 weeks of double-blind therapy, after which patients continued to receive this dosage of medication for 8 more weeks. Control patients received placebo.The Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH GOCS), and the NIMH Clinical Global Impressions of Severity of Illness (CGI-S) and Improvement (CGI-I) rating scales.In intent-to-treat analyses, patients treated with sertraline showed significantly greater improvement than did placebo-treated patients on the CY-BOCS (adjusted mean, -6.8vs -3.4, respectively; P=.005), the NIMH GOCS (-2.2 vs -1.3, respectively; P=.02), and the CGI-I (2.7 vs 3.3, respectively; P=.002) scales. Significant differences in efficacy between sertraline and placebo emerged at week 3 and persisted for the duration of the study. Based on CGI-I ratings at end point, 42% of patients receiving sertraline and 26% of patients receiving placebo were very much or much improved. Neither age nor sex predicted response to treatment. The incidence of insomnia, nausea, agitation, and tremor were significantly greater in patients receiving sertraline; 12 (13%) of 92 sertraline-treated patients and 3 (3.2%) of 95 placebo-treated patients discontinued prematurely because of adverse medical events (P=.02). No clinically meaningful abnormalities were apparent on vital sign determinations, laboratory findings, or electrocardiographic measurements.Sertraline appears to be a safe and effective short-term treatment for children and adolescents with obsessive-compulsive disorder.

    View details for Web of Science ID 000077081400030

    View details for PubMedID 9842950

  • Posttraumatic stress disorder among female juvenile offenders JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Cauffman, E., Feldman, S. S., Waterman, J., Steiner, H. 1998; 37 (11): 1209-1216


    While there is a growing body of evidence that psychopathology is common among incarcerated boys, relatively little is known about the prevalence and manifestations of mental health problems among incarcerated girls. This study examines the incidence of posttraumatic stress disorder (PTSD) in a sample of 96 adolescent female offenders and its relation to socioemotional adjustment.Self-report questionnaires were used to tap socioemotional adjustment, and a semistructured interview was conducted to determine PTSD symptomatology.The results indicate that the rate of PTSD among incarcerated female delinquents not only is higher than that in the general population but surpasses the incidence of PTSD among incarcerated male delinquents. In addition, those who suffer from PTSD also tend to exhibit higher levels of distress and lower levels of self-restraint.These findings provide a starting point for more detailed investigations of the relations between trauma, psychopathology, and violence and suggest that the study of trauma may offer a new way of looking at links between victim and perpetrator.

    View details for Web of Science ID 000076629100021

    View details for PubMedID 9808933

  • Juvenile justice, delinquency, and psychiatry CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA Steiner, H., Cauffman, E. 1998; 7 (3): 653-?


    Juvenile delinquency is a serious problem in the United States, and is likely to remain so for many years to come. Because delinquency often is accompanied by high rates of coincidental and causal comorbidities, effective treatment programs for CD youths must use multimodal approaches tailored to each youth's particular set of psychopathologies. Child psychiatrists are uniquely qualified to provide assistance and leadership in the treatment of delinquent youths, as their problems are best captured by a developmental psychopathology model. Knowledge regarding the epidemiology of CD, and of the risk factors associated with it, is excellent, although a thorough understanding of resilience and treatment is still developing. Successful involvement in the treatment of delinquent youth requires that psychiatrists maintain a diverse set of skills, a high level of flexibility in treatment approaches, and a special awareness of the legal parameters governing the rehabilitation of these youngsters.

    View details for Web of Science ID 000074838000013

    View details for PubMedID 9894060

  • The Academy of Psychosomatic Medicine practice guidelines for psychiatric consultation in the general medical setting PSYCHOSOMATICS Bronheim, H. E., Fulop, G., Kunkel, E. J., Muskin, P. R., Schindler, B. A., Yates, W. R., Shaw, R., Steiner, H., Stern, T. A., Stoudemire, A. 1998; 39 (4): S8-S30


    This practice guideline seeks to provide guidance to psychiatrists who regularly evaluate and manage patients with medical illnesses. The guideline is intended to delineate the knowledge base, professional expertise, and integrated clinical approach necessary to effectively manage this complex and diverse patient population. This guideline was drafted by a work group consisting of psychiatrists with clinical and research expertise in the field, who undertook a comprehensive review of the literature. The guideline was reviewed by the executive council of the Academy of Psychosomatic Medicine and revised prior to final approval. Some of the topics discussed include qualifications of C-L consultants, patient assessment, psychiatric interventions (e.g., psychotherapy, pharmacotherapy), medicolegal issues, and child and adolescent consultations.

    View details for Web of Science ID 000075014800023

    View details for PubMedID 9691717

  • Differences in caloric utilization in eating disordered adolescents CHILD PSYCHIATRY & HUMAN DEVELOPMENT Nasserbakht, A., Brantner-Inthaler, S., Shih, G., Steiner, H. 1998; 28 (4): 265-271


    Caloric utilization is an important aspect of the clinical management of eating disorders. Caloric intake and body weight of 32 inpatient bulimic and anorectic girls and 30 normal adolescents were measured. Normal weight bulimics ate fewer calories while anorectics ate more calories per kilogram body weight compared with the control group. Anorectics have greater difficulty to eat sufficient calories to maintain their weight. These findings indicate that treatment should be extended beyond the point of time where normal weight is reached.

    View details for Web of Science ID 000074049400005

    View details for PubMedID 9628058

  • A comparison between the Weinberger Adjustment Inventory and the Minnesota multiphasic personality inventory with incarcerated adolescent males CHILD PSYCHIATRY & HUMAN DEVELOPMENT Huckaby, W. J., Kohler, M., Garner, E. H., Steiner, H. 1998; 28 (4): 273-285


    Empirical work on psychopathology and delinquency requires concise and specific instruments. The Weinberger Adjustment Inventory (WAI), was correlated with the Minnesota Multiphasic Personality Inventory (MMPI) using a sample of incarcerated adolescent males (N = 178). The distress dimension of the WAI was significantly and positively associated with scales 2, 4 and 7 of the MMPI. The restraint dimension was significantly and positively associated with the Lie and K scales of the MMPI. Distress and restraint were distinct dimensions. The WAI may be a brief and helpful personality measure, determining responses to conflict and subjective stress in delinquents with poor reading skills and other special education impairments. The length of the WAI makes it especially suitable for populations such as incarcerated adolescent males who exhibit short attention spans and frequent episodes of noncompliant and resistant behavior.

    View details for Web of Science ID 000074049400006

    View details for PubMedID 9628059

  • Anorexia nervosa and bulimia nervosa in children and adolescents: A review of the past 10 years JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Steiner, H., Lock, J. 1998; 37 (4): 352-359


    To critically review the research in juvenile anorexia nervosa and bulimia nervosa over the past 10 years and highlight recent advances in normal development as it pertains to these disorders and their diagnosis, prevention, and treatment.Computerized search methods were combined with manual searches of the literature. A detailed review of the most salient articles is provided. Preference was given to studies involving children and adolescents that approached the subject from a developmental perspective.The information from these studies is presented in a developmental framework. Research in eating disorders has progressed, but definitive longitudinal data are still absent from the literature. Research specific to treatment of child and adolescent eating disorders remains rare.Data approaching eating disorders from a developmental perspective are available in only a few studies. Research is needed addressing normative data on the development of eating behavior and specific risk and resilience factors for pathology in specific developmental periods. Especially lacking are studies regarding the continuities and discontinuities of eating disturbances across the life span. Best documented are epidemiological studies of prevalence and incidence, long-term outcome in anorexia nervosa, and short-term treatment response in bulimia.

    View details for Web of Science ID 000072657600011

    View details for PubMedID 9549954

  • Defense style and family environment CHILD PSYCHIATRY & HUMAN DEVELOPMENT Thienemann, M., Shaw, R. J., Steiner, H. 1998; 28 (3): 189-198


    Prospective observations of the defense styles of normal individuals suggest that the quality of the childhood family environment may influence the maturity of defense styles used in adulthood. In this study, 106 female adolescent psychiatric patients completed the Defense Style Questionnaire, and the Family Environment Scale (FES). Positive family characteristics such as cohesion and expressiveness, as measured by the FES, were correlated with the report of Mature Defenses. Negative family characteristics such as conflict were correlated with the report of Immature Defenses. Similar although weaker correlations were found after controlling for the effects of depression and defensiveness on the self-report measures.

    View details for Web of Science ID 000072516800005

    View details for PubMedID 9540242

  • The juvenile wellness and health survey (JWHS-76): A school based screening instrument for general and mental health in high school students CHILD PSYCHIATRY & HUMAN DEVELOPMENT Steiner, H., Pavelski, R., Pitts, T., McQuivey, R. 1998; 29 (2): 141-155


    Existing screening instruments address adolescent health from a pediatric/public health perspective. We developed a school based screening instrument (the JWHS-76) for high schools measuring multiple health related domains from a child psychiatric viewpoint. We studied 1769 students in two suburban high schools (48% girls, mean age 16, predominantly white). Factor analyses revealed five coherent factors: general risk taking, mental health problems, sex related risks, eating and dietary problems, and general health problems. Analyses by gender, age and coping style revealed significant and consistent associations. The JWHS-76 is supported by preliminary evidence as a valid screening instrument in high school.

    View details for Web of Science ID 000076695800004

    View details for PubMedID 9816733

  • Defense reactions and coping strategies in normal adolescents Symposium on Legacies of Insight and Perspective from the Recent Past, at the Biennial Meeting of the Society-for-Research-in-Child-Development Erickson, S., Feldman, S. S., Steiner, H. HUMAN SCI PRESS INC. 1997: 45–56


    In exploring the relationship between defense reactions and coping strategies in a non-clinic sample of adolescents (N = 81), we assessed: defense structure by the Bond Defense Style Questionnaire (DSQ); coping behaviors by the Coping Responses Inventory-Youth Form (CRI-Youth); and general adjustment by Global Assessment of Functioning (GAF) ratings. Defense reactions and coping strategies were modestly associated and made independent contributions in predicting the GAF. Mature and immature defenses and avoidance coping comprised the optimal combination in predicting the GAF, accounting for 20% of GAF variance. It is therefore important to assess both unconscious and conscious processes when assessing general functioning in normal adolescents.

    View details for Web of Science ID A1997XM83900006

    View details for PubMedID 9256528

  • Practice parameters for the assessment and treatment of children and adolescents with conduct disorder JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Steiner, H., Dunne, J. E., Ayres, W., Arnold, V., Benedek, E., Benson, R. S., Bernstein, G. A., Bernet, W., Bukstein, O., Kinlan, J., Leonard, H., McClellan, J., Sloan, L. E., Miles, C. M., McQuivey, R. W., Matthews, Z., Pitts, T., BentonHardy, L., Williams, S., Perry, B., ROGENESS, G., Shaw, J., Kruesi, M., Angell, R., Lewis, R., Riggs, P. D. 1997; 36 (10): S122-S139
  • Summary of the practice parameters for the assessment and treatment of children and adolescents with conduct disorder JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Steiner, H., Dunne, J. E. 1997; 36 (10): 1482-1485


    This summary of the practice parameters describes the diagnosis, treatment, and prevention of conduct disorder in children and adolescents. The rationales for these recommendations are based on a review of the scientific literature and clinical consensus, which are contained in the complete document. Clinical features of youths with conduct disorder include predominance in males, low socioeconomic status, and familial aggregation. Important continuities to oppositional defiant disorder and antisocial personality disorder have been documented. Extensive comorbidity, especially with other externalizing disorders, depression, and substance abuse, has been documented and has significance for prognosis. Clinically significant subtypes exist according to age of onset, overt or covert conduct problems, and levels of restraint exhibited under stress. To be effective, treatment must be multimodal, address multiple foci, and continue over extensive periods of time. Early treatment and prevention seem to be more effective than later intervention.

    View details for Web of Science ID A1997XZ47300039

    View details for PubMedID 9334562

  • Practice parameters for the assessment and treatment of children and adolescents with conduct disorder. American Academy of Child and Adolescent Psychiatry. Journal of the American Academy of Child and Adolescent Psychiatry Steiner, H. 1997; 36 (10): 122S-39S


    These practice parameters address the diagnosis, treatment, and prevention of conduct disorder in children and adolescents. Voluminous literature addresses the problem from a developmental, epidemiological, and criminological perspective. Properly designed treatment outcome studies of modern psychiatric modalities are rare. Ethnic issues are mentioned but not fully addressed from a clinical perspective. Clinical features of youth with conduct disorder include predominance in males, low socioeconomic status, and familial aggregation. Important continuities to oppositional defiant disorder and antisocial personality disorder have been documented. Extensive comorbidity, especially with other externalizing disorders, depression, and substance abuse, has been documented and has significance for prognosis. Clinically significant subtypes exist according to age of onset, overt or covert conduct problems, and levels of restraint exhibited under stress. To be effective, treatment must be multimodal, address multiple foci, and continue over extensive periods of time. Early treatment and prevention seem to be more effective than later intervention.

    View details for PubMedID 9334568

  • Temperament in juvenile eating disorders PSYCHOSOMATICS Shaw, R. J., Steiner, H. 1997; 38 (2): 126-131


    Previous studies have suggested an association between temperament and eating disorder pathology. The purpose of this study was to differentiate on the basis of temperament among patients with anorexia, bulimia, and major depression. In this study, 101 adolescent girls completed the Revised Dimensions of Temperament Survey (Self), a self-report measure that identifies nine dimensions of temperament. Significant differences were found between the diagnostic groups while controlling for disturbances in mood and defensiveness. Specific subscales differentiated the subjects with anorexia from those with bulimia. These data support the concept of using temperament to differentiate patients with related psychiatric syndromes.

    View details for Web of Science ID A1997WL68300006

    View details for PubMedID 9063043

  • Posttraumatic stress disorder in incarcerated juvenile delinquents 41st Annual Meeting of the American-Academy-of-Child-and-Adolescent-Psychiatry Steiner, H., Garcia, I. G., Matthews, Z. LIPPINCOTT WILLIAMS & WILKINS. 1997: 357–65


    To assess the prevalence of posttraumatic stress disorder (PTSD) in severely delinquent subjects and to measure associated personality characteristics.Eighty-five incarcerated boys (mean age 16.6, SD = 1.2) with mostly violent offenses were studied. The sample was representative of the California Youth Authority population. They received a standard psychiatric screen, a semistructured interview for PTSD, and self-report questionnaires measuring personality traits and defenses. A nonclinical sex- and age-matched group was used for comparing psychometrics.Subjects suffered from PTSD at higher rates than other adolescent community samples and at higher rates than those found in county probation camps. Thirty-two percent fulfilled criteria for PTSD, 20% partial criteria. One half of the subjects described the witnessing of interpersonal violence as the traumatizing event. Psychometric results converged in the predicted way: Subjects with PTSD showed elevated distress, anxiety, depression, and lowered restraint, impulse control, and suppression of aggression; they had high levels of immature defenses such as projection, somatization, conversion, dissociation, and withdrawal.PTSD occurs at high rates in delinquents, and this finding has implications for management and treatment. Personality characteristics that might put individuals at risk for the development of PTSD were identified.

    View details for Web of Science ID A1997WK27400014

    View details for PubMedID 9055516

  • Reports of stress: A comparison between eating disordered and non-eating disordered adolescents CHILD PSYCHIATRY & HUMAN DEVELOPMENT Sharpe, T. M., Ryst, E., Hinshaw, S. P., Steiner, H. 1997; 28 (2): 117-132


    This study utilizes a unique method to examine reports of stressful life events provided by eating disordered and non-eating disordered adolescents. Subjects (all females) participated in a standardized procedure to obtain reports of stressful life events. The Life Events and Coping Inventory (LECI) was used to categorize reported stressors. Eating disorder subjects discussed more stressors than non-eating disorder subjects only when eating disorder events were included. Furthermore, eating disorder subjects reported more events that could not be classified within the LECI and were rated as non-normative. The findings point to the importance of qualitative rather than purely quantitative approaches to stressful life events assessment with adolescents.

    View details for Web of Science ID 000071849700005

    View details for PubMedID 9494237

  • Violent crime paths in incarcerated juvenile - Psychological, environmental, and biological factors NATO Advanced Study Institute on the Biosocial Bases of Violence Steiner, H., Williams, S. E., BentonHardy, L., Kohler, M., Duxbury, E. PLENUM PRESS DIV PLENUM PUBLISHING CORP. 1997: 325–328
  • A comparison of adolescent and adult defense styles CHILD PSYCHIATRY & HUMAN DEVELOPMENT Nasserbakht, A., Araujo, K., Steiner, H. 1996; 27 (1): 3-14


    Despite the great need for assessment of the adaptive and defensive style of adolescents, there are few instruments available to assess these characteristics. We assessed Vaillant's defense hierarchial model in adolescents, using Bond's self-report questionnaire (DSQ) for adults adopted for adolescents. In all cases, the factor structure in adolescents differed from adults, which may represent a manifestation of development.

    View details for Web of Science ID A1996VD05500001

    View details for PubMedID 8810112

  • Defense mechanisms in adolescents as a function of age, sex, and mental health status JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Feldman, S. S., Araujo, K. B., Steiner, H. 1996; 35 (10): 1344-1354


    To modify an existing instrument to provide a valid assessment of defense mechanisms in adolescents and to examine defense structure and usage as a function of age, sex, and mental health status.Six hundred ninety-three subjects (187 nonclinic adolescents, 229 internalizing females, 99 incarcerated male delinquents, and 178 nonclinic adults) completed the modified Defense Style Questionnaire (DSQ), which yielded 19 defense scores.Factor analyses of the 19 defense scores on the adolescent sample yielded three factors: Immature, Mature, and Prosocial Defenses. These were similar to those from studies of adults. Additional factor analyses were conducted on defense scores of subjects grouped by age, sex, and mental health status. The Immature and Mature Factors were relatively consistent across groups, but the Prosocial Factor varied by group. Multivariate analyses of variance and analyses of variance on individual and composite defense scores revealed differences by age, sex, and mental health status.Although the modified DSQ needs further work to improve its psychometric properties, it is clearly fruitful to assess adolescent defense mechanisms. Results from extant studies of adults and males on the structure of defenses cannot be validly extrapolated to other age groups and to females.

    View details for Web of Science ID A1996VK05500022

    View details for PubMedID 8885589

  • Defense mechanisms and adjustment in normal adolescents AMERICAN JOURNAL OF PSYCHIATRY Erickson, S. J., Feldman, S. S., Steiner, H. 1996; 153 (6): 826-828


    This study compared self-perception of defense patterns with objective and independent ratings of general adjustment in normal adolescents.Self-perception of defense utilization by 140 high school students was measured by an adolescent version of Bond's Defense Style Questionnaire. The DSM-III-R Global Assessment of Functioning Scale was used by clinicians in determining general adjustment.Defense style and adjustment were significantly related; greater maturity of defense style was associated with better global adjustment, and conversely, greater immaturity of defense style was associated with a lower level of functioning.Adolescents' self-perceived defense patterns have conscious correlates associated with general adjustment. This study extends the validity of the defense mechanism paradigm to the adolescent age group.

    View details for Web of Science ID A1996UN63200018

    View details for PubMedID 8633700

  • Temperament as a correlate of adolescent defense mechanisms CHILD PSYCHIATRY & HUMAN DEVELOPMENT Shaw, R. J., Ryst, E., Steiner, H. 1996; 27 (2): 105-114


    The Revised Dimensions of Temperament Survey, which assesses nine dimensions of temperament, and the Defense Style Questionnaire, used to assess defense mechanisms, were completed by 107 female adolescents. Temperament was found to be strongly correlated with defense style, particularly with immature defenses (p = 0.0001). The findings support the hypothesis that the biological dimension of temperament is correlated with specific defense mechanisms.

    View details for Web of Science ID A1996VP57900004

    View details for PubMedID 8936796

  • Criminal recidivism predicted from narratives of violent juvenile delinquents CHILD PSYCHIATRY & HUMAN DEVELOPMENT Tinklenberg, J. A., Steiner, H., Huckaby, W. J., Tinklenberg, J. R. 1996; 27 (2): 69-79


    Youth violence poses a major public health problem. It is important to find treatable predictors of recidivism. Our Subjects had committed offenses of physical and sexual assault. The personality dimensions of restraint and distress were rated by two independent and blind raters from narratives of offender's committing offenses, which were obtained at baseline during incarceration. Inter and intrarater kappas for each narrative were significant. In a 10-13 year follow-up, subjects lowest in self- restraint had significantly higher recidivism and their reoffenses differed in quality. Restraint may be influenced by clinical intervention and constitutes a new target in the treatment of delinquents.

    View details for Web of Science ID A1996VP57900001

    View details for PubMedID 8936793



    This project evaluated the discriminant validity of two self-report measures of adaptive styles.The Weinberger Adjustment Inventory, which assesses distress, restraint, denial, and repressive defensiveness, and the Bond Defense Style Questionnaire, which assesses immature, neurotic, and mature defenses, were administered to 272 adolescents: normal comparison group boys (n = 63), normal comparison group girls (n = 68), girls with psychosomatic disorders (n = 75), and incarcerated delinquent boys (n = 66). Multivariate analyses of covariance, analyses of covariance, and discriminant analyses (with socioeconomic status and age as covariates) were conducted.Adaptive styles from the Defense Style Questionnaire differentiated the adolescent groups better than did the Weinberger Adjustment Inventory styles.Measurement of adaptive style by the Defense Style Questionnaire may be a useful adjunct to other measures of psychopathology and can assist in assessment of risk, treatment planning, and treatment progress.

    View details for Web of Science ID A1995QD09100013

    View details for PubMedID 7896651


    View details for Web of Science ID A1994MN51600009

    View details for PubMedID 8134532

  • Adaptive styles in adolescents with psychosomatic illness. Acta paedopsychiatrica Steiner, H., CANNING, E. H. 1994; 56 (4): 255-259


    Repressive defense style, characterized by low levels of self-reported distress and high levels of defensiveness, has been well studied in adult patients. This study identified four adaptive styles (repressor, impression manager, low anxious, and high anxious) in an adolescent psychosomatic patient sample (n = 120) by standardized psychometric examination. Adolescents with an active medical diagnosis on DSM III-R axis III or with an axis I diagnosis associated with physical symptoms (conversion disorder, somatization disorder, and psychological factors affecting physical condition) were more likely to be repressors. Those with affective disorders were more likely to be impression managers. Implications for pediatric and psychiatric management are discussed.

    View details for PubMedID 7976330



    To examine the relationship between psychiatric disorder and psychological characteristics at 6-year follow-up of adolescent-onset anorexia nervosa.Twenty-three subjects were interviewed by telephone using the Structured Clinical Interview for DSM-III-R diagnosis. These subjects and 23 demographically similar controls completed standardized questionnaires that assessed their defense and coping styles, level of depression, defensiveness, and eating disorder psychopathology.Of the anorexic subjects 35% had no DSM-III-R diagnosis, 43% an eating disorder, (9% anorexia nervosa, 17% bulimia nervosa, 22% eating disorder not otherwise specified), 30% an affective disorder, and 43% an anxiety disorder at follow-up. Factors at presentation associated with good outcome included greater use of mature defenses, less depression, and a lower drive for thinness. Psychological characteristics of anorexic subjects with good outcome resembled those of controls except that the former anorexics expressed greater dissatisfaction with their bodies and reported less use of cognitive avoidance as a coping mechanism. Anorexic subjects with continuing psychiatric problems differed from controls on most of the measures studied.Distribution of psychiatric disorders at follow-up is similar for adolescent and adult-onset anorexia nervosa. Self-report measures of some psychological characteristics are useful prognostic indicators. Absence of psychiatric disorder at follow-up is associated with normalization of many psychological characteristics.

    View details for Web of Science ID A1993MD60300019

    View details for PubMedID 8282670



    We designed this study to replicate previous findings which suggest a relationship between the qualities found in family environments and specific eating disorders through the examination of subjects' reports of family environments. We also attempted to refine previous findings of such relationships by adding an additional psychiatric contrast group. Subjects included patients with the following diagnoses: (1) Anorexia nervosa, restrictor type; (2) anorexia nervosa with bulimic features; (3) normal weight bulimia; and, as a psychiatric control population (4) major depression. In contrast to previous findings, subjects in each diagnostic group do not differ statistically either from each other or from a normative population with regard to reported family environments. However, when we grouped subjects by self-reported level of depression, those with a high level of depression described family environments that are significantly different, independent of the severity of illnesses or diagnoses. We discuss the use of self-report instruments in measuring such complex phenomena as family environment.

    View details for Web of Science ID A1993LJ73800005

    View details for PubMedID 8339098



    Fifty-six adolescents meeting DSM-III-R criteria for anorexia nervosa, bulimia, and major depression, were asked to complete self-assessments of temperament using the Dimensions of Temperament Survey--Revised (DOTS-R). Parents independently rated their children using a parent version of this scale. We found that parents and patients agreed significantly on all nine subscales. This high correlation suggests that parents' perceptions of their adolescents' temperaments concur with the adolescents' self-perceptions. These findings suggest that the observation of temperament remains concordant even in parent/child dyads often characterized by significant conflict.

    View details for Web of Science ID A1993LF00800006

    View details for PubMedID 8325137



    It has been hypothesized that anorexia nervosa is characterized by ineffectiveness, interpersonal distrust, and lack of interoceptive awareness. The Eating Disorder Inventory differentiates patients with anorexia nervosa from weight-preoccupied women on the basis of these subscales. To test further the specificity of these characteristics to anorexia nervosa, the Eating Disorder Inventory scores of 20 adolescent girls diagnosed with anorexia nervosa were compared with those of 21 girls with major depression and 21 girls with both anorexia nervosa and depression. Analyses of variance and discriminant function analysis revealed no significant differences in the scores of the three groups. By 2-year followup, subjects initially diagnosed with only anorexia nervosa showed less psychopathology than those with an additional diagnosis of depression. These findings raise further questions about the overlap between depression and anorexia nervosa and leave open the question of characteristic psychological features in anorexia nervosa.

    View details for Web of Science ID A1992JM58400009

    View details for PubMedID 1400114

  • Defense style and adaptation in adolescents with depressions and eating disorders. Acta paedopsychiatrica Smith, C., Thienemann, M., Steiner, H. 1992; 55 (3): 185-186


    Maturity of defense style has been associated with the level of adaptive functioning, but few studies have assessed defense style using self-report questionnaires which can provide ratings with great reliability and objectivity. We compared self-perception of defense style (using Bond's Defense Style Questionnaire) with ratings of adaptation assessed retrospectively by two independent raters (using the DSM III-R Global Assessment of Functioning scale) in a population of 100 adolescent girls diagnosed as having either an eating disorder or depression. There was significant correlation between maturity of defense style and level of adaptation, with greater maturity of defense style being associated with higher levels of adaptive functioning. This effect was independent of diagnosis within this population.

    View details for PubMedID 1414355

  • Respiratory stridor and repressive defense style in adolescent somatoform disorders. Acta paedopsychiatrica Smith, C., Steiner, H. 1992; 55 (4): 199-202


    Three cases of adolescents with respiratory stridor of psychiatric etiology are described. All three fulfilled DSM-III-R criteria for diagnoses of somatoform disorders and showed characteristics of repressive defense style. Such patients are likely to undergo extensive medical investigation and treatment if the psychiatric nature of their disorder is not recognized, but few data describing their psychological characteristics or treatment exist. Repressors are typically unaware of emotional arousal and do not recognize the negative affects which lead to their somatic symptoms. They therefore respond poorly to confrontational psychotherapy and are at risk of discontinuing treatment and repeating their maladaptive symptom cycle. Identification of repressive defense style in patients with stridor which has no obvious organic cause may be useful both as a possible "marker" of psychiatric disorder and as a guide to treatment.

    View details for PubMedID 1492547

  • Repressive adaptation and family environment. Acta paedopsychiatrica Steiner, H. 1992; 55 (3): 121-125


    The hypothesized connection between adaptive style, specifically repressive adaptation, and the family environments of adolescent clinical samples was investigated. Adolescent patients (n = 221) were studied, who were then divided into four groups matched for sex, age, and socioeconomic status (mean age = 15.7 years, SD 2; sex = 14% boys, 86% girls; SES = 2.4). Grouping was based on the Marlowe Crowne Social Desirability Scale and Spielberger's Trait Anxiety Inventory Scores [repressors (n = 43), impression managers (n = 54), high anxious (n = 55) and low anxious (n = 69)]. Results by MANOVA, Scheffe and discriminate function analysis confirmed our hypothesis. Repressors had distinct family environments as measured by the Family Environment Scale (p = 0.0001). Families were characterized by high levels of cohesion, expressiveness, independence, and organization, displaying correspondingly low levels of achievement orientation, conflict, control and incongruence. Repression may be an effort to adapt to an idealized family environment.

    View details for PubMedID 1414343

  • Psychometric measures in clarifying diagnosis in malnourished adolescents. Acta paedopsychiatrica Thienemann, M., Steiner, H. 1992; 55 (4): 207-210


    Three cases of adolescent females suffering from unexplained weight loss are presented. Differential diagnoses included psychiatric and medical illnesses. We describe how psychometric measures were used in each case to clarify diagnosis.

    View details for PubMedID 1492549



    We treated four patients with chronic vomiting during childhood in whom a tentative diagnosis of psychogenic vomiting was made after an extensive evaluation. In each case, the diagnosis was reconsidered during the course of treatment, as observations about the patients and their response to interventions accumulated. In three instances, these observations did not fit those expected if the diagnosis of psychogenic vomiting was correct. This led to a reexamination of the organic evaluation and the discovery of an undiagnosed organic contribution to the vomiting. In the fourth patient, gastric emptying studies confirmed that there was a strong psychological contribution to the vomiting, and helped to more carefully define this contribution. Family and individual psychotherapy and treatment were aided by the greater clarity in diagnosis.

    View details for Web of Science ID A1991FZ98300026

    View details for PubMedID 1858729



    Using the Ward Atmosphere Scale, we reassessed the ward atmosphere of a psychosomatic unit for children and adolescents that has been operating successfully for 10 years. There was remarkable stability in essential treatment program characteristics despite the complete turnover in patients and a 60% turnover in staff. There was substantial correlation between patient and staff perceptions in 1988 and across time (Spearman's rho: 0.951-0.660, all p values less than 0.05). Patients and staff subgroups differed somewhat in their relative emphases on certain program dimensions but, overall, the program still correlated highly with the therapeutic community cluster described by Moos (Spearman's rho: 0.660-0.809, all p values less than 0.05). This stability was achieved despite multiple health care changes, most notably shortened length of stay. Stability was probably due to high staff/patient ratio, continuity of the medical direction, and focus on milieu maintenance in staff meetings.

    View details for Web of Science ID A1991FU28100004

    View details for PubMedID 1874425



    Comparing mothers' reports of early feeding practices in 18 mothers of anorexics and 25 mothers of normal children by means of a questionnaire, we found that the mothers of anorexics introduced solids earlier and used Schedule rather than Demand feedings more frequently. The mothers of anorexics did not treat patients and control siblings differentially. Our study suggests that differences in early feeding and in infant temperament may be operative in the pathogenesis of anorexia nervosa.

    View details for Web of Science ID A1991EZ76300001

    View details for PubMedID 2007340



    Anorexia nervosa is notoriously difficult to treat, but little is known regarding the relationship of compliance to treatment outcome. We investigated in 41 adolescents who fulfilled DSM-III-R criteria for anorexia nervosa, the relationship between the completion of a standard psychosocial treatment program, subtypes of anorexia nervosa, and outcome as determined by standardized measurements. These adolescents were observed for an average of 32.4 months. Overall, 29 patients (70%) improved considerably, but 10 (24%) were symptomatic, and 2 (5%) remained in poor condition. There were no deaths. Of the 41 patients, 14 (34%) completed our entire treatment program, 15 (37%) received major treatment and failed in the outpatient follow-up phase only, 7 (17%) dropped out of inpatient treatment before its completion, and 5 (12%) refused treatment in our system altogether. Of all the dropouts, 10 received no further treatment. One patient was admitted to hospital elsewhere but again dropped out in the outpatient phase of that program. Seven patients (17%) received further outpatient treatment only, and 9 (22%) received inpatient and outpatient care and seemingly completed their treatment. Treatment completion significantly affected the measures of global clinical functioning and specific psychopathologic features, but only for those patients who completed the initial program. Bulimic patients did considerably worse on follow-up and were less likely to complete treatment. Patients with restricted anorexia nervosa were more likely to complete treatment than those with a bulimic subtype (P = .03). Differential compliance rates in the two subtypes confound the effects of treatment completion and need to be controlled for in future studies. Depression was not associated with noncompliance but, if present, was associated with poor outcome on follow-up and abated in only a third of those in whom it was initially present.

    View details for Web of Science ID A1990DU82600001

    View details for PubMedID 2219868



    A patient referred to the authors for evaluation and treatment of depression, behavioral dyscontrol syndrome, and polydipsia is described. The authors reviewed his medical status and, finding damage to his right temporal lobe, conceptualized his symptom constellation as representing interictal syndrome and treated him with carbamazepine. His affective symptoms, but not the polydipsia, improved following treatment with carbamazepine.

    View details for Web of Science ID A1990DE38700023

    View details for PubMedID 2347849

  • Defense Styles in Eating Disorders International Journal of Eating Disorders Steiner, H. 1990


    The authors explored the role of Cyclo [His-Pro] (CHP) in 50 adolescents who fulfilled DSM III diagnostic criteria for anorexia nervosa and bulimia. CHP, a relatively new neuro modulator which has a role in inducing satiety, was assayed in serum during routine blood work. CHP levels correlated significantly with weight in restrictor (AN-R) (R = -0.449, P less than 0.05) and bulimic anorexics (AN-B) (R = +0.489, P less than 0.01). There was no significant correlation in normal-weight bulimics (NWB) (R = +0.556, P less than 0.01). It did not correlate with weight in a depressed control group. Longitudinal data on six patients showed a similar relationship between weight, purging and CHP binge/purge activity and/or weight changes of around 2 kilograms correlated with average CHP changes of 42%. Clinical material suggests changes in satiety during CHP changes consistent with a satiety disturbance model of these disorders.

    View details for Web of Science ID A1989AW51800006

    View details for PubMedID 2615922



    The effect of desipramine hydrochloride was studied in children who were treated for eating disorders (5), attention deficit disorder (13), or affective disturbance (3). Serial heart rate, blood pressure, ECG, and 24-hour ambulatory monitoring were recorded before treatment and at 4 and 8 weeks during treatment. Maximum dose of desipramine was 5 mg/kg/day, average 4.25. A 21% increase in heart rate and 2.5% increase in QTc at 4 weeks were sustained at 8 weeks. No dysrhythmias or clinically significant changes in blood pressure occurred. Desipramine is safe in children who have normal cardiovascular examinations and ECGs when used within the limits of the study design. The cardiovascular effects of desipramine should be kept in mind and monitored when patients are starting tricyclic antidepressant therapy such as desipramine.

    View details for Web of Science ID A1989U609000012

    View details for PubMedID 2661525


    View details for Web of Science ID A1988N956700002

    View details for PubMedID 3402259



    The purpose of this study was to test the relationship between social environment and the activity of the HPA axis in adolescents. Ten elective admissions to Children's Hospital at Stanford were assessed by standard psychiatric interview. Five fulfilled criteria for a DSM-III diagnosis, five others did not. The groups were comparable in age, height, weight, SES, and number of previous hospitalizations. All subjects and their families completed the Family Environment Scale. All subjects had plasma cortisol concentrations determined on days 1, 3, and 5 of hospitalization and at the time of discharge. Samples were drawn under standardized conditions, after a brief interview during which potentially stressful events of the day were discussed. Results revealed that the five individuals with poor coping skills, as defined by the presence of a DSM-III diagnosis, had significantly higher peak concentrations of plasma cortisol, than the five psychiatrically normal subjects. Peak cortisol elevations occurred upon discharge from the hospital. Family environment in the two groups differed significantly on the dimensions of cohesion, conflict, control, and incongruence of perception of the environment among family members themselves. The findings support the hypothesis that social environmental characteristics are associated with psychiatric and physiological measures of coping.

    View details for Web of Science ID A1988Q222900005

    View details for PubMedID 3227090

  • DEFENSE STYLE AND THE PERCEPTION OF ASTHMA PSYCHOSOMATIC MEDICINE Steiner, H., Higgs, C. M., Fritz, G. K., Laszlo, G., Harvey, J. E. 1987; 49 (1): 35-44


    Approximately 15% of patients with bronchial asthma are unable to sense marked changes in airway obstruction. We have investigated the hypothesis that inability to sense changes in the severity of bronchial asthma varies with insensitivity to emotional arousal, which in turn is associated with repressive defense styles. Nine asthmatic patients were studied comparing actual changes in peak flow rate using a coded peak flow meter and in arousal during a stress-inducing psycholinguistic protocol with perceived changes. Our hypotheses were confirmed. Ability to perceive changes in asthma could be predicted from performance on the psycholinguistic stress test (Spearman's rho = +0.733, p less than 0.01). Repressors performed significantly worse on the asthma perception task (Spearman's rho = -0.650, p less than 0.05). The results suggest a role for defense pathology in the psychomaintenance of asthma.

    View details for Web of Science ID A1987F961800003

    View details for PubMedID 3823349



    Bulimia is a serious and prevalent eating disorder in the adolescent population. The pediatrician is often in a position to make the initial diagnosis of bulimia but must suspect the disorder in light of subtle physical evidence. Denial and embarrassment reduce the likelihood of self-report of symptoms. Hand lesions resulting from self-induced emesis have a distinctive configuration and appearance. Noting these characteristic lesions during a physical examination should alert a physician to the diagnosis of bulimia or to an exacerbation of symptoms in a patient whose condition was previously diagnosed.

    View details for Web of Science ID A1986AXF5200023

    View details for PubMedID 3455790


    View details for Web of Science ID A1984TW58500004

    View details for PubMedID 6510030


    View details for Web of Science ID A1983AUZ9000001

    View details for PubMedID 6678710


    View details for Web of Science ID A1982QN37200001

    View details for PubMedID 7182114

  • A PSYCHOSOMATIC APPROACH TO CHILDHOOD ASTHMA JOURNAL OF ASTHMA Steiner, H., Hilliard, J., Fritz, G. K., LEWISTON, N. J. 1982; 19 (2): 111-121

    View details for Web of Science ID A1982QC06800008

    View details for PubMedID 7118812



    The authors evaluated six acute short-stay admission wards in a community mental health center using the sociometric Ward Atmosphere Scale. There was an attempt to run three of the six wards as therapeutic communities. No differences were found on Ward Atmosphere Scale dimensions between the therapeutic communities and other types of programs, nor did the therapeutic communities conform to an empirically derived therapeutic community program dimension profile. Possible reasons for this failure and its implications for community mental health centers are discussed.

    View details for Web of Science ID A1982NW07200010

    View details for PubMedID 7091407



    With many asthmatic children for whom emotional factors are significant, joint pediatric and psychiatric management is essential. A three-level model of collaboration is presented, including (1) pediatric care, (2) psychiatric consultation, and (3) inpatient psychosomatic treatment. The organization, professional roles, and treatment protocol of the psychosomatic inpatient service are described. A review of the first 16 asthmatic children who received inpatient care in the program suggests that such a model may present a viable alternative to long-term residential care.

    View details for Web of Science ID A1981MT91700003

    View details for PubMedID 7307410



    The psychiatric complications occurring in a group of adult burn patients were correlated with pertinent data in the literature and a classification constructed, based on the three stages of the acute grief response to injury: psychiatric complications occur when the process of mourning is arrested in a regressive episode. Thirty-five adult patients with burns of greater than 7% body surface area were studied. It was found that Body Surface Area burned, the presence of a Premorbid Psychiatric Diagnosis, and Age are all significantly correlated with the occurrence of psychiatric complications following burn injuries and account for 61% of the variance in the sample. The implications of these findings and possibilities for further research are discussed.

    View details for Web of Science ID A1977DA91600008

    View details for PubMedID 846020