In many jurisdictions, adolescents acquire the right to consent to treatment; but in some cases their refusals – e.g. of life-saving treatment – may not be respected. This asymmetry of adolescent consent and refusal seems puzzling, even incoherent. The aim here is to offer an original explanation, and a justification, of this asymmetry. Rather than trying to explain the asymmetry in terms of a variable standard of competence – where the adolescent is competent to consent to, but not (...) refuse, certain interventions – the account offered here focuses more closely on the normative power to render actions permissible. Where normative powers are shared they can readily give rise to an asymmetry between consent and refusal. We then turn to why it is justifiable that normative powers be shared in adolescence. Transitional paternalism holds that the acquisition of normative powers by competent adolescents should not be an instant one, achieved in a single step, but that there should be a transitional period where paternalistic protection is rolled back, but not entirely withdrawn until a later date. Transitional paternalism could be implemented without generating the asymmetry between consent and refusal but, it is argued, the asymmetric version of transitional paternalism is to be preferred insofar as it offers a greater respect for the adolescent's decisions than the symmetrical alternative. (shrink)

Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced (...) a tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

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

Drawing on a conception of scientists and community members as partners in the construction of ethically responsible research practices, this article urges investigators to seek the perspectives of teenagers and parents in evaluating the personal and political costs and benefits of research on adolescent risk behaviors. Content analysis of focus group discussions involving over 100 parents and teenagers from diverse ethnic and socioeconomic backgrounds revealed community opinions regarding the scientific merit, social value, racial bias, and participant and group harms (...) and benefits associated with surveys, informant reports, intervention studies, blood sampling, and genetic research on youth problems. Participant comments highlight new directions for socially responsible research. (shrink)

An informed consent and voluntary assent in biomedical research with adolescents is contingent on a variety of factors, including adolescent and parent perceptions of research risk, benefit, and decision-making autonomy. Thirty-seven adolescents with asthma and their parents evaluated a high or low aversion form of a pediatric asthma research vignette and provided an enrollment decision; their perceptions of family influence over the participation decision; and evaluations of risk, aversion, benefit, and burden of study procedures. Adolescents and their parents agreed (...) on research participation decisions 74% of the time, yet both claimed ultimate responsibility for the participation decision. Both rated most study procedures as significantly more aversive than risky. Parents were more likely to rate aspects of the hypothetical study as beneficial and to provide higher risk ratings for procedures. Disagreements concerning research participation decisions and decision-making autonomy have implications for the exercise of voluntary assent in biomedical research. (shrink)

Standards for professional training and practice are defined by accrediting organisations or statutory bodies. These describe the arena in which the practitioner may speak with authority. The sphere of authorised practice is further delineated by the external resources available. Within this explicit framework, unconscious mental processes can affect the professional response in potentially adverse ways. This is particularly important in mental health practice. Professionals must be prepared to examine their own responses on this basis in order to enhance their knowledge (...) of the patient and minimise the possibilities of the patient becoming the victim of the professional's own psychopathology. The maintenance of such a position in an institution or organisation requires a similar process within its structure in order to provide the necessary setting and define the limits of good practice. In this paper, the field of adolescent mental health is specifically examined. (shrink)

The Declaration of Helsinki and the Council of the International Organization of Medical Sciences provide guidance on standards of care and prevention in clinical trials. In the current and increasingly challenging research environment, the ethical status of a trial design depends not only on protection of participants, but also on social value, feasibility, and scientific validity. Using the example of a study assessing efficacy of a vaccine to prevent human papilloma virus in HIV-1 infected adolescent girls in low resource (...) countries without access to the vaccine, we compare several trial designs which rank lower on some criteria and higher on others, giving rise to difficult trade-offs. This case demonstrates the need for developing more nuanced guidance documents to help researchers balance these often conflicting criteria. (shrink)

BackgroundAcrophobia is a specific phobia characterized by a severe fear of heights. The purpose of the present study was to investigate the efficacy of two therapies that may ameliorate symptoms of acrophobia and anxiety sensitivity, i.e., virtual reality exposure therapy (VRET) and eye movement desensitization and reprocessing (EMDR) therapy with a Waiting List Control Condition (WLCC).MethodsWe applied a three-armed randomized controlled pre-post-test design with 45 female adolescent students. Students who met DSM-5 criteria for acrophobia were randomly assigned to either (...) VRET (N = 15;Mage = 17.26; SD = 1.32), EMDR (N = 15;Mage = 17.15; SD = 1.57), or a WLCC (N = 15;Mage = 17.50; SD = 1.26). The study groups were evaluated one week before the intervention and one week after the last intervention session regarding symptoms of acrophobia (Severity Measure for Acrophobia) and anxiety sensitivity (Anxiety Sensitivity Index).ResultsThe data showed that both the application of VRET and EMDR therapy were associated with significantly reduced symptoms of acrophobia (d = 1.03 for VRET and d = 1.08 for EMDR) and anxiety sensitivity (d = 1.15 for VRET and d = 1.13 for EMDR) in comparison to the Waiting List.LimitationsThe sample consisted only of adolescent women. Due to the recognizable differences between the two interventions, the therapists and the participants were not blind to the conditions.ConclusionThe results suggest that both VRET and EMDR are interventions that can significantly improve symptoms of acrophobia and anxiety sensitivity in female adolescents.Clinical Trial Registrationhttps://www.irct.ir/trial/57391, identifier: IRCT20210213050343N1. (shrink)

In this paper, I explore the ways in which consideration of adolescent parents forces us to confront and question common presuppositions about parental rights. In particular, I argue that recognising the right of adolescent mothers not to be forcibly separated from their newborn children justifies rejecting the notion that parental rights are all acquired in the same manner and acquired as a ‘bundle’ of concomitant moral rights. I conclude that children and adolescents who conceive and give birth have (...) some parental rights concerning their newborn children – in particular, the right not to be forcibly separated from those children – even if they do not have the ‘full complement’ of parental rights as we generally characterise these. (shrink)

ObjectivePrevious research has shown that adolescents in single-mother households are at heightened risk for adjustment problems. However, limited studies have investigated the mechanisms leading to adolescent problem behaviors in single-mother households. To address this research gap, this study applied the Family Stress Model to examine how single mothers’ material hardship is linked to adolescent problem behaviors, focusing on the mediating roles of mothers’ depression and mother-adolescent closeness. The moderating role of adolescent school connectedness in the relationships (...) between mother-adolescent closeness and school connectedness and between mothers’ depression and school connectedness was also investigated.Materials and methodsThe study analyzed data from 1,384 adolescents and their single mothers who participated in the Fragile Families and Child Wellbeing Study at Wave 6. The associations between study variables were analyzed using structural equation modeling by decomposing the direct, indirect, and total effects of material hardship on adolescent problem behaviors. School connectedness’s interactions with mother-adolescent closeness and mothers’ depression were also examined.ResultsResults showed a significant indirect relationship between material hardship and adolescent problem behaviors through sequential mediation of mothers’ depression and mother-adolescent closeness. Mothers’ depression also significantly mediated the relationship between material hardship and problem behaviors. Lastly, school connectedness moderated the relationship between mother-adolescent closeness and adolescents’ internalizing behaviors. The association between mother-adolescent closeness and adolescents’ internalizing behavior was weaker for adolescents with higher levels of school connectedness.ConclusionThe results indicate the important indirect effect of economic strain on adolescents’ problems behaviors in single-mother households, which has been less emphasized compared to the effects in earlier childhood. High rates of material hardship and adolescent problem behaviors in single-mother families call for multifaceted interventions focusing on family processes and protective factors, including school environment. (shrink)

In an Israeli qualitative study with adolescent cancer survivors and parents who had considered fertility preservation, practically all participants could not recall any discussions with healthcare providers about plans for cryopreserved biological materials in the case of death. This finding is surprising given recent court struggles in Israel over the posthumous use of cryopreserved sperm. In interviews with these adolescent survivors and their parents, intended future use of cryopreserved biological materials is directed for affected individuals’ reproductive purposes later (...) in life, with hardly any consideration of others' use of these materials for posthumous reproduction. To avoid future ethical and legal quagmires, healthcare professionals should have frank discussions with adolescents and their parents about what to do with such materials in the case of death. This paper discusses the socio-cultural and legal Israeli context and considers the ethical implications of using minors’ biological materials for posthumous assisted reproduction in Israel. (shrink)

Consumer (in)vulnerability is studied via a quasi-ethnographic longitudinal study of adolescents aged 11–15. The study focuses on how adolescents define their vulnerabilities within their adolescent consumption subcultures, the factors enhancing this vulnerability, and the social actors involved in their experience of vulnerability. The findings contribute to consumer vulnerability literature in three ways. First, by adopting an adolescent-centric approach based on an emic perspective, we go beyond the monolithic approach of studying one source of vulnerability at a time seen (...) in present marketing literature. Instead, we introduce a polyadic or multiple simultaneous approaches that can consider risk sources. Second, the findings show that adolescents’ perceptions of consumer vulnerability are anchored within their consumption subcultures. This study introduces the concept that young consumers experience vulnerability in multiple ways, including imposed by adults or by adolescents deliberately engaging in risky behaviors. Third, this research provides ethics policy-makers and scholars with the conceptual framework of adolescent-centric vulnerability, which can help them to develop actions based on both imposed and deliberate sources of vulnerability from the perception of the adolescent. (shrink)

There is a continued need to consider ways to prevent early adolescent engagement in a variety of harmful risk-taking behaviours for example, violence, road-related risks and alcohol use. The current prospective study examined adolescents? reports of intervening to try and stop friends? engagement in such behaviours among 207 early adolescents (mean age?=?13.51?years, 50.1% females). Findings showed that intervening behaviour after three months was predicted by the confidence to intervene which in turn was predicted by student and teacher support although (...) not parental support. The findings suggest that the benefits of positive relationship experiences might extend to the safety of early adolescent friendship groups particularly through the development of confidence to try and stop friends? risky and dangerous behaviours. Findings from the study support the important role of the school in creating a culture of positive adolescent behaviour whereby young people take social responsibility. (shrink)

_Illegal Leisure _offers a unique insight into the role drug use now plays in British youth culture. The authors present the results of a five year longitudinal study into young people and drug taking. They argue that drugs are no longer used as a form of rebellious behaviour, but have been subsumed into wider, acceptable leisure activities. The new generation of drug user can no longer be seen as mad or bad or from subcultural worlds - they are ordinary and (...) everywhere. Illustrated throughout with interview material, _Illegal Leisure _shows how drug consumption has become normalised, and provides a well-informed analysis of the current debate. (shrink)

PurposePast research has documented a significant relationship between family violence and adolescent violence. However, much is unknown about the processes through which this association occurs, especially in the non-Western cultural context. To address this gap, we propose an integrated model encompassing multiple pathways that connect family violence to adolescent violence. Specifically, this study investigates how family violence is related to adolescent violence through violent peer association, normative beliefs about violence, and negative emotions.MethodWe tested the model using the (...) two-wave survey data collected from a probability sample of more than 1,100 adolescents residing in one of the largest metropolitan areas in China in 2015 to 2016.Results and ConclusionsThe results indicated that family violence predicted adolescent violence perpetration. Violent peer association, normative beliefs, and negative emotions, however, mediated much of the relationship between family violence and adolescent violence. (shrink)

This essay pursues the psychological and communicological problematic of “lying” from the standpoint of Nietzsche, Bataille, and the psychoanalytic study of family systems. For purposes of this essay, “lying” will be defined as a conscious misrepresentation of one’s own experiential memory. The essential argument of the essay, closely following Bataille’s concept of eroticism and communication, will be that the transformation of selfhood from childhood to adolescent sexual embodiment necessitates the performance of the lie as a necessary “crime” against the (...) home-world of the family system. Herman Hesse’s novel, Demian, serves as a critical source of illustration for the existential bargain of adolescence. (shrink)

Capacity and competence in the field of child and adolescent psychiatry are complex issues, because of the many different influences that are involved in how children and adolescents make treatment decisions within the setting of mental health. This article will examine some of the influences which must be considered, namely: developmental aspects, the paradoxical relationship between the need for autonomy and participation and the capacity of children, family psychiatry, and the duty of care towards children and adolescents. The legal (...) frameworks relevant to consideration of consent and competence will be briefly considered, as well as some studies of children's consent, participation and competence. A case vignette will be used as a focus to consider the complexity of the issue of competence in child and adolescent psychiatry, in the particular mental disorder of anorexia nervosa. (shrink)

Of the different features of this case, I focus on the pediatric endocrinologist's refusal to treat the patient. Providers generally have wide latitude in accepting or refusing patients. Appropriat...

Of the different features of this case, I focus on the pediatric endocrinologist's refusal to treat the patient. Providers generally have wide latitude in accepting or refusing patients. Appropriat...

Internet addiction is a growing social problem with negative mental and social outcomes; the present study examined whether rejection sensitivity mediates the relationship between interparental conflict and adolescent IA and the moderating role of school connectedness. One thousand and seven adolescents anonymously completed questionnaires to assess interparental conflict, school connectedness, rejection sensitivity, IA, and demographic information. The model results showed that: the positive association between interparental conflict and adolescent IA was partially mediated by rejection sensitivity; this indirect link (...) was moderated by the school connectedness and was stronger for adolescents with high school connectedness. The results provide support for the attachment theory that high interparental conflict could increase adolescents’ rejection sensitivity, and high school connectedness plays a double-edged role that adolescents show more rejection sensitivity while reporting high interparental conflict and high school connectedness. (shrink)

Die forensische Kinder- und Jugendpsychiatrie steht in einem komplexen Spannungsfeld medizinischer, rechtlicher und sozialer Anforderungen. Die ethischen Herausforderungen, die sich daraus für den stationären Maßnahmenvollzug ergeben, sind bisher kaum untersucht, spezifische Hilfestellungen für Behandelnde fehlen. Diese Studie hat zum Ziel, ethische Themenfelder und Probleme in diesem Bereich zu identifizieren und ein Instrument zur Früherkennung und -intervention ethischer Probleme im Klinikalltag zu entwickeln. Methode: Eine systematische Literaturrecherche sowie eine Beobachtungstudie in der Jugendforensik der Universitären Psychiatrischen Kliniken Basel werden durchgeführt. Die Beobachtungsdaten (...) werden mittels qualitativer Inhaltsanalyse ausgewertet. Das Instrument wird auf der Basis der Resultate nach einer neuen Methode entwickelt. In der Literaturrecherche wurden 14 valide Publikationen identifiziert, die hauptsächlich ethische Probleme der Gerichtspsychiatrie thematisieren wie professionelle Rollenkonflikte, ethische Probleme der Diagnostik und Begutachtung oder der Umgang mit vertraulichen Informationen. Empirische oder empirisch-normative Studien fehlen. In der Beobachtungsstudie wurden 24 ethische Themen und spezifische Probleme identifiziert, besonders häufig sind ethische Fragen zu Moralkompetenzen der Jugendlichen, zur Behandlungsqualität, zum Umgang mit Regeln und Sanktionen und zur Freiheits- und Privatsphäre. Das Instrument zur Früherkennung und -intervention ethischer Probleme enthält die vier Kernelemente Risikofaktoren, Indikatoren, Interventionsplanung und Entscheidungsfindung. Der Maßnahmenvollzug der forensischen Kinder- und Jugendpsychiatrie offenbart ein breites Spektrum ethischer Themen mit spezifischen ethischen Problemen, welche in der Literatur bisher nur unzureichend untersucht sind. Das hier entwickelte Instrument FIEP unterstützt Behandelnde dabei, ethische Probleme frühzeitig zu erkennen und effizient zu bearbeiten. (shrink)

Adolescents are routinely treated differently to adults, even when they possess similar capacities. In this article, we explore the justification for one case of differential treatment of adolescents. We attempt to make philosophical sense of the concurrent consents doctrine in law: adolescents found to have decision-making capacity have the power to consent to—and thereby, all else being equal, permit—their own medical treatment, but they lack the power always to refuse treatment and so render it impermissible. Other parties, that is, individuals (...) who exercise parental responsibility or a court, retain the authority to consent on an adolescent’s behalf. We explore four defences of the doctrine. We reject two attempts to defend the asymmetry in the power to consent to and refuse medical treatment by reference to transitional paternalism. We then consider and reject a stage of life justification. Finally, we articulate a justification based on the distinctiveness of adolescent well-being. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page W1-W3, June 2011.

The present study focuses on meeting online strangers face-to-face. This activity represents one of the least prevalent but also most feared online risks for youth. Due to the low number of youth experiencing upsetting meetings and the dominance of quantitative research designs in the area, the current state of knowledge does not provide a clear view of what happens at meetings that youths find upsetting. The aim of the present study is to enrich knowledge in this area by exploring such (...) upsetting experiences in more depth by using qualitative methodology. Based on 14 interviews with Czech girls aged 15 to 18, who reported upsetting meetings with online strangers, the study identifies the discrepancy between expectations and reality as the core reason for these negative feelings. There were several reasons for this discrepancy: different developmental phases, related different experiences with romantic relationships, and exaggeration of impressions formed online. (shrink)

This study examines how evidence is used differently in argumentative discourse compared to individual arguments. Applying a 1×2 crossover study design, 37 secondary school students were asked either to discuss a social issue with their partner before individually writing an essay outlining their opinion or, vice versa, first to discuss and then to write. As background information, they were provided with pieces of evidence with different levels of quality. Dialogs and essays were analyzed regarding (a) the type of evidence and (...) (b) the way evidence was used. Results showed that in their essays students referred more often to the pieces of evidence provided to them (shared evidence). In contrast, they used evidence more often to address the opposing viewpoint in dialogs by incorporating it in a more elaborated (clearer) line of reasoning. Findings suggest that dialogues are a more effective tool than individual writing production, and the study provides first hints regarding how to design curricula that will encourage students to use evidence in a more sophisticated way in their argumentation. (shrink)