sou · GTB381d6 · 2006-01-01 00:00:00 — Sociala barn- och ungdomsvårdskommitténs hearing Vetenskap och praktik Sociala barn- och ungdomsvårdskommittén anordnade en forsk- ningshearing med temat Vetenskap och praktik . Syftet med hearingen var att få resultaten av aktuell nationell forskning presenterad samt att få en verksamhetspresentation från två av de kommuner som sekretariatet besökt. Vi eftersträvade också att få en konstruktiv dialog omkring vilka slutsatser som bör dras och om vilka åtgärder som samhället bör vidta för att möta otillfredsställda behov inom den sociala barn- och ungdomsvården. I denna bilaga återfinns de tre inbjudna forskarnas inlednings- anföranden samt och kommuns presentation av sitt arbete inom den sociala barn- och ungdomsvården. Kommittésekreterare var moderator. Kommitténs ordförande, riksdagsledamoten De medverkandes anföranden återges i den form de skickades in till kommittésekretariatet. Barn i riskzonen, vilka är de och hur ser riskzonen ut? Av professor , ................ Time trends in the adjustment of Swedish teenage girls: A 26-year comparison of 15-year olds................................. Time Trends in the Adjustment of Swedish Teenage Girls: A 26-year Comparison of 15-year-olds............................... Time Trends in Child and Adolescent Behavior Problems..... Time Trends in Psychosocial Disorders................................... Vetenskap och värderingar i social barnavård Av fil.dr , , .................. Problem inom den sociala barnavården .................................... Förslag till lösningar .................................................................. Kunskap, organisation och resurser i den sociala barn- och Av professor , .... Resurscentrum En – berättelse om samverkan Av rektor , , chef för och Ungdom ........................ Kommunmedborgaren i centrum.............................................. kommun – Hur arbetar vi med familjen som resurs? Kamlen och , i kommun.505 Barn i riskzonen, vilka är de och hur ser riskzonen ut? Av professor , . Underlag till denna föredragning är skriven på engelska ******************************************************** Time trends in the adjustment of Swedish teenage girls: A 26-year comparison of 15-year olds of Psychology, , of Psychology, , of Behavioural, Social and Legal Sciences, RUNNING HEAD: Time trends in the adjustment of Swedish teenage girls DRAFT 04 01 27 Wångby, M., , D., & , H. (2004). Time trends in the adjustment of Swedish teenage girls: A 26-year comparison of 15-year olds. The aim of this study was to investigate stability and change over 26 years in self-reported adjustment of Swedish teenage girls. Data were collected with the same questionnaire from two school- cohorts in a middle-sized Swedish community: 522 girls attending Grade 8 (approximately at age 15) in 1970, and 529 girls attending Grade 8 in 1996. The first cohort was part of the longitudinal research programme Individual Development and Adaptation In most domains, adjustment problems were approximately as common in 1996 as in 1970, with the exception for increases in problems with self-esteem and antisocial problems. In the anti- social domain, a polarization process was indicated, with increases also in positive adjustment. Furthermore, positive adjustment was also more common in relations to others, especially in relations to peers. The results are discussed in relation to earlier findings and to social changes during the period. Keywords: adjustment problems, polarization, positive adjustment, repeat study, secular change, teenage girls Corresponding author: M. Wångby Time Trends in the Adjustment of Swedish Teenage Girls: A 26-year Comparison of 15-year-olds Since the 90s, increasing interest has been focused on the question whether the widespread social changes during past decades have caused changes in levels of psychosocial disturbances among children and adolescents (, Slomkowski, & Robins, 1999; Rutter & , 1995). The identification of such changes is of high concern and has important implications for public health policies and the planning of prevention and intervention efforts. It is also essential for understanding the relation between social conditions and the development of psychosocial disturbances (Achenbach & Howell, 1993; Fombonne, 1995a; Verhulst, 1995). To identify and measure time trends in psychosocial distur- bances, two main types of study designs are preferable: the prospective longitudinal study of multiple birth cohorts, which provides unbiased estimates of incidence and age of onset; and repeated cross-sectional surveys of community samples which supply time series of point prevalences for specific age groups (Fombonne, 1995). Information on time trends from these types of studies is still scarce, however (Achenbach, Dumenci, & Rescorla, 2003; Rutter & , 1995). Repeat surveys on substance abuse, for example, have been performed in the and in since the 1970s (CAN, 1998; Silbereisen, Robins, & Rutter, 1995). But, to our knowledge there are only a few repeat surveys that cover a broader spectrum of problems among young people. Time Trends in Child and Adolescent Behavior Problems The first study that is usually cited in this connection was performed by and co-workers in Sudanese villages near (, 1968; , 1984) between 1964/65 and 1979/80. This was a period of rapid urbanisation of the area. The methodological procedures employed at each phase of the study were strictly identical: First, there was a screening of all children aged 3–15 years in the area concerning four behavior problems. Secondly, a psychiatric investigation was made of a stratified sample of children from three different symptom groups. Both in the extensive and the intensive study, the mother was interviewed about the childrens symptoms. The results showed that behavioral problems had increased in 1980, particularly among boys of school age, who were the children most exposed to the rapidly changing social conditions. Still, however, the children in the area showed remarkably low frequencies of most behavioural problems as compared with children in other (both developing and developed) countries. In the , a series of studies have been carried out on time trends in the problems and competences of American children and adolescents with the Based Assessment (ASEBA; Achenbach & Rescorla, 2001). This series spans the 23-year period from 1976 to 1999, and makes use of both parent-ratings (Achenbach & Howell, 1993; Achenbach et al, 2003) and teacher ratings (Achenbach, Dumenci, & Rescorla, 2002a) for demographically similar samples of non-referred American children aged 7–16 years at three time points. In 1989 and 1999, data were also collected for randomly selected popula- tion-based national samples, using parent- and teacher-ratings for children aged 7–16 years and parent-, teacher- and self-ratings for children aged 11–18 years (Achenbach, Dumenci, & Rescorla, The main findings from these studies were that adjustment problem scores increased and competence scores decreased among American children during the first time period between 1976 and 1989, but that these trends were reversed during the following time period, between 1989 and 1999. The total problem scores using parental ratings were higher in 1999 than in 1976, but not as high as in the intermediate time point, 1989 (Achenbach et al., 2003). A partly similar pattern was found for teacher ratings over an 18-year period: the total problem score was highest in 1989 but non- significantly lower in 1999 than in 1981/82 (Achenbach et al., 2002a). These time trends were similar for boys and girls and for children of different ages. All effect sizes were small, however. The authors suggested that childrearing conditions might have been enhanced by better economic conditions, lower unemployment, and less crime during the 1990s than the 1980s and that this might have contributed to the identified pattern of time trends (Achenbach et al., 2003, p. A similar study with instruments from the ASEBA system was also performed for Dutch children over a 10-year period by Verhulst, and Rietbergen (1997). They compared problems and competencies rated by parents and teachers in 1983 and 1993, for two random samples of Dutch children, aged 4 - 16 years. No significant differences were found on the total scores of the Child Behavior Checklist (CBCL; Achenbach, 1991a) or the Teachers Report Form (TRF; Achenbach, 1991b). A few differ- ences indicating an increase in problems were found for the CBCL somatic complaints, delinquent behavior and thought problem scales and for the TRF attention problem scale. The magnitude of these differences was very small, however, accounting for or less of the variance. The overall conclusion made by the authors was that there was no evidence of a clear increase in the malfunc- tioning of Dutch children and adolescents over the 10-year period. Time Trends in Psychosocial Disorders While the findings from repeat studies of adjustment problems in general population samples suggest that there has been change over the past decades, the study of time trends in psychosocial disorders has presented a different picture. In 1990, Academia Europaea established a study group to consider the scientific evidence on whether psychosocial disorders in young people had become more, or less, frequent over the past 50 years. The psycho- social disorders covered were crime, suicide and suicidal behavior, depression, eating disorders, and the abuse of alcohol and psychoactive drugs. The overall conclusion of the study group was that for all of the disorders, except eating disorders (for which no conclusions could be drawn), there was unmistakable evidence of an increase since the Second World War in nearly all developed countries (Rutter & , 1995). For several of the disorders the increase was most pronounced up to the 80s, however, and then levelled off. This was true at least for alcohol consumption and suicide and to a certain extent also for crime (Rutter, Giller, & Hagell, 1998). The repeat studies of general population samples were mainly confined to the 80s and the 90s. This difference in time frame makes it difficult to decide whether there is a real discrepancy between the findings concerning psychosocial dis- orders and the findings concerning adjustment problems in general population samples. To be sure, a small but general increase in adjustment problems among American children was reported by Achenbach and coworkers for the time period between 1976 and 1989. The Academia Europaea study group reported substantial diffi- culties in finding measures for each of the target disorders, and in establishing reliable time series data (, 1995). The difficulties appear to have been especially troublesome for disor- ders with a female preponderance, such as depression, eating disor- ders and suicidal behavior. Unlike crime, alcohol abuse, and com- pleted suicides, these disorders leave few traces in official statistics. Concerning depressions, it is only in recent years that general population surveys have been carried out that provide estimates of their prevalence (Fombonne, 1995a). Crucial to the conclusion of a rise in depressive conditions were the results of a number of cross- sectional general population surveys, of which the US Epidemi- ological Catchment Area Study (ECA; Robins, Locke & Regier, 1991, cited from Fombonne, 1995a) was one of the most impor- tant. The population survey data on subjects earlier depressions in these surveys were retrospective. The conclusion of the Academia Europaea study group, however, was that recall effects were not likely to be the main explanation for the increase of depressive disorders in younger age cohorts (Fombonne, 1995a; , 1995). In a review of the Academia Europaea study, (1996) made the note that, with their focus on psychopathology, the study group might only have presented one side of the story about young peoples adjustment during the past 50 years. suggested that the increasing structural diversity characterizing childrearing conditions in the western societies during this time period would lead to an increasing variability in adolescent adjustment patterns (p. 486), which might be expressed not only in increasing numbers of young people with adjustment problems at one tail of the distri- bution, but also in increasing numbers of young people showing positive adjustment at the other tail of the distribution. This is a description of a polarization process, although the term is not used by . As pointed out by Achenbach et al. (2003), the decrease in competence scores and increase in problem scores among American children between 1976 and 1989 would not be in line with hypothesis. Consistent with the hypothesis, however, Achenbach and coworkers found an increasing variability (i.e., larger standard deviations) in problem scores of American children across the whole time period from 1976 to 1999. One way of investigating time trends in young peoples psycho- social adjustment is to repeat earlier cross-sectional studies of adjustment problems, originally not intended as repeat surveys. This is the approach taken in the present study, which compares the findings from two surveys of adjustment problems among 15 year-old Swedish girls. The first survey was made in the community of in 1970 as part of the Swedish longitudinal research program Individual Development and Adaptation (); the repeat survey was made in the same community 26 years later, in 1996. These two school-cohorts are compared with regard to three aspects of the girls adjustment reports: (a) overall adjustment, (b) negative adjustment, and (c) positive adjustment. There are important theoretical reasons for studying negative and positive adjustment separately, the most fundamental being that positive adjustment can be something qualitatively different from negative adjustment and not just the negation of it (, 1997; , 2002). The distinction between good and poor adjustment might be of specific importance in the study of time trends, if there are different time trends in good and poor adjustment, as indicated by (1996). Further, if there is an increasing diversity in young peoples adjustment patterns, as suggested by , this may show up in an increased variability of overall adjustment. To test for this possi- bility we followed Achenbach et al. (2003) in comparing the stand- ard deviations of the two cohorts in the various areas of adjust- ment. Where differences in standard deviations were found we also tested if this was the result of a polarization process. Data from two Swedish school-cohorts were used in the present study. The 1970 school-cohort included all adolescent girls attending Grade 8 in in the spring term 1970. These girls were all enrolled in the Swedish longitudinal research program Individual Development and Adaptation (; , 1988). A detailed description of the 1970 investigation is given by (1972) and by , and Zetterblom (1975). The 1996 school-cohort included all adolescent girls attending Grade 8 in in the spring term 1996. Data were taken from a series of data collections performed by professor in the schools of in 1995 and 1996. Both in 1970 and 1996, the data were collected in when the subjects were 14 years and 10 months at the average. The 1970 cohort. The 1970 school cohort included 590 girls, and 522 () of them were present at school and filled out the questionnaire when the data were collected. An analysis of the drop-out was made for the 1970 data (, 1972, 1986): The absence from school at the time of the data collection was mostly due to illness (of absentees), but girls with severe adjustment problems were over-represented among the absent girls. For instance, girls who had been in contact with any professional net- work because of their own adjustment problems constituted of those who filled out the questionnaire, but of those who did not. The 1996 cohort. The 1996 school cohort included 602 girls, and 529 () of them filled out the questionnaire. This drop-out was of the same size as in the 1970 cohort. Unfortunately, no data were available for an analysis of the drop-out. The reduced 1996 cohort. In the time period between 1970 and 1996, the immigration to increased substantially. In the 1996 version of the questionnaire, the girls were asked about the birth country of their mother and their father, respectively. Five- hundred and nine girls answered both of these questions. Out of these, seventy girls () stated that their mother and/or their father was born in a non-Nordic country. For some analyses these girls were excluded from the 1996 cohort. The reduced 1996 cohort included 439 girls (see below). Teenage girls adjustment problems were documented with a self- report questionnaire, the Symptom Questionnaire, constructed by the investigators of the research program (, 1972; , 2001; et al., 1975). Measures of adjustment problems based on data from this questionnaire have been used in several studies that have found associations with con- temporary, registered adjustment problems (, 1995), biological age (, 1990), and registered adjustment problems in early adulthood (Wångby, 1997), which suggests that it has a reasonable validity. The questionnaire includes a total of 132 items, covering ten different adjustment domains: physical problems, emotional prob- lems, self-esteem, antisocial problems, relation to mother, relation to father, relations to parents (unspecified), relations to teachers, rela- tions to peers and sexuality. The main purpose of the questionnaire was to measure adjustment problems, but most items in the questionnaire have scales that span from very good to very bad adjustment. The 26-year comparisons presented here concerned 95 items that fulfilled five criteria: a) The item belonged to one of the nine adjustment domains; b) the item scale had one pole that reflected an adjustment problem while the other pole reflected good adjustment or at least absence of an adjustment problem; c) the item scale level was at least ordinal; d) the item scale had five scale-steps; and e) the item was identical in the 1970 and 1996 version of the questionnaire. These items are presented in the Appendix. For each individual and domain, three different sum scores were computed, reflecting (1) overall adjustment (a sum score of the full-scale items), (2) negative adjustment (number of adjustment problems), and (3) positive adjustment (number of well-adjusted item-scores). It should be noted that the three types of sum scores are not independent measures, but based on the same sets of items: Physical problems: 13 items; emotional problems: 13 items; self- esteem: 13 items; antisocial problems: 12 items; relation to mother: 4 items; relation to father: 5 items; relations to parents (unspeci- fied): 9 items; relations to teachers: 7 items; relations to peers: 15 items; and sexuality: 4 items. Overall adjustment within domains. For each individual and domain, a sum-score of the full-scale items was computed. Before being summed up, all items were turned so that a high value signi- fied poor adjustment, while a low value signified good adjustment. This sum-score reflected the overall adjustment of the individual within the domain. The main reason for computing this sum score was to study possible changes over time in the variability of overall adjustment. Cronbachs alpha was computed for each domain sum score. For all sum scores except sexuality, Cronbachs alpha was at least acceptable, varying between .73 and .89 in 1970 (median: .80); and between .71 and .88 in 1996 (median: .83). Cronbachs alpha of the overall sum score in the sexuality domain was very low, however (1970: .26; 1996: .27). No further analyses were performed within this domain, but the items included in the domain are presented in the Appendix. Number of adjustment problems within domains. All items were dichotomised at the negative end of the distributions: For each item, scores of 4 and 5 were considered as presence of an adjust- ment problem and recoded into 1, while lower scores were considered as absence of an adjustment problem and recoded into 0. It should be noted that this cut-off point to some extent was arbitrary; it was not intended to define adjustment problems in any absolute or clinical sense. However, as the dichotomizations were made in the same way at both time points the frequencies for each item will be comparable between the two cohorts. These frequen- cies are presented in the Appendix. For each individual and domain, except the sexuality domain, the sum score of the dichotomised items was computed, signifying the number of adjustment problems experienced by the individual in the specific domain. Cronbachs alpha for these problem sum scores was at least acceptable, varying between .62 and .83 in 1970 (median: .70); and between .61 and .83 in 1996 (median: .73). Number of well-adjusted item scores within domains. For each individual and domain, except the sexuality domain, a sum score was also computed with the item-dichotomizations made at the positive end of the five-point scales: For each item, scores of 1 and 2 were considered to indicate good adjustment and recoded into 1, while higher scores were considered as absence of good adjust- ment and recoded into 0. These sum scores signified the number of well-adjusted item scores for each individual and domain. The frequencies of good adjustment for each item are presented in the Appendix. Cronbachs alpha for the well-adjusted item sum scores was at least acceptable, varying between .66 and .83 in 1970 (median: .71); and between .66 and .82 in 1996 (median: .75). The differences between 1970 and 1996 in the mean values of the overall sum scores, the problem sum scores and the well-adjusted sum scores were tested for significance with two-tailed t-tests in each of the nine adjustment domains. In addition, the significance of the differences in standard deviations of the overall sum scores was tested with test. In domains where a significant increase in the standard deviation of the overall sum score was found, additional analyses were performed in order to decide whether the increase in variability had the form of a polarization. The mass significance problem. In all studies where a number of significance tests are carried out the mass significance problem is present. Of course, the problem is especially salient when a large number of tests are made and the theoretical expectations are not very precise. This is the situation in the present study. significance tests were made of 27 differences in sum score means and 9 differences in standard deviations. Differences significant at the nominal one-percent level should be regarded as tendencies; and differences significant at the .0014-level (.05 / 36) should be regarded as significant at the level after correction for mass significance. It should be observed that, of course, the tests for the three types of sum scores are to some extent dependent. Controlling for ethnicity. In order to investigate the effect on the results of the increased ethnic heterogeneity of the population between 1970 and 1996, each of the presented analyses was made twice: First, the complete 1996 cohort was compared to the 1970 cohort. Secondly, all girls with a mother and/or a father born in a non-Nordic country were excluded from the 1996 cohort, and the reduced cohort was compared to the 1970 cohort. Differences in the results of the two types of comparisons were then investigated. Overall Adjustment Within Domains As a starting point, the mean values in overall adjustment in each domain were compared between 1970 and 1996. The results are presented in Table 1. Significant differences in mean values were found in two domains: relations to parents and relations to peers (p < .05, corrected for mass significance).