Abstract
Theory and research highlight the mismatch between puberty-associated challenges and personal coping resources among youth with early actual or perceived pubertal timing. This study (N = 167; Mage = 12.41 years; 51.5% female; 77.8% White American) examined whether coping resources provided by mothers (maternal socialization of coping) exert protective or exacerbating effects on risk for depression among early-maturing youth. Results revealed that earlier perceived timing predicted higher subsequent depressive symptoms in girls with low (B = .40, SE = .15), but not high (B = −.08, SE = .17), levels of engagement coping suggestions, whereas earlier perceived timing predicted higher subsequent depressive symptoms in boys with high (B = .40, SE = .17), but not low (B = −.12, SE = .15), levels of engagement coping suggestions. These findings build on prior theory and research by highlighting that maternal coping suggestions may mitigate or enhance depression risk in youth who perceive themselves as early maturers; the differential effects in girls and boys suggest that the impact of these suggestions may depend on whether they are in line with gender-specific norms for coping.
Keywords: puberty, socialization of coping, depression, adolescence, parenting
Puberty presents various challenges to adolescents as they experience rapid changes in body size, shape, and composition, as well as development of secondary sexual characteristics. These changes are accompanied by structural and functional brain developments and vast shifts in hormonal functioning that may lead to heightened emotion reactivity and vulnerability for emotion dysregulation (Spear, 2009). Furthermore, the transition to puberty is marked by the introduction of novel social demands and upheavals in interpersonal relationships (Rudolph, 2014). The co-occurrence of somatic, physiological, psychological, and social transformations can result in new experiences that provoke feelings of loneliness, insecurity, and anxiety. These developmental challenges may heighten risk for the onset of depression, particularly when they occur earlier relative to peers (Ge & Natsuaki, 2009; Rudolph, 2014). However, not all early-maturing youth develop depression, making it essential to understand factors that confer heightened risk or protection. To address this question, the present study investigated whether parental provision of coping resources (i.e., socialization of coping) can serve to either mitigate or exacerbate the contribution of early actual timing or perceived timing to subsequent depressive symptoms.
Conceptualizations of Pubertal Timing and Risk for Depression
Theoretical perspectives on the timing of puberty and its effect on mental health consider the psychological and social consequences of maturing earlier relative to peers. According to the stage-termination hypothesis (Petersen & Taylor, 1980), early-maturing youth may be more vulnerable to stress associated with puberty because they lack sufficient time to complete developmental tasks required for an adaptive transition, making them unprepared to deal with the associated challenges. Underdeveloped cognitive resources and coping skills resulting from a mismatch between physical and sociocognitive maturity are further compounded by demanding social and biological transitions and a lack of support from peers undergoing similar changes (Petersen & Taylor, 1980).
Theory and accumulating evidence indicate that early actual timing can be disadvantageous for both girls and boys. Physical and social changes accompanying early maturation can expose youth to stressors, such as peer victimization, early entrance into romantic and sexual relationships, diminished peer relationship quality, and interactions with older and norm-breaking peer groups (Compian & Hayward, 2003; Conley et al., 2012; Ge et al., 2002; Skoog & Kapetanovic, 2021). Moreover, early actual timing is associated with negative perceptions of the self and anxious arousal, social problems, and higher levels of delinquency and substance use in both girls and boys (Negriff et al., 2008; Rudolph et al., 2014). In turn, these psychological, socio-behavioral, and interpersonal risks are associated with heightened depressive symptoms (Kaltiala-Heino et al., 2003; Rudolph et al., 2014). Indeed, compared to adolescents who experience late or on-time maturation, early-maturing girls and boys exhibit more negative mood and depressive symptoms concurrent to puberty (Mendle et al., 2010; Negriff et al., 2008), as well as more symptoms (Rudolph et al., 2014) and depressive episodes (Hamlat et al., 2019) over time (for a review on internalizing symptoms, see Ullsperger & Nikolas, 2017).
Beyond adolescents’ actual timing of maturation, perceived timing may contribute to mental health outcomes. According to Cance et al. (2012), measures of actual timing (e.g., comparisons of adolescents’ self-reports of secondary sexual characteristics relative to same-age peers) can be viewed as stage-normative, whereas measures of perceived timing (e.g., adolescents’ subjective appraisals of their stage of development relative to their peers) can be viewed as peer-normative, highlighting that this construct involves social comparison processes. Indeed, perceived timing can be influenced by characteristics (e.g., race and ethnicity) of the peer group with which girls and boys compare themselves (Carter et al., 2020). Although perceived timing is correlated with actual timing (Carter et al., 2011; Conley & Rudolph, 2009), it more precisely captures youth’s responses to their growing bodies beyond physical indicators of pubertal development and may, therefore, have distinct implications for adolescent adjustment.
Youth with earlier perceived timing may be particularly attentive to their physical maturation relative to peers and thus more tuned into how their external environment responds to their physical changes. Perceiving themselves as “different” or even “weird” may confer additional risks, by adversely shaping their social-cognitive functioning (e.g., self-image, social problem-solving). For instance, youth who perceive themselves as early maturers, such as girls who are worried that their breast development is conspicuous, or boys who think their body odor is stronger and more unpleasant than their than peers, may experience overwhelming emotions and declines in self-worth, which in turn can further impact how youth navigate their social environment. Beyond the external stressors experienced by youth with early actual timing, youth who identify as early matures may experience subjective feelings of alienation or isolation, perhaps heightening their loneliness and preventing them from building intimate and meaningful connections. It is also possible that youth identify as more physically mature than their peers because they have already received distressing public reactions to their development, thereby heightening their sensitivity to their physical stature. Supporting the importance of considering actual and perceived timing as distinct indexes of development, studies reveal that these indexes show differential effects on behavioral and emotional problems (Carter et al., 2009; Conley & Rudolph, 2009). Research on perceived timing suggests that girls who perceive themselves as more physically advanced than their peers demonstrate higher levels of depressive symptoms both concurrently and over time (Conley & Rudolph, 2009; Graber et al., 2004; Hoyt et al., 2020; Siegel et al., 1999). Among boys, a few cross-sectional studies reveal higher depression risk in youth who perceive themselves as early developers compared to those who perceive themselves as on-time developers (Alsaker, 1992; Graber et al., 1997); however, there is a dearth of prospective longitudinal data elucidating the association between perceived timing and depressive symptoms in boys.
Moderating Effect of Socialization of Coping
Nonetheless, not all youth with earlier actual or perceived timing show elevated depressive symptoms. As suggested by the stage-termination hypothesis (Petersen & Taylor, 1980), these differences potentially can be explained by the quality of their coping resources. Given heightened exposure to external stressors as well the need to manage subjective feelings of insecurity, poor self-image, and loneliness stemming from negative social comparisons, risk for depression in youth with early actual or perceived pubertal timing may be determined by their ability to successfully cope with stressors as well as puberty-related negative cognitions and emotions. Unfortunately, early-maturing youth show less effective coping and more maladaptive responses to stress (Rudolph et al., 2014; Sontag et al., 2008), suggesting they may need to rely on alternate coping resources to manage external and internal disruptions during this time. Because early-maturing youth may feel alienated from peers, parental guidance may play a particularly critical role in helping them navigate this transition by establishing an effective coping repertoire. Although youth with earlier actual and perceived timing may benefit from such parental guidance, those who self-identify as earlier maturers may be more attuned to their social environment and, therefore, more susceptible to parental guidance.
Parents can help youth learn how to cope with challenges by promoting a positive family emotional climate or modeling coping strategies (Zimmer-Gembeck & Locke, 2007), or by offering explicit suggestions about different forms of coping (Abaied & Rudolph, 2010, 2011; Kliewer et al., 1996). The content of these coping suggestions guides youth in tackling both objective stressors and subjective distress and helps them form skills they eventually integrate into a coping repertoire. However, not all suggestions provided by parents are adaptive for youth, thereby raising the question of what types of suggestions are adaptive and for whom.
Broadly, coping suggestions can be characterized in terms of a tendency toward engagement versus disengagement (Abaied & Rudolph, 2010). Engagement coping suggestions encourage youth to engage in voluntary behaviors directed towards the source of stress or its cognitive and emotional consequences, such as seeking support, regulating affect, solving problems, and reflecting about potential positive effects of the stressor. Disengagement coping suggestions encourage youth to direct themselves away from the source of stress or stress-related cognitions and emotions, such as avoiding or denying the stressor or distracting themselves from the problem or negative emotions. Some research suggests that maternal engagement coping suggestions predict more adaptive youth responses to peer stress, such as higher levels of engagement coping (Gaylord-Harden et al., 2013) and fewer involuntary disengagement responses, such as emotional numbing, cognitive interference, inaction, and escape from stressors, among youth exposed to heightened peer stress (Abaied & Rudolph, 2011), whereas maternal disengagement suggestions predict less adaptive youth responses to stress (Stroud & Fitts, 2017). Moreover, in youth who experience higher levels of interpersonal problems, receiving disengagement coping suggestions significantly predicts heightened depression; however, these harmful effects can be buffered by moderate to high levels of engagement suggestions (Abaied & Rudolph, 2010). Taking these findings together, Abaied and Rudolph (2010, 2011) suggested that the effects of parent socialization of coping are particularly salient when youth face significant challenges yet find their own coping resources inadequate. Because early-maturing youth may encounter a fraught transition to adolescence while possessing less effective personal coping resources, they may require more external resources to cope. Thus, different patterns of parent socialization of coping may serve to exacerbate or protect early-maturing youth against depressive symptoms, with the potential for particularly strong effects in youth who perceive themselves as early developers and thus may be particularly attuned to their environments.
Gender Differences in the Moderating Effect of Socialization of Coping
Particular socialization of coping patterns may have a differential impact on early-maturing girls’ and boys’ risk for depression, as the effectiveness of coping strategies may vary due to gender differences in relationship orientations, peer socialization, and parent socialization. According to the gender-intensification hypothesis (Hill & Lynch, 1983), during early adolescence, girls and boys are increasingly socialized by parents and peers to conform to gender stereotypes (e.g., socializing boys to become more independent and girls to become less confrontational). Hill and Lynch (1983) further contend that this process of gender socialization is expedited in adolescents who appear more mature and adult-like, suggesting that early-maturing youth may be subject to gender norms to a larger extent than their peers. Thus, coping behaviors that more closely align with gender stereotypes may be more effective.
Socialization of Coping in Girls
In girls, gender-specific expectations and preferences may cause engagement coping suggestions to be protective and disengagement coping suggestions to heighten risk. Engagement coping suggestions that encourage youth to take active steps to deal with stressors or associated emotions (e.g., support seeking, emotional expression) can potentially be implemented more easily and effectively by girls. Girls’ preference for close emotional communication and self-disclosure within friendships (Rudolph & Dodson, 2022) can facilitate engagement coping strategies, such as seeking emotional support, gaining advice about how to confront problems, rethinking the meaning of a stressor, or directly resolving conflict in relationships. Girls may therefore be able to identify and have access to appropriate sources of support, thereby allowing them to effectively implement a range of engagement suggestions, which may provide further assistance in developing adaptive coping skills (Kliewer et al., 1996), helping early-maturing girls to manage stressors during the adolescent transition.
In contrast, disengagement suggestions encourage passive or avoidant responses that may create an obstacle to the successful resolution of problems in girls. Consistent use of avoidance and withdrawal might contribute to continuing stressors and even generate more stress, which in turn increases risk for the development of depressive symptoms (Flynn & Rudolph, 2011). Girls tend to be more relationship-oriented (Rose & Rudolph, 2006); thus, leaving interpersonal conflicts unresolved disrupts social relationships and networks over time and heightens their risk for depression (Hammen, 2018). Indeed, the use of disengagement coping strategies are generally understood as detrimental to girls (Sontag et al., 2008).
Socialization of Coping in Boys
In boys, it is less clear which socialization of coping patterns are likely to dampen versus amplify risk for depression. Encouraging boys to seek support or self-reflect may help them figure out effective ways to alleviate their distress. However, these suggestions may be inconsistent with the societal image of stress management in boys. Boys are often taught to show qualities such as independence and absolute self-assurance that opposes introspection and “caring too much.” Likewise, even though emotion expression may help boys calm down and process their feelings, when boys display negative emotions to their same-sex friends, friends are more likely to respond with victimization or neglect compared to girls (Klimes‐Dougan et al., 2014). Problem-solving suggestions may encourage boys to address stressors and prevent their negative consequences from worsening. Yet, Kliewer and colleagues (1996) found that paternal support-seeking suggestions are associated with higher levels of distraction in boys. This finding may suggest that instead of directly discussing their problems with friends, boys may view distraction (e.g., playing sports and video games) as a more socially accepted way to cope with stressors. Indeed, both female and male adolescents believe that distraction is a more characteristic coping style in boys than in girls (Broderick & Korteland, 2002). Given these gender differences, parental encouragement of certain types of engagement in early-maturing boys may backfire, causing them to engage in coping strategies (e.g., seeking emotional support) that are ignored or even elicit negative feedback from peers, thereby heightening their risk for depression.
Given boys’ inclination toward distracting themselves from stressors, it is possible that encouraging early-maturing boys to use disengagement coping is consistent with gender schemas and protects them against depression. On the other hand, as in girls, disengagement also can create additional stressors in boys (Flynn & Rudolph, 2011). Continued reliance on denial and voluntary avoidance prevents them from directly confronting and attempting to solve problems. Indeed, some research shows disengagement coping suggestions are associated with adverse outcomes in boys (e.g., Abaied & Rudolph, 2011).
Study Overview
Despite substantial research demonstrating the risks associated with earlier actual and perceived timing, less is known about factors that may amplify or attenuate these risks. Expanding on recent developments in research on socialization of coping and its effects on youth psychopathology, the current study investigated the hypothesis that actual and perceived timing will make a differential contribution to subsequent youth depression depending on maternal socialization of coping and gender. In past research using the same data set, we found that girls and boys with earlier actual timing showed higher levels of depressive symptoms over time (Rudolph et al., 2014). Also, prior evidence reveals that youth who perceive themselves as early maturers may be at higher risk for depression (Conley & Rudolph, 2009; Graber et al., 1997). Building on these findings, we hypothesized that the effects of actual and perceived timing on depression would be moderated by maternal socialization of coping and gender. For girls, we predicted that earlier actual and perceived timing would predict higher levels of depressive symptoms in girls who received: (1) low but not high engagement coping suggestions (i.e., a protective effect); and (2) high but not low disengagement coping suggestions (i.e., an amplifier effect). Because both theory and research suggest a mixed picture regarding the effects of engagement and disengagement coping suggestions in boys, exploratory analyses were conducted to examine the moderating effects of socialization of coping in boys. In addition, the interaction effect of perceived timing and maternal socialization of coping on depression may be stronger compared to that of actual timing, given that youth who self-identify as early-maturers may be more sensitive to distress caused by their different pubertal development relative to peers, which in turn heightens their need for, and susceptibility to, maternal guidance.
Method
Participants
Participants included 167 youth (M age at baseline = 12.41 years, SD = 1.19, range = 9.6 – 14.8; 51.5% female; 77.8% White, 12.6% African American, 9.6% other) and their female caregivers (88.6% biological mothers; 1.8% stepmothers; 4.2% adoptive mothers; 5.4% others) from a longitudinal study examining the development of depression in youth (for previous reports examining the effects of puberty in this data set, see Conley & Rudolph, 2009). Families were diverse in socioeconomic status (total family income below $30,000 for 16.7% and above $75,000 for 19.1% of the sample).
Participants were recruited from several mid-sized Midwestern cities and rural towns in the United States based on the following criteria: Children’s Depression Inventory (CDI; Kovacs, 1981) scores from school screenings, presence of maternal caregiver in the household, and distance from the university (within one hour). Participants were excluded if the maternal caregiver was a non-English speaker or if youth had a developmental disability that may impede completion of assessments. In total, 1985 youth participated in the screenings, representing approximately 80% of the targeted youth. Based on our criteria, we selected 468 potential participants for recruitment. Youth scoring at the high end of CDI scores were oversampled (15.8% of the screening sample had CDI scores > 18; 20.3% of the targeted participants had CDI scores > 18). Participants were recruited until the targeted sample size was reached.
Participants and targeted nonparticipants did not significantly differ in gender, χ2(1) = 0.39, p = .53, race/ethnicity (White vs. non-White), χ2(1) = 0.02, p = .89, or depressive symptoms, t(281) = −1.11, p = .13, at the initial screening. Participants were slightly younger than nonparticipants (M = 12.65, SD = .89), t(275) = 2.28, p = .012. Youth with complete data on all measures (n = 117) did not significantly differ from youth with missing data (n = 50) in terms of gender, χ 2(1) = 0.58, p = .45, age, t(165) = - 0.98, p = .33, race/ethnicity, χ 2(1) = 0.33, p = .56, or W1 pubertal timing variables, maternal socialization of coping (i.e., engagement and disengagement coping suggestions), and depression variables, ts (165) < 1.58, ns.
Procedure
Female caregivers were initially contacted via telephone and were introduced to the study. To participate, caregivers provided informed consent and youth provided written assent. Two interviewers conducted in-person assessment sessions with the maternal caregiver and youth separately. Each assessment lasted approximately 3–4 hours. Diagnostic interviews were administered by a clinical psychology faculty member, several trained psychology graduate students, and a post-BA research assistant. Several advanced undergraduate research assistants administered surveys. Follow-up assessments were conducted approximately one year after the initial assessment (mean time interval = one year, one week). After each assessment, caregivers received a cash stipend, and youth received a gift certificate. All study procedures were approved by the university’s Institutional Review Board.
Measures
Depression
The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children — Epidemiologic Version 5 (Orvaschel, 1995) was administered to both youth and their maternal caregiver to assess youth depression. At Wave 1 (W1) and Wave 2 (W2), interviewers assessed depressive symptoms over the past year. To assign consensual diagnoses, a best-estimate approach (Klein et al., 1994) combined youth and caregiver reports regarding the nature, severity, frequency, and resulting impairment of the reported symptoms. Based on Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-IV; American Psychiatric Association, 1994) for depressive disorders, interviewers provided ratings on a 5-point continuous scale (0 = No symptoms, 1 = Mild symptoms, 2 = Moderate symptoms, 3 = Diagnosis with mild impairment, 4 = Diagnosis with severe impairment) for each episode and type (e.g., major depressive disorder, dysthymic disorder, depressive disorder not otherwise specified) of depression; interviews were coded in consultation with a clinical psychology faculty member. Approximately 25% of the interview audiotapes were coded by two independent raters. The intraclass correlation coefficient (ICC) for past-year depression ratings was strong (ICC = 0.95).
For each wave, these 5-point ratings were summed across episode and type of depression to compute one continuous depression score for the past year, such that higher scores reflect more severe symptoms within a single diagnostic category, the presence of symptoms from multiple categories, and/or multiple episodes of depression (for similar rating approaches, see Conley & Rudolph, 2009; Hammen et al., 2003). This rating approach is consistent with extensive research on the conceptualization of depression that argues for a dimensional rather than categorical approach (Prisciandaro & Roberts, 2009). Establishing validity, these summary scores were significantly correlated with scores on self-report measures of depressive symptoms (rs = .52 - .53, ps < .001).
Of the 167 participants at W1, 53 youth (31.74%) had at least mild depressive symptoms (i.e., a score above 0 for at least one type of depression); 24 youth (14.37%) met criteria for a clinical diagnosis of depression (i.e., a score of 3 or 4 for at least one type of depression). At W2, out of 159 participants with available data, 57 youth (35.85%) had at least mild depressive symptoms, and 20 youth (12.58%) met criteria for a diagnosis.
Actual Pubertal Timing
Youth and caregivers completed two measures of youth’s pubertal status. First, they provided ratings on the Udry line drawings of Tanner stages (Morris & Udry, 1980). Participants were asked to choose the line drawing out of a set of five that most closely resembled the youth’s current stage of development. Girls rated breast development and pubic hair growth, and boys rated genital development and pubic hair growth. Past research has established validity of self-reported Tanner stages through significant correlations between girls’ and boys’ reports on Tanner stages and physician ratings on physical exams (for a review, see Shirtcliff et al., 2009). Due to the sensitive and private nature of the content, maternal caregivers were asked for permission before this measure was administered to youth participants. Youth also were provided the option to not complete this questionnaire.
At W1, Tanner stages scores were available for 118 youth and 140 caregivers. There were strong correlations between youth and caregiver ratings for girls’ breast development (r = .83, p < .001; 97% agreement within one category) and pubic hair development (r = .68, p < .001; 86% agreement within one category). Moderate correlations were identified for boys’ genital development (r = .47, p < .01; 83% agreement within one category) and pubic hair development (r = .65, p < .01; 78% agreement within one category). Composite scores were computed by first averaging each of the two items across informants and then taking the mean of these two scores. If information was missing from one informant, the other informant’s answers were used.
Second, youth and caregivers completed the Pubertal Development Scale (PDS; Petersen et al., 1988), which includes five questions that assess stages of growth spurt, body hair, skin changes, boys’ voice changes and facial hair, and girls’ breast development and menarche status. Menarche was rated as a dichotomous variable (1 = Absent, 4 = Completed). Other questions were rated on a 4 point-scale (1 = Not yet started, 2 = Has barely started, 3 = Is definitely underway, 4 = Seems completed). The PDS is widely used and has well-established reliability and validity. Past research has found correlations of around .70 with physician ratings of pubertal development (Shirtcliff et al., 2009).
At W1, PDS data were available for 132 youth and 140 caregivers. There were strong correlations between youth and caregiver reports in both girls (r = .88, p < .001) and boys (r = .72, p < .01). Composite scores were computed by first averaging each of the five items across informants and then taking the mean of these five average scores. If information was missing from one informant, the other informant’s answers were used.
Confirmatory factor analyses in this sample yielded well-fitting measurement models using the seven items (two Tanner and five PDS) as indicators for a latent variable (Conley & Rudolph, 2009). The seven items showed strong reliability as a single scale, both for girls (α = 0.93) and boys (α = 0.91). All seven items were available for 135 out of 167 participants; eleven participants had five or six items available. A composite pubertal status score was created by averaging the standardized scores on the seven items, with higher scores reflecting more advanced pubertal status. To capture actual timing, residualized scores were calculated by regressing pubertal status onto chronological age separately for girls and boys. Higher scores reflected earlier maturation relative to same-gender youth.
Perceived Pubertal Timing
To assess perceived timing relative to their peers, youth responded to the question on the PDS: “Do you think your development is any earlier or later than most other [girls/boys] your age?” Response options included Much earlier, Somewhat earlier, About the same, Somewhat later, Much later, yielding a continuous score from 1 to 5. Responses were recoded so that higher scores reflected earlier perceived timing relative to same-gender youth, similar to the calculated actual timing item. Previous studies have used similar items to assess perceived timing and yielded strong validity in predicting depression (Conley & Rudolph, 2009; Graber et al., 2004).
Socialization of Coping
To assess socialization of coping, maternal caregivers reported on coping suggestions they provided to their children (Abaied & Rudolph, 2010; see Appendix A for a list of all the items). In response to the question: “When your child has a problem or is upset, how much do you do each of the following?”, mothers rated 16 items on a five-point scale (1 = Not at all to 5 = Very much). Supported by confirmatory factor analyses (Abaied & Rudolph, 2010), two subscales were created: engagement suggestions (7 items), which involve encouraging youth to direct resources toward the stressor or related cognitions and emotions, such as problem solving (e.g., “Encourage him/her to think of different ways to change the problem or fix the situation.”), cognitive reappraisal (e.g., “Encourage him/her to think about things he/she is learning from the situation”), and support seeking (e.g., “Encourage him/her to ask me or other people for help or for ideas about how to make the problem better.”); and disengagement suggestions (9 items), which involve encouraging youth to direct resources away from the stressor or related cognitions and emotions, such as avoidance (e.g., “Encourage him/her to try to stay away from people and things that make him/her upset or remind him/her of the problem”), distraction (e.g., “Encourage him/her to keep his/her mind off of the problem by getting involved in other activities”), and denial (e.g., “Encourage him/her just to act like the problem never happened and go on with his/her life”). Scores were calculated as the mean of the items on each subscale, with higher scores reflecting higher levels of each type of suggestion. This measure has established reliability and validity (Abaied & Rudolph, 2010, 2011).
Overview of Analyses
Hierarchical multiple regression analyses were conducted to assess the independent and interactive contributions of W1 pubertal timing (actual or perceived), maternal socialization of coping, and gender to W2 depression, adjusting for W1 depression. Pubertal timing and socialization of coping variables were mean-centered prior to analysis, and interaction terms were created as the product of the mean-centered variables. Gender was dummy coded as boys (0) and girls (1). Each regression included the main effects of W1 depressive symptoms entered at the first step, the main effects of pubertal timing, coping suggestions, and gender entered at the second step, the two-way interactions entered at the third step, and the three-way Pubertal Timing x Socialization of Coping x Gender interaction entered at the fourth step. Regions of significance (RoS) tests (Preacher et al., 2006) were conducted to determine at what level of coping suggestions earlier pubertal timing was significantly associated with depressive symptoms. Significant interactions were interpreted using slope differences tests (Dawson & Richter, 2006). The significance of the simple slopes (Aiken & West, 1991) were interpreted by solving the unstandardized regression equations for pubertal timing predicting depression at high (1 SD above mean) and low (1 SD below mean) levels of coping suggestions in girls and boys.
Two sets of sensitivity analyses also were conducted. First, given prior studies suggesting potential effects of family income, race/ethnicity, stress, and maternal depression on pubertal timing, socialization of coping, or depression (Deardorff et al., 2021; Goodman et al., 2003; Hammen, 2018; Monti et al., 2014), we conducted analyses adjusting for these variables. Second, given the significant positive correlation between engagement and disengagement suggestions, we conducted analyses including main effects and interactions for both types of coping suggestions in the same models.
Transparency and Openness
We have complied with the requirement of the Transparency and Openness Promotion (TOP) guidelines at Level 2. We have appropriately cited all methods developed by others. The study materials, data, and analysis code that support the findings of this study are available from the corresponding author upon reasonable request. This study’s design and analysis were not preregistered.
Results
Data Imputation
Results from Little’s Missing Completely at Random (MCAR) test indicated data were missing completely at random, χ 2(132) = 132.56, p = .47, so we assumed the missing values were not systematically different from observed values and used multiple imputation to address missing values (5.39% of actual timing, 25.15% of perceived timing, and 3.60% of W1 socialization of coping variables). Multiple imputation with forty imputations was conducted with the mice package in R (van Buuren & Groothuis-Oudshoorn, 2011). Specifically, the predictive mean matching procedure was used to estimate missing values. Thus, data from all 167 participants were used in the regression analyses. Results from the forty imputed datasets were combined to produce pooled estimates for the regression analyses.
Descriptive and Correlational Analyses
Table 1 shows descriptive statistics for each of the variables by gender. In the original data, there was a significant gender difference in W1 PDS scores, t(139.57) = −4.71, p < .001, but no significant gender differences in W1 Tanner Stages scores, W1 coping suggestions, perceived timing, or W1 and W2 depressive symptoms, ts(123 – 165) < 1.85, ps = .06 - .98. In the imputed data, there were no significant gender differences in perceived timing, W1 coping suggestions, or W1 and W2 depressive symptoms, ts(31.98 – 162.65) < 1.00, ps = .32 - .94. It is likely that we did not identify a gender difference in depression because much of our sample was younger than the age range during which the gender difference in depression typically emerges (about age 13; e.g., Salk et al., 2016). Past research using this sample has shown a gender difference in depression at mid-puberty (Tanner Stage 3 or above; Conley & Rudolph, 2009). Table 2 shows the intercorrelations among the variables for girls and boys. In girls, more advanced actual and perceived timing were significantly positively associated with W1 and W2 depression scores. In boys, there were no significant correlations between actual or perceived timing and depression.
Table 1.
Descriptive Statistics for Study Variables
Girls |
Boys |
|||||||||
---|---|---|---|---|---|---|---|---|---|---|
n | a | SD | b | α | n | a | SD | b | α | |
Wave 1 | ||||||||||
Pubertal Status | 82 | 0.01 | 0.84 | 0.02 | 0.93 | 76 | 0.01 | 0.80 | 0.03 | 0.91 |
PDS | 76 | 2.54 | 0.79 | 0.86 | 69 | 1.99 | 0.61 | 0.86 | ||
Tanner stages | 82 | 2.99 | 1.20 | 0.91 | 70 | 2.65 | 1.04 | 0.92 | ||
Actual timing | 82 | 0.00 | 0.99 | 0.00 | 76 | 0.00 | 0.99 | 0.01 | ||
Perceived timing | 66 | 3.05 | 0.97 | 3.06 | 59 | 3.00 | 0.93 | 2.99 | ||
Engagement suggestions | 85 | 4.09 | 0.62 | 4.09 | 0.86 | 76 | 4.05 | 0.72 | 4.05 | 0.88 |
Disengagement suggestions | 85 | 2.75 | 0.74 | 2.76 | 0.86 | 76 | 2.78 | 0.90 | 2.79 | 0.91 |
Depression | ||||||||||
Wave 1 | 86 | 1.01 | 1.88 | 1.01 | 81 | 0.89 | 1.57 | 0.89 | ||
Wave 2 | 82 | 0.96 | 1.64 | 1.02 | 77 | 0.81 | 1.31 | 0.77 |
Note. PDS = Pubertal Development Scale.
Calculated from original data.
Calculated from imputed data.
Table 2.
Pearson Correlations for Study Variables
Variable | 1 | 2 | 3 | 4 | 5 | 6 |
---|---|---|---|---|---|---|
1. W1 Actual timing | — | .46* | .12 | .14 | .33* | .39** |
2. W1 Perceived timing | .18 | — | .06 | .10 | .34* | .32* |
3. W1 Engagement coping suggestions | −.04 | −.09 | — | .34* | .04 | −.11 |
4. W1 Disengagement coping suggestions | .03 | −.08 | .43** | — | .08 | .03 |
5. W1 Depression | −.17 | −.16 | .00 | −.08 | — | .75** |
6. W2 Depression | .08 | −.03 | −.03 | −.07 | .59** | — |
Note. W1 = Wave 1; W2 = Wave 2. Correlations for girls are above the diagonal, and correlations for boys are below the diagonal.
p < .01.
p < .001.
Pubertal Development, Engagement Coping Suggestions, and Gender Predicting Depression
Regression analyses using actual timing, engagement coping suggestions, and gender revealed a significant positive main effect of actual timing, nonsignificant main effects of engagement suggestions and gender, and nonsignificant two-way and three-way interactions (Table 3). Regression analyses using perceived timing, engagement coping suggestions, and gender revealed nonsignificant main effects of perceived timing, engagement suggestions, and gender, nonsignificant two-way interactions, and a significant Perceived Timing x Engagement Coping Suggestions x Gender interaction.
Table 3.
Puberty, Engagement Coping Suggestions, and Gender Predicting Depression
Actual timing |
Perceived timing |
|||||
---|---|---|---|---|---|---|
B | SE | t | B | SE | t | |
Step 1 | R2 = .48 | R2 = .48 | ||||
W1 Depression | .60 | .05 | 11.60** | .60 | .05 | 11.60** |
Step 2 | ΔR2 = .046 | ΔR2 = .020 | ||||
Puberty | .28 | .09 | 3.10** | .14 | .11 | 1.21 |
Engagement | −.21 | .13 | −1.63 | −.20 | .13 | −1.45 |
Gender | .18 | .17 | 1.07 | .17 | .17 | .96 |
Step 3 | ΔR2 = .022 | ΔR2 = .012 | ||||
Puberty × Engagement | −.24 | .14 | −1.74 | .04 | .15 | .26 |
Puberty × Gender | .18 | .20 | .90 | .11 | .24 | .46 |
Engagement × Gender | −.43 | .26 | −1.65 | −.36 | .27 | −1.32 |
Step 4 | ΔR2 = .005 | ΔR2 = .036 | ||||
Puberty × Engagement × Gender | −.30 | .28 | −1.07 | −.75 | .33 | −2.28* |
Note. Engagement = Engagement coping suggestions. Bs and ts represent unstandardized coefficients and t statistics at each step. ΔR2 represents percentage of variance accounted for at each step.
p < .05.
p < .01.
As shown in Figure 1, earlier perceived timing significantly predicted heightened depressive symptoms in girls receiving low (B = .40, t = 2.66, p = .009), but not high (B = −.08, t = −.45, p = .655, levels of engagement coping suggestions. RoS testing revealed that perceived timing significantly predicted depressive symptoms in girls when engagement suggestions were < .30 SD below the mean. Slope difference tests revealed a significantly stronger effect for girls receiving low levels of engagement coping suggestions than girls receiving high levels of engagement coping suggestions (slope difference test: t = −2.15, p = .033). At earlier levels of perceived timing, girls receiving high levels of engagement coping suggestions had levels of depressive symptoms .55 standard deviations (SD) lower than girls receiving low levels of engagement coping suggestions. Earlier perceived timing significantly predicted depressive symptoms in boys receiving high (B = .40, t = 2.28, p = .024), but not low (B = −.12, t = −.82, p = .412), levels of engagement coping suggestions. RoS testing revealed that perceived timing significantly predicted depressive symptoms in boys when engagement suggestions were > .60 SD above the mean. Slope difference tests revealed a significantly stronger effect for boys receiving high levels of engagement coping suggestions than boys receiving low levels of engagement coping suggestions (slope difference test: t = 2.51, p = .013). At earlier levels of perceived timing, boys receiving high levels of engagement coping suggestions had levels of depressive symptoms .41 SD higher than boys receiving low levels of engagement coping suggestions. At later levels of perceived timing, boys receiving high levels of engagement coping suggestions had levels of depressive symptoms .38 SD lower than boys receiving low levels of engagement coping suggestions. There was a significantly stronger effect of earlier perceived timing on depressive symptoms for girls receiving low levels of engagement coping suggestions than boys receiving low levels of engagement coping suggestions (slope difference test: t = 2.50, p = .013), and a marginally significant stronger effect of earlier perceived timing on depressive symptoms for boys receiving high levels of engagement coping suggestions than girls receiving high levels of engagement coping suggestions (slope difference test: t = −1.94, p = .054). Both sets of sensitivity analyses revealed a highly similar pattern of findings (see Supplemental Material).
Figure 1.
Simple Slope Plot of Interaction between Perceived Timing, Engagement Coping Suggestions, and Gender Predicting Wave 2 Depressive Symptoms, Adjusting for Wave 1 Depressive Symptoms
Pubertal Development, Disengagement Coping Suggestions, and Gender Predicting Depression
Regression analyses using actual timing, disengagement coping suggestions, and gender revealed a significant positive main effect of actual timing, nonsignificant main effects of disengagement suggestions and gender, and nonsignificant two-way and three-way interactions (Table 4). Regression analyses using perceived timing, disengagement coping suggestions, and gender revealed nonsignificant main effects of perceived timing, disengagement suggestions, and gender, and nonsignificant two-way and three-way interactions (Table 4). Both sets of sensitivity analyses revealed a highly similar pattern of findings (see Supplemental Material).
Table 4.
Puberty, Disengagement Coping Suggestions, and Gender Predicting Depression
Actual timing |
Perceived timing |
|||||
---|---|---|---|---|---|---|
B | SE | t | B | SE | t | |
Step 1 | R2 = .48 | R2 = .48 | ||||
W1 Depression | .60 | .05 | 11.60** | .60 | .05 | 11.60** |
Step 2 | ΔR2 = .038 | ΔR2 = .013 | ||||
Puberty | .28 | .09 | 3.07** | .14 | .11 | 1.23 |
Disengagement | −.06 | .10 | −.61 | −.04 | .11 | −.35 |
Gender | .17 | .17 | 1.00 | .16 | .17 | .91 |
Step 3 | ΔR2 = .003 | ΔR2 = .006 | ||||
Puberty × Disengagement | −.01 | .12 | −.06 | −.01 | .11 | −.05 |
Puberty × Gender | .10 | .20 | .49 | .10 | .24 | .43 |
Disengagement × Gender | −.06 | .22 | −.30 | −.05 | .22 | −.24 |
Step 4 | ΔR2 = .003 | ΔR2 = .005 | ||||
Puberty × Disengagement × Gender | −.19 | .24 | −.78 | −.21 | .21 | −.95 |
Note. Disengagement = Disengagement coping suggestions. Bs and ts represent unstandardized coefficients and t statistics at each step; ΔR2 represents percentage of variance accounted for at each step.
p < .05.
p < .01.
Discussion
During the transition through puberty, youth are confronted with a host of challenging developmental tasks. Mounting evidence suggests youth who mature earlier than peers or who perceive their development as earlier than their agemates demonstrate heightened risk for depression (Conley & Rudolph, 2009). Theories concerning the impact of early pubertal development propose that this risk emerges, in part, from confrontation with unfamiliar puberty-associated developmental tasks that challenge underdeveloped internal coping resources (Brooks-Gunn et al., 1985; Petersen & Taylor, 1980; for a review, see Rudolph et al., 2014). Postulating that early-maturing youth, particularly those who perceive themselves as early maturers, may be particularly reliant on, and sensitive to, external guidance during this time, this study provided a novel examination of how maternal socialization of coping may play a critical role in attenuating or amplifying risk for depressive symptoms in early-maturing youth.
Consistent with the stage-termination hypothesis as well as prior research (Ge & Natsuaki, 2009), including analysis of this data set (Rudolph et al., 2014), earlier actual timing predicted subsequent depressive symptoms in both girls and boys. However, maternal socialization of coping did not significantly moderate this effect, suggesting that coping guidance by mothers did not amplify or mitigate risk for depression in early-maturing youth. In contrast, we did not identify a main effect of perceived timing on depressive symptoms. Rather, a three-way interaction revealed that depression risk in youth who perceive themselves as maturing earlier than their peers is contingent on socialization of coping and gender. Supporting our hypotheses, earlier perceived timing predicted elevated depressive symptoms over time in girls whose mothers encouraged low but not high levels of engagement coping. Thus, when mothers encouraged girls with earlier perceived timing to rethink or resolve stressors, seek help, and manage negative emotions and cognitions, these girls were protected against the adverse effects of earlier perceived timing.
Whereas actual timing measures girls’ physical maturation relative to same-age peers, perceived timing captures more precisely the extent to which youth feel deviant from peers. It is possible that this discrepant pattern of findings for actual versus perceived timing is accounted for by internal attributes of girls or by their social contexts. With regard to internal attributes, perhaps girls who perceive themselves as maturing earlier than peers are more attuned to their social environment in general. This attunement not only may cause them to engage in peer comparisons about their physical status, which may heighten emotional distress stemming from a sense of alienation or declines in self-worth, but also may heighten their sensitivity to maternal guidance, thereby increasing the likelihood that they benefit from engagement coping suggestions. With regard to social contexts, perhaps girls who perceive themselves as maturing earlier than peers are embedded in peer groups with less physically mature girls; compared to girls who associate with older peers, who may disregard parent socialization efforts, they may be more susceptible to maternal guidance. Overall, it will be important to better understand why maternal socialization of coping protects girls with earlier perceived timing but not actual timing, and to identify other resources that may protect the latter group.
In contrast to girls, earlier perceived timing predicted heightened depression in boys whose mothers encouraged high but not low levels of engagement coping, but engagement suggestions seem to protect boys with later perceived timing against symptoms. Consistent with gender intensification theory (Hill & Lynch, 1983), during early adolescence, boys experience increasing pressure to conform to gender norms; this pressure may be particularly strong for boys who perceive themselves as more mature than their peers. Because of their beliefs that they are growing into men earlier than others, boys with earlier perceived timing may repudiate certain engagement coping suggestions that suggest more dependence (e.g., asking others for help or advice about problem solving), self-reflection (e.g., better understanding themselves by thinking about the problem), or emotional vulnerability (e.g., discussing their feelings with others) and that do not align with the traditional gender norms for boys, specifically, the need to be self-reliant and nonchalant (i.e., appearing effortless, acting as though everything is under control). In line with this reasoning, both boys and girls demonstrate a strong bias against boys showing a ruminative coping style (e.g., worrying; Broderick & Korteland, 2002), which suggests that prompting boys to engage in introspective processes, such as cognitive reframing, may be incongruent with gender norms that call for indifference in the face of challenges. Thus, boys who perceive themselves as more mature may view these suggestions as unconstructive. Even though seeking support or expressing negative emotions may help boys manage stressors and process negative emotions and cognitions, as well as improve their psychosocial health (Piko, 2001), certain types of engagement coping (e.g., emotional expression, help seeking) may elicit dismissive or punitive responses from same-gender peers (Klimes‐Dougan et al., 2014). In contrast, boys who perceive themselves as late maturers may feel less of a need to conform to gender roles associated with older males, thus allowing them to be more receptive to maternal engagement coping suggestions.
It is also possible that encouraging boys with earlier perceived timing to directly engage with stressors may prompt them to choose ineffective strategies that further provoke negative feelings or create further stressors. For example, in the context of a social stressor, boys may confront peers in a hostile manner, thus exacerbating the problem. Consistent with a potential detrimental effect of engagement suggestions in adolescent boys, one study found that engagement suggestions predicted heightened externalizing behavior among high-stressed boys (Abaied & Rudolph, 2010). Because analyses regarding boys were exploratory, however, replication of this pattern of findings is needed before drawing firm conclusions.
Contrary to our hypotheses, disengagement suggestions did not moderate the association between actual or perceived timing and depression in youth. Of note, our disengagement subscale included suggestions for distinct ways of directing oneself away from stressors and related cognitions and emotions. Whereas some types of disengagement, such as distraction, may have some adaptive advantages (e.g., helping youth to distance themselves from stressors when they are unable to process difficult emotions and thoughts), other types of disengagement, such as avoiding or denying stressful situations, may have more pernicious effects (Flynn & Rudolph, 2011). Because of the limited number of items reflecting each type of disengagement, we were unable to examine them individually. Thus, further research is needed to examine whether distinguishing among specific types of disengagement suggestions has more predictive power in terms of moderating the effects of early perceived timing on youth depression.
Implications, Limitations, and Future Directions
Although the stage-termination hypothesis has long suggested under-developed or insufficient coping resources may contribute to risk for depression among early-maturing youth, this study is the first to directly examine the moderating role of external resources, as reflected in maternal socialization of coping. As such, findings provide a novel perspective on the stage-termination hypothesis by elucidating how parental guidance may exacerbate or mitigate risk resulting from inadequate coping resources in early-maturing youth. Moreover, this study highlights the importance of providing gender-specific and developmentally adaptive external coping resources to youth who view themselves as early maturers.
A few limitations of the current study should be noted. First, to examine the unique interactive effects of actual and perceived pubertal timing with coping suggestions and gender, it would be informative to include both constructs in the same analytic model. This approach would help determine whether maternal coping suggestions alleviate or worsen the risk of depression among girls and boys who perceive themselves as early maturers, regardless of their actual pubertal maturation compared to their peers. In light of our current sample size, incorporating additional predictors into the regression models would potentially compromise the precision of the estimates. It is recommended that future researchers replicate our study with larger sample sizes to explore how actual or perceived pubertal timing uniquely interact with coping suggestions and gender to influence depression.
Second, data on socialization of coping were available only for maternal caregivers, but socializers’ gender can play an important role in how coping socialization processes unfold. Although prior research reveals that mothers’ behaviors have a greater impact than those of fathers on children’s coping (Kliewer et al., 1996), paternal caregivers also may provide vital coping resources during the transition through puberty. As reflected in several studies on emotion socialization, the content and effects of socialization behaviors from fathers may differ from those of mothers (Cassano et al., 2007). Further, girls and boys may react differently to coping suggestions from fathers and mothers (Kliewer et al., 1996). It is possible that gender of the socializer impacts how well certain types of engagement suggestions are received. For instance, engagement coping suggestions consist of various coping strategies differing in conformity with social conventions for boys. Boys may be more likely to accept suggestions that potentially violate gender norm adherence, such as discussing emotions with others, when received from fathers. Moreover, engagement suggestions that encourage boys to independently problem solve, regardless of the gender of the socializer, would not violate gender norms or elicit disapproval from peers, perhaps providing a protective effect for boys. Future examinations of socialization of coping in boys would benefit from a more detailed examination of both the content and the source of engagement coping suggestions, which may reveal a protective effect on depression in the context of suggestions that focus on emotion-oriented strategies coming from paternal caregivers or problem-oriented strategies coming from either caregiver.
Third, while these results have direct implications for parenting practices, we must also consider the possibility that youth differ in their interpretation of the messages communicated by parents. How youth interpret these messages and whether maternal coping suggestions are actually translated into differences in youth responses to stress may depend on their relationship with parents (Zimmer-Gembeck & Locke, 2007), parents’ effectiveness in communicating the messages, and youth’s own characteristics (e.g., temperament). Although prior research demonstrates that maternal socialization of coping predicts the development of coping repertoires in youth (Abaied & Rudolph, 2011), one important direction for future studies will be to determine whether youths’ responses to stress account for the amplifying or mitigating effects of coping suggestions on depression in those who perceive themselves as early maturers.
Fourth, future studies should examine how self-disclosure of problems and expression of negative emotions when parents are present may impact the moderating role socialization of coping plays. Socialization of coping necessitates disclosure of stressful experiences by youth or clear demonstration of being upset. However, both parents and adolescents believe adolescents are less obligated to disclose issues to parents as they grow older, and adolescents differ in the extent to which they disclose information voluntarily (Smetana et al., 2006). Whether they decide to disclose stressful experiences may depend upon parenting practices and features of the parent-child relationship (Brown & Bakken, 2011). Moreover, youth might not disclose stressful events that may elicit parents’ disapproval, such as involvement with norm-breaking groups, illicit drug use, or sexual relationships (Brown & Bakken, 2011). However, suggestions on how to deal with these stressors may have considerable implications for youth depression.
Fifth, a few studies reveal that later actual timing (Conley & Rudolph, 2009; Kaltiala-Heino et al., 2003) and perceived timing (Siegel et al., 1999) are concurrently associated with elevated depressive symptoms, particularly in boys, although a recent meta-analysis did not support this association (Ullsperger & Nikolas, 2017). The present study did not examine the curvilinear effect of puberty, which would have required testing a four-way interaction, due to insufficient power, but it would be helpful for future research to further explore the curvilinear effect of pubertal timing on depression risk in the context of maternal socialization of coping.
Sixth, at this stage of development, youth increasingly desire behavioral and psychological autonomy and agency (Daddis, 2011). As adolescents demonstrate greater peer orientation, peers become a more regular source of support and values (Brechwald & Prinstein, 2011) and may provide an alternative source of modeling behaviors and coping suggestions. Prior research on socialization of cyber-victimization coping skills shows that both parent and peer coaching predict adolescents’ use of coping (Bradbury et al., 2018). Given the growing influence of peers across adolescence, future studies should examine the role of peer coping socialization on depression risk among early-maturing youth.
Seventh, we speculated that different patterns of coping socialization may be effective in girls and boys due to gender socialization and norms about acceptable coping scripts during adolescence. Supporting this idea, one previous study revealed that early adolescents demonstrate gender-polarized beliefs about appropriate coping behavior (Broderick & Korteland, 2002). It would be helpful for future research to track the changing landscape of gendered beliefs about appropriate coping behaviors across pubertal development and to investigate how these beliefs affect youths’ interpretation, reception, and implementation of coping suggestions.
Finally, although the sample represented the community from which participants were recruited and included several ethnic groups, it was comprised of mostly White families from the United States. Limited research reports associations between maternal socialization of coping and child responses to stress among African American youth (Gaylord-Harden et al., 2013), but additional research should confirm whether the present findings can be replicated within larger and more diverse samples.
Supplementary Material
Public Significance Statement.
The present study suggests that encouraging youth who view themselves as early maturers to engage with stressors and related emotions—through strategies such as seeking support, reappraising stressors, and problem solving—can buffer girls against depression but heighten risk for depression in boys. These opposing findings highlight the importance of considering gender-specific developmental contexts when teaching youth how to cope with stress.
Acknowledgments
This work was supported by a University of Illinois Research Board Beckman Award, a William T. Grant Foundation Faculty Scholars Award, and National Institute of Mental Health Grand MH59711 (to K.D.R.) and by a University of Illinois Distinguished Fellowship (to Z.Y.). This study was not preregistered. The study materials, data, and analysis code that support the findings of this study are available from the corresponding author upon reasonable request.
Appendix A. Socialization of Coping Questionnaire
When your child has a problem or is upset, how much do you do each of the following? | Not At All | A Little | Some | Much | Very Much | |
---|---|---|---|---|---|---|
1. | Encourage him/her to think of different ways to change the problem or fix the situation. | 1 | 2 | 3 | 4 | 5 |
2. | Encourage him/her to think about happy things to take his/her mind off of the problem or how he/she is feeling. | 1 | 2 | 3 | 4 | 5 |
3. | Encourage him/her to think that it doesn’t matter, that it isn’t a big deal. | 1 | 2 | 3 | 4 | 5 |
4. | Encourage him/her to ask me or other people for help or for ideas about how to make the problem better. | 1 | 2 | 3 | 4 | 5 |
5. | Encourage him/her to keep his/her mind off of the problem by getting involved in other activities (e.g., seeing friends, playing games, exercising, doing a hobby). | 1 | 2 | 3 | 4 | 5 |
6. | Encourage him/her not to cry about the problem. | 1 | 2 | 3 | 4 | 5 |
7. | Encourage him/her to think that everything will be all right. | 1 | 2 | 3 | 4 | 5 |
8. | Encourage him/her to try to stay away from people and things that make him/her upset or remind him/her of the problem. | 1 | 2 | 3 | 4 | 5 |
9. | Encourage him/her to discuss his/her feelings with me or others. | 1 | 2 | 3 | 4 | 5 |
10. | Encourage him/her to do something to try to fix the problem or take action to change things. | 1 | 2 | 3 | 4 | 5 |
11. | Encourage him/her to better understand him/herself by thinking about the problem. | 1 | 2 | 3 | 4 | 5 |
12. | Encourage him/her not to focus on his/her negative feelings. | 1 | 2 | 3 | 4 | 5 |
13. | Encourage him/her not to think about the problem. | 1 | 2 | 3 | 4 | 5 |
14. | Encourage him/her to think about things he/she is learning from the situation. | 1 | 2 | 3 | 4 | 5 |
15. | Encourage him/her to just act like the problem never happened and to go on with his/her life. | 1 | 2 | 3 | 4 | 5 |
16. | Encourage him/her to better understand him/herself by discussing the problem with me or others. | 1 | 2 | 3 | 4 | 5 |
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