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Contains fulltext : 240012.pdf (Publisher’s version ) (Open Access) Many adolescents in residential care have experienced traumatic events and suffer from posttraumatic stress. Prolonged activation of neurobiological stress systems as the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis can result in long-lasting maladaptive alternations. This study investigated the effectiveness of Muse, a game-based meditation intervention, on the sympathetic nervous system (SNS), parasympathetic nervous system (PNS), and cortisol basal activity and reactivity to acute stress among adolescents with posttraumatic symptoms in residential care. The intervention consisted of two gameplay sessions a week, for 6 consecutive weeks. Seventy-seven adolescents with clinical levels of posttraumatic symptoms (10-18 years old) received either Muse as an addition to treatment as usual (n = 40) or treatment as usual alone (n = 37). We expected reduced basal activity for the SNS and cortisol and increased basal activity for the PNS. As for the response to acute stress, we expected decreased PNS and increased HPA axis reactivity. The Muse group exhibited lower basal activity for the SNS and increased HPA reactivity to acute stress. There were no differences between conditions on SNS and HPA axis activity during rest and on SNS and PNS reactivity to acute stress. Game-based meditation therapy is a promising intervention for the treatment of adolescents with posttraumatic symptoms in residential care. Implications for clinical relevance and trauma-focused treatment purposes are discussed. 8 p.

Contains fulltext : 219443.pdf (Publisher’s version ) (Closed access) Aim: Many youth in residential care suffer from post-traumatic symptoms that have adverse effects on a range of psychological, behavioural and physiological outcomes. Although current evidence-based treatment options are effective, they have their limitations. Meditation interventions are an alternative to traditional trauma-focused treatment. This pilot study aimed to evaluate three game-based meditation interventions in a sample of traumatized youth in residential care. Methods: Fifteen participants were randomly divided over three conditions (Muse, DayDream and Wild Divine) that all consisted of twelve 15-minute game-play sessions. Physiological measurements (heart rate variability) were conducted at baseline, post-treatment and during each intervention session. Post-traumatic symptoms, stress, depression, anxiety and aggression were assessed at baseline, post-treatment and 1-month follow-up. Results: Physiological stress regulation was improved during the meditation sessions of all three interventions. User evaluations were in particular high for Muse with a rating of 8.42 out of 10 for game evaluation. Overall, outcomes on psychopathology demonstrated the most robust effect on stress. Muse performed best, with all participants showing reliable improvements (reliable change indexes [RCIs]) in post-traumatic symptoms, stress and anxiety. Participants who played Daydream or Wild Divine showed inconsistent progression: some participants improved, whereas others remained stable or even deteriorated based on their RCIs. Conclusions: Preliminary findings show promising outcomes on physiology, psychopathology and user evaluations. All indicate the potential of this innovative form of stress regulation intervention, and the potential of Muse in particular, although findings should be considered preliminary due to our small sample size. Further studies are warranted to assess intervention effectiveness effects of Muse or other game-based meditation interventions for traumatized youth. 10 p.

Contains fulltext : 252906.pdf (Publisher’s version ) (Open Access) Seclusion can be harmful for children and adolescents. Hence, all locations for secure residential youth care in the Netherlands are committed to reduce its use by implementing monitoring and feedback as a seclusion reduction intervention. This study examined change over time in the use of seclusion in secure residential youth care in the Netherlands using a broad conceptualization of seclusion and by analyzing four variables (frequency, duration, room, reason). During two six months periods, seclusions were registered in 19 locations. Every month, all locations received feedback on the use of seclusion. Negative binomial mixed model analyses were used to investigate change over time in frequency and duration of seclusion. Logistic mixed model analyses were used to identify change over time in reason for use and type of room used for seclusion. Results showed that seclusion frequency significantly decreased (RR = 0.92, p < .001). Further, duration of placement in a seclusion room significantly increased (RR = 1.04, p < .001). This change was only significant in seclusion in response to aggression (RR = 1.06, p < .001). The results emphasize the need for future studies to examine reduction using a broad conceptualization of seclusion. 19 p.

Contains fulltext : 214790.pdf (Publisher’s version ) (Closed access) The aim of the current study was to compare levels of oxytocin, cortisol, and testosterone in adolescents with either autism spectrum disorder (ASD), or oppositional defiant disorder (ODD)/conduct disorder (CD), and in typically developing individuals (TDI), and relate hormone levels to severity and subtype of aggression and callous-unemotional (CU) traits. Saliva concentrations of oxytocin, cortisol, and testosterone were assessed in 114 male participants (N = 49 ASD, N = 37 ODD/CD, N = 28 TDI,) aged 12-19 years (M = 15.4 years, SD = 1.9). The ASD and the ODD/CD groups had significantly lower levels of oxytocin than the TDI group, and the ODD/CD group had significantly higher levels of testosterone than the ASD group. There were no group effects on cortisol levels. Group differences remained for oxytocin after correcting for the influence of CU traits, but were not significant after controlling for aggression. Results for testosterone became non-significant after correction for either CU traits or aggression. Across groups, higher levels of CU traits were related to higher levels of cortisol and testosterone, however, proactive and reactive aggression were unrelated to all three hormonal levels. The current findings show that, regardless of cognitive ability or comorbid disorders, the diagnostic groups (ASD, ODD/CD) differ from each other by their hormonal levels, with the ASD group characterized by relative low level of oxytocin, and the ODD/CD group by a relative low level of oxytocin and high level of testosterone. These group effects were partly driven by differences in CU traits between the groups. 15 p.

In de klinische praktijk wordt veel gebruikgemaakt van Routine Outcome Monitoring om inzicht te krijgen in het beloop van de behandeling op individueel en geaggregeerd niveau. Voorwaarde voor het geaggregeerd gebruik van de onderzoeksgegevens ten behoeve van wetenschappelijk onderzoek is dat er door clienten expliciet en geinformeerd toestemming wordt gegeven (informed consent). Het doel van de huidige studie is om inzicht te verkrijgen in de beweegredenen van jongeren om al dan niet toestemming te geven voor gebruik van hun klinische data voor wetenschappelijk onderzoek. In drie instellingen voor gesloten jeugdzorg, die onderling verschillen in het percentage jongeren dat toestemming verleent voor landelijk gebruik van hun gegevens, zijn gestructureerde interviews afgenomen met jongeren (N = 14). Daarnaast zijn focusgroepen gehouden met medewerkers uit deze drie instellingen. Jongeren (ongeacht of ze weigerden of toestemden) herinnerden zich weinig van de toestemmingsprocedure en in hoeverre ze geinformeerd waren. Jongeren gaven aan dat dit mede komt doordat de toestemming op een hectisch moment direct bij de start van de behandeling wordt gevraagd, waardoor ze de informatie over een dergelijke toestemming niet opnemen. Overwogen zou moeten worden jongeren meerdere keren op verschillende manieren te informeren over de metingen, wat daarvan het doel is, wat er met hun informatie gebeurt en wat hun rechten zijn.

Cognitive behavioural therapy and depressive symptoms among youth with and without Mild Intellectual Disability in residential care: an exploratory study investigating ‘Op Volle Kracht’ Depression is at least as prevalent in youth with a mild intellectual disability (MID) as it is in youth without disabilities. Little is known however about the etiology and treatment of depression in this group. This paper aims to investigate the possiblities for cognitive behavioural therapy in youth with MID by (1) testing the validity of Beck’s cognitive theory and Nolen-Hoeksema’s response style theory in youth with and without a MID in residential youth care; and (2) to examine the effects of Op Volle Kracht (OVK), a CBT-based depression prevention program among youth with and without a MID in a residential treatment setting. In study 1 the relationship between negative cognitive errors (Beck), response styles (Nolen- Hoeksema) and depressive symptoms was examined in 135 adolescents (age 9-17 years) using linear regression. Study 2 was an initial cluster randomized controlled trial in which twenty residential treatment groups (including in total N=92 adolescents aged 9-17 years), half of which targeted adolescents with a MID, were randomly assigned to either treatment as usual (TAU), or a combination of TAU and the group-CBT-program Op Volle Kracht (OVK+TAU). Depressive symptoms, cognitive errors and response styles were assessed at pre-test, post-test and 3 months follow-up. The data were analyzed by mixed effects linear regression analyses with age and gender as covariates. Results Study 1 showed that only the cognitive error ‘underestimation of the ability to cope’, and a ruminative and distractive response style predicted depressive symptoms in both youth with- and without MID. The negative cognitive error ‘underestimation of the ability to cope’ was more prevalent among youth with MID than among youth without MID. Study 2 showed that the group CBT-program OVK was effective in reducing rumination, but not in reducing depressive symptoms or cognitive errors. This effect was the same for youth with and without a MID. The main premises of Beck’s cognitive theory and Nolen-Hoeksema’s response style theory of depression are applicable to both youth with and without a MID. The cognitive error ‘underestimation of the ability to cope’ poses a specific risk factor for developing a depression for youth with a MID and may require special attention in treatment and prevention of depression. The specifically adapted program OVK did not show effectiveness in reducing symptoms of depression in youth in residential care.

Aim: Many adolescents in residential care have experienced traumatic events and suffer from posttraumatic stress. This study examined the effectiveness of Muse, a game-based meditation intervention, as an addition to treatment as usual (TAU) for traumatized adolescents in residential care.Methods: Seventy-seven traumatized adolescents (10 – 18 years old) received either Muse and TAU (n = 37) or treatment as usual alone (n = 40). TAU consisted of evidence-based treatments that did not specifically target posttraumatic symptoms. Outcomes were measured at T1, T2, and two-months follow-up (FU). Primary outcomes were posttraumatic symptoms (self-report and mentor-report) and stress (self-report) at T2. Secondary outcomes included anxiety, depression, and aggression at T2, and all outcomes at follow-up.Results: The Muse group showed significantly greater improvements than the control group at T2 regarding self-reported posttraumatic symptoms, stress, anxiety, depression, and aggression. Mentor reports showed marginally significant decreases in posttraumatic stress at T2. There were no differences between the groups at FU, except for a marginally significant difference in self-reported posttraumatic symptoms, where the Muse participants showed larger decreases.Conclusions: Game-based meditation therapy is a promising intervention that is more effective than treatment as usual alone. Implications of these findings for the role of game-based meditation interventions for traumatized adolescents in residential care are discussed.

Item does not contain fulltext In 2018 hebben de JeugdzorgPlus-instellingen de beweging in gang gezet naar vermindering van gedwongen afzonderingen. Actieonderzoek laat zien dat er verbetering in de instellingen is. Maar om het aantal naar nul terug te brengen, is een cultuurverandering nodig. 9 p.

Contains fulltext : 237108.pdf (Publisher’s version ) (Open Access) Using seclusion in youth mental health care is controversial, as it can have physical and psychological consequences for youth and professionals. Notably, there is a wide disparity in how seclusion is defined in literature and practice. This leads to a diffuse image of what seclusion comprises, complicates measuring its prevalence, and hampers initiatives to reduce its use. Therefore, the objective of this study was to establish an unambiguous and measurable definition of seclusion supported by youth and professionals in secure residential youth care in the Netherlands. A qualitative multiphase approach was used to examine which elements of the definition are essential and receive consensus among youth and professionals. After a brief literature review, a Delphi survey and focus groups were performed. In total, 11 (ex-)clients and 33 professionals with extensive experience in secure residential youth care participated. Youth and professionals arrived at the following definition: ?an involuntary placement in a room or area the client is not allowed or able to leave? During the implementation process, observations showed broad support for the definition by youth and professionals. With this, a foundation has been provided to monitor and reduce the use of seclusion in secure residential youth care in the Netherlands. 20 p.

Contains fulltext : 234328.pdf (Publisher’s version ) (Open Access) Alterations in neurobiological stress systems such as the autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis contribute to the development and maintenance of psychological and behavioral problems after traumatic experiences. Investigating neurobiological parameters and how these relate to each other may provide insight into the complex mechanisms at play. Whereas the preponderance of studies focuses on either the ANS or the HPA axis separately, the current study is the first to evaluate relations between posttraumatic stress and both basal activity during rest and stress reactivity of the ANS as well as the HPA axis in a sample of traumatized adolescents and healthy controls. The traumatized sample (n = 77), based on clinical levels of posttraumatic stress, was a convenience sample that was recruited within residential institutions, was compared to a healthy control sample (n = 48) recruited within the general community. For the ANS, we expected increased SNS and decreased PNS activity during rest and increased SNS and decreased PNS reactivity to social stress among traumatized adolescents compared to healthy controls. Regarding the HPA axis, we expected increased basal cortisol levels and decreased cortisol reactivity to stress in the traumatized sample. Compared to healthy controls, traumatized adolescents exhibited significantly higher sympathetic and lower parasympathetic activation during rest and increased sympathetic reactivity to acute stress (ANS parameters). Outcomes on the HPA axis (i.e. cortisol) indicated that traumatized adolescents showed increased cortisol levels during rest and blunted cortisol reactivity to acute stress. Implications for clinical relevance and trauma-focused treatment purposes are discussed. 12 p.

Background Many adolescents in residential care have been exposed to prolonged traumatic experiences such as violence, neglect, or abuse. Consequently, they suffer from posttraumatic stress. This not only negatively affects psychological and behavioral outcomes (eg, increased anxiety, depression, and aggression) but also has adverse effects on physiological outcomes, in particular on their neurobiological stress systems. Although current evidence-based treatment options are effective, they have their limitations. An alternative to traditional trauma treatment is meditation-based treatment that focuses on stress regulation and relaxation. Muse is a game-based meditation intervention that makes use of adolescents’ intrinsic motivation. The neurofeedback element reinforces relaxation abilities. Objective This paper describes the protocol for a randomized controlled trial in which the goal is to examine the effectiveness of Muse (InteraXon Inc) in reducing posttraumatic stress and normalizing neurobiological stress systems in a sample of traumatized adolescents in residential care. Methods This will be a multicenter, multi-informant, and multimethod randomized controlled trial. Participants will be adolescents (N=80), aged 10 to 18 years, with clinical levels of posttraumatic symptoms, who are randomized to receive either the Muse therapy sessions and treatment as usual (intervention) or treatment as usual alone (control). Data will be collected at 3 measurement instances: pretest (T1), posttest (T2), and at 2-month follow-up. Primary outcomes will be posttraumatic symptoms (self-report and mentor report) and stress (self-report) at posttest. Secondary outcomes will be neurobiological stress parameters under both resting and acute stress conditions, and anxiety, depression, and aggression at posttest. Secondary outcomes also include all measures at 2-month follow-up: posttraumatic symptoms, stress, anxiety, depression aggression, and neurobiological resting parameters. Results The medical-ethical committee Arnhem-Nijmegen (NL58674.091.16) approved the trial on November 15, 2017. The study was registered on December 2, 2017. Participant enrollment started in January 2018, and the results of the study are expected to be published in spring or summer 2021. Conclusions Study results will demonstrate whether game-based meditation therapy improves posttraumatic stress and neurobiological stress systems, and whether it is more effective than treatment as usual alone for traumatized adolescents. Trial Registration Netherlands Trial Register NL6689 (NTR6859); https://www.trialregister.nl/trial/6689 International Registered Report Identifier (IRRID) DERR1-10.2196/19881

BACKGROUND Many adolescents in residential care have been exposed to prolonged traumatic experiences such as violence, neglect, or abuse. Consequently, they suffer from posttraumatic stress. This not only negatively affects psychological and behavioral outcomes (eg, increased anxiety, depression, and aggression) but also has adverse effects on physiological outcomes, in particular on their neurobiological stress systems. Although current evidence-based treatment options are effective, they have their limitations. An alternative to traditional trauma treatment is meditation-based treatment that focuses on stress regulation and relaxation. Muse is a game-based meditation intervention that makes use of adolescents’ intrinsic motivation. The neurofeedback element reinforces relaxation abilities. OBJECTIVE This paper describes the protocol for a randomized controlled trial in which the goal is to examine the effectiveness of Muse (InteraXon Inc) in reducing posttraumatic stress and normalizing neurobiological stress systems in a sample of traumatized adolescents in residential care. METHODS This will be a multicenter, multi-informant, and multimethod randomized controlled trial. Participants will be adolescents (N=80), aged 10 to 18 years, with clinical levels of posttraumatic symptoms, who are randomized to receive either the Muse therapy sessions and treatment as usual (intervention) or treatment as usual alone (control). Data will be collected at 3 measurement instances: pretest (T1), posttest (T2), and at 2-month follow-up. Primary outcomes will be posttraumatic symptoms (self-report and mentor report) and stress (self-report) at posttest. Secondary outcomes will be neurobiological stress parameters under both resting and acute stress conditions, and anxiety, depression, and aggression at posttest. Secondary outcomes also include all measures at 2-month follow-up: posttraumatic symptoms, stress, anxiety, depression aggression, and neurobiological resting parameters. RESULTS The medical-ethical committee Arnhem-Nijmegen (NL58674.091.16) approved the trial on November 15, 2017. The study was registered on December 2, 2017. Participant enrollment started in January 2018, and the results of the study are expected to be published in spring or summer 2021. CONCLUSIONS Study results will demonstrate whether game-based meditation therapy improves posttraumatic stress and neurobiological stress systems, and whether it is more effective than treatment as usual alone for traumatized adolescents. CLINICALTRIAL Netherlands Trial Register NL6689 (NTR6859); https://www.trialregister.nl/trial/6689 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19881

Contains fulltext : 191435.pdf (Publisher’s version ) (Open Access) Residential care is among the most intensive forms of treatment in youth care. It serves youths with severe behavioral problems and is primarily focused on targeting externalizing problems. Despite best efforts, effect sizes remain moderate, which may be due to the disregarding of internalizing symptoms - in particular anxiety - and to limitations regarding the delivery model of interventions. This initial randomized controlled trial (n = 37) aimed to examine the effectiveness of a biofeedback videogame intervention (Dojo) as an addition to treatment as usual for youths with and without intellectual disability (ID) in residential care with clinical levels of anxiety and externalizing problems. Dojo targets both anxiety and externalizing problems, and incorporates the principles of conventional treatment, while addressing its limitations. Youths were randomly assigned to play Dojo (eight 30-min gameplay sessions) or to treatment as usual (TAU). Measurements of anxiety and externalizing problems were conducted at baseline, posttreatment, and 4-months follow-up through youths’ self-report and mentor-report. Completers-only analyses revealed decreases in self-reported anxiety and externalizing problems, and mentor-reported anxiety at posttreatment for participants in the Dojo condition compared to the control condition. Only mentor-reported anxiety was maintained at follow-up. No effect was found for mentor-reported externalizing problems. These findings provided preliminary evidence that Dojo is a promising, innovative intervention that engages high-risk youths. Practical implications are discussed. 11 p.

Contains fulltext : 222315.pdf (Publisher’s version ) (Open Access) Wearable monitoring devices are an innovative way to measure heart rate (HR) and heart rate variability (HRV), however, there is still debate about the validity of these wearables. This study aimed to validate the accuracy and predictive value of the Empatica E4 wristband against the VU University Ambulatory Monitoring System (VU-AMS) in a clinical population of traumatized adolescents in residential care. A sample of 345 recordings of both the Empatica E4 wristband and the VU-AMS was derived from a feasibility study that included fifteen participants. They wore both devices during two experimental testing and twelve intervention sessions. We used correlations, cross-correlations, Mann-Whitney tests, difference factors, Bland-Altman plots, and Limits of Agreement to evaluate differences in outcomes between devices. Significant correlations were found between Empatica E4 and VU-AMS recordings for HR, SDNN, RMSSD, and HF recordings. There was a significant difference between the devices for all parameters but HR, although effect sizes were small for SDNN, LF, and HF. For all parameters but RMSSD, testing outcomes of the two devices led to the same conclusions regarding significance. The Empatica E4 wristband provides a new opportunity to measure HRV in an unobtrusive way. Results of this study indicate the potential of the Empatica E4 as a practical and valid tool for research on HR and HRV under non-movement conditions. While more research needs to be conducted, this study could be considered as a first step to support the use of HRV recordings provided by wearables. 11 p.

Contains fulltext : 179426.pdf (Publisher’s version ) (Closed access) This study examines the external validity of a nationwide dataset, considering the fact that clients can refuse the extraction of their clinical information to aggregate datasets. Data of 949 youths (56% boys, mean age 15.6 years, Sd = 1.49) from six Dutch residential institutions were included. An individual-variables and a person-oriented approach were applied to examine the extent to which the group giving permission to the use of their data for aggregate purposes (66%) is representative for the total population in secure residential youth care. Both static, non-changeable client information as well as dynamic, changeable client information were gathered. Youths who assented to the use of their information were overrepresented amongst the population of some of the participating institutions, and were more often Caucasian. Three start profiles based on the dynamic variables were distinguished. Youths who assent were overrepresented in the most problematic profile, whereas youth who did not assent were overrepresented in the least problematic profile. To improve the external validity and the value of the monitor, it is important to achieve more uniformity between institutions as far as the procedures are concerned, and to find creative ways to increase assent levels, particularly among ethnic minorities. 22 p.

Contains fulltext : 205889.pdf (Publisher’s version ) (Closed access) Oppositional defiant disorder, conduct disorder (ODD/CD), and autism spectrum disorder (ASD) share poor empathic functioning and have been associated with impaired emotional processing. However, no previous studies directly compared similarities and differences in these processes for the two disorders. A two-choice emotional valence detection task requiring differentiation between positive, negative, and neutral IAPS pictures was administered to 52 adolescents (12-19 years) with ODD/CD, 52 with ASD and 24 typically developing individuals (TDI). Callous–unemotional (CU) traits were assessed by self- and parent reports using the Inventory of callous–unemotional traits. Main findings were that adolescents with ODD/CD or ASD both performed poorer than TDI in terms of accuracy, yet only the TDI - not both clinical groups - had relatively most difficulty in discriminating between positive versus neutral pictures compared to neutral-negative or positive-negative contrasts. Poorer performance was related to a higher level of CU traits. The results of the current study suggest youth with ODD/CD or ASD have a diminished ability to detect emotional valence which is not limited to facial expressions and is related to a higher level of CU traits. More specifically, youth with ODD/CD or ASD seem to have a reduced processing of positive stimuli and/or lack a 'positive perception bias' present in TDI that could either contribute to the symptoms and/or be a result of having the disorder and may contribute to the comorbidity of both disorders. 12 p.

Contains fulltext : 195177.pdf (Publisher’s version ) (Open Access) Autism Spectrum Disorder (ASD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) are often associated with emotion recognition difficulties. This is the first eye-tracking study to examine emotional face recognition (i.e., gazing behavior) in a direct comparison of male adolescents with Autism Spectrum Disorder or Oppositional Defiant Disorder/Conduct Disorder, and typically developing (TD) individuals. We also investigate the role of psychopathic traits, callous–unemotional (CU) traits, and subtypes of aggressive behavior in emotional face recognition. A total of 122 male adolescents (N = 50 ASD, N = 44 ODD/CD, and N = 28 TD) aged 12-19 years (M = 15.4 years, SD= 1.9) were included in the current study for the eye-tracking experiment. Participants were presented with neutral and emotional faces using a Tobii 1750 eye-tracking monitor to record gaze behavior. Our main dependent eye-tracking variables were: (1) fixation duration to the eyes of a face and (2) time to the first fixation to the eyes. Since distributions of eye-tracking variables were not completely Gaussian, non-parametric tests were chosen to investigate gaze behavior across the diagnostic groups with Autism Spectrum Disorder, Oppositional Defiant Disorder/Conduct Disorder, and Typically Developing individuals. Furthermore, we used Spearman correlations to investigate the links with psychopathy, callous, and unemotional traits and subtypes of aggression as assessed by questionnaires. The relative total fixation duration to the eyes was decreased in both the Autism Spectrum Disorder group and the Oppositional Defiant Disorder/Conduct Disorder group for several emotional expressions. In both the Autism Spectrum Disorder and the Oppositional Defiant Disorder/Conduct Disorder group, increased time to first fixation on the eyes of fearful faces only was nominally significant. The time to first fixation on the eyes was nominally correlated with psychopathic traits and proactive aggression. The current findings do not support strong claims for differential cross-disorder eye-gazing deficits and for a role of shared underlying psychopathic traits, callous–unemotional traits, and aggression subtypes. Our data provide valuable and novel insights into gaze timing distributions when looking at the eyes of a fearful face. 15 p.

Contains fulltext : 175507.pdf (Publisher’s version ) (Closed access) Aim: This study tests the validity of Beck’s cognitive theory and Nolen-Hoeksema's response style theory of depression in adolescents with and without MBID. Methods: The relationship between negative cognitive errors (Beck), response styles (Nolen-Hoeksema) and depressive symptoms was examined in 135 adolescents using linear regression. Results: The cognitive error ‘underestimation of the ability to cope’ was more prevalent among adolescents with MBID than among adolescents with average intelligence. This was the only negative cognitive error that predicted depressive symptoms. There were no differences between groups in the prevalence of the three response styles. In line with the theory, ruminating was positively and problem-solving was negatively related to depressive symptoms. Distractive response styles were not related to depressive symptoms. The relationship between response styles, cognitive errors and depressive symptoms were similar for both groups. Conclusion: The main premises of both theories of depression are equally applicable to adolescents with and without MBID. The cognitive error 'Underestimation of the ability to cope' poses a specific risk factor for developing a depression for adolescents with MBID and requires special attention in treatment and prevention of depression. What this paper adds? Despite the high prevalence of depression among adolescents with MBID, little is known about the etiology and cognitive processes that play a role in the development of depression in this group. The current paper fills this gap in research by examining the core tenets of two important theories on the etiology of depression (Beck's cognitive theory and Nolen-Hoeksema's response style theory) in a clinical sample of adolescents with and without MBID. This paper demonstrated that the theories are equally applicable to adolescents with MBID, as to adolescents with average intellectual ability. However, the cognitive bias 'underestimation of the ability to cope' was the only cognitive error related to depressive symptoms, and was much more prevalent among adolescents with MBID than among adolescents with average intellectual ability. This suggests that underestimating one's coping skills may be a unique risk factor for depression among adolescents with MBID. This knowledge is important in understanding the causes and perpetuating mechanisms of depression in adolescents with MBID, and for the development of prevention- and treatment programs for adolescents with MBID. 10 p.

Contains fulltext : 102692.pdf (Publisher’s version ) (Closed access) Background By interacting with children, group care workers shape daily living environments to influence treatment. Current literature provides little knowledge about the content of youth residential care. Objective In this study, a questionnaire called the Group care worker Intervention Checklist was developed. Method Group care workers completed the questionnaires for 212 children placed in youth residential care in the Netherlands. Results Factor analyses revealed three constructs: controlling, warmth/support, and autonomy granting. Reliability of these scales proved to be good. Controlling was associated with Externalizing Behavior Problems while both Warmth/Support and Autonomy Granting were associated with Internalizing Behavior Problems. Conclusions These findings imply that group care worker interventions can be reliably measured and are related to child problem behavior. 14 p.

Contains fulltext : 99368.pdf (Publisher’s version ) (Closed access) In the present study, group care workers' behavior toward adolescents' problem behavior was measured. The sample consisted of 126 adolescents (M age = 15.80, SD = 1.23, 56% boys), residing in a new Dutch compulsory residential treatment program. Latent growth curve analyses revealed that group care workers exerted more structuring and controlling behavior toward adolescents with externalizing problems and more warmth and support toward adolescents with internalizing problems. No associations were found between group care workers' behavior and the adolescents' treatment progress. Clinical implications of these findings and suggestions for future research are discussed. 19 p.

Contains fulltext : 99654.pdf (Publisher’s version ) (Open Access) The present study examined whether a sample of 214 (52.8% male, M age=15.76, SD=1.29) institutionalized adolescents could be classified into subgroups based on psychopathic traits. Confirmatory Factor Analyses revealed a relationship between the subscales of the Youth Psychopathic traits Inventory (YPI) and the three latent constructs of the original model on which it is based. Latent Class Analyses showed that adolescents showing psychopathic traits could be classified into three subgroups. The first group showed low scores on the grandiose/manipulative dimension, the callous/ unemotional dimension, and the impulsive/irresponsible dimension (normal group). The second group scored moderate on the grandiose/manipulative dimension and the callous/ unemotional dimension and high on the impulsive/irresponsible dimension (impulsive, non-psychopathic-like group). The third group scored high on all three dimensions (psychopathy-like group). The findings revealed that the impulsive, non-psychopathic like group scored significantly higher on internalizing problem behavior compared to the normal group, while the psychopathy-like and the impulsive, non-psychopathic-like group both scored higher on externalizing problem behavior compared to the normal group. Based on a self-report delinquency measure, it appeared that the psychopathy-like group had the highest delinquency rates, except for vandalism. Both the impulsive and psychopathylike group had the highest scores on the use of soft drugs. 12 p.

In this longitudinal study, the authors investigated short-term criminal pathways of children and early adolescents starting under the age of 14 years and the extent to which characteristics of the 1st crime influenced criminal pathways. Participants were 387 juvenile offenders with a mean age of 12.1 years (SD = 2.05 years). The authors followed all participants in the police systems for 2 years to get insight into the crimes that they committed. Then, 2 years after the 1st police contact, 46.5% of these offenders were still considered 1st offenders, and 53.5% had become recidivists. Most of the children began their criminal pathway with less serious covert crimes. Further analyses showed that when the 1st crime was a serious overt crime, the risk of recidivism within 1 year increased. The likelihood of committing a serious overt crime increased with age. The results supported the authors' hypotheses in that juvenile offenders who committed both overt and covert delinquent acts had the highest rates of offense, were more aggressive, and committed more serious offenses. Furthermore, children who committed only overt crimes developed even more serious criminal pathways.

Contains fulltext : 143437.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Externalizing problems, which are the main reason for youth referrals to mental health agencies, are highly persistent and predict a range of negative outcomes. Youths with externalizing problems are also frequently comorbid with anxiety. Among the most widely recognized evidence-based treatments is cognitive behavioral therapy (CBT). Although CBT principles seem to be sound, effect sizes remain moderate, suggesting improvements could be made to this conventional treatment approach. The main premise of the current pilot study is to investigate the feasibility of implementing a videogame intervention ("Dojo" [Gamedesk, Los Angeles, CA]) that incorporates CBT principles and aims to address the limitations of conventional CBT delivery models, with the ultimate goal of improving outcomes for this difficult-to-treat population. MATERIALS AND METHODS: "Dojo" is an emotion management game that helps youths to recognize and control their physiological and emotional arousal. We explored the implementation and user experience of "Dojo" in a sample of eight adolescents in residential treatment for both externalizing and anxiety problems. RESULTS: Participants attended all sessions without complaints. They evaluated "Dojo" very positively and exhibited high compliance during the training sessions. We encountered some problems with session scheduling and obtaining mentor reports. Quantitative data show the predicted decrease in three out of four measurements. CONCLUSIONS: The smooth implementation, high user satisfaction, high self-reported compliance during training sessions, and initial outcome results all indicate the high potential "Dojo" holds as an innovative intervention. If additional rigorously designed randomized controlled trials prove to be successful, "Dojo" can be a cost-effective way to engage high-risk youths in effective intervention. 8 p.

Contains fulltext : 154017.pdf (Publisher’s version ) (Open Access) BACKGROUND: Although adolescents are often referred to residential treatment centres because of severe externalizing behaviours, a vast majority demonstrated comorbid symptoms of depression and anxiety. Covert internalizing symptoms in these adolescents might be easily unrecognized and therefore untreated. Adolescents with mild intellectual disability (MID) are overrepresented among youth with both externalizing and internalizing problems. There are yet few treatment programs available for adolescents with both externalizing and internalizing problems. METHODS/DESIGN: The CBT-based resiliency program, Op Volle Kracht (OVK), which is based on the US Penn Resiliency Program (PRP), was adapted to suit the needs of adolescents with both externalizing and internalizing problems, either with or without MID, in Dutch residential treatment centres. The effectiveness of this group intervention program of eight sessions will be tested in a randomised controlled trial (RCT) with N = 182 adolescents aged 12-16, allocated to either the target intervention plus treatment as usual (OVK + TAU) or treatment as usual only (TAU). The main outcome variables include depressive symptoms (primary), anxiety, behavioural problems, and group therapeutic climate. Cognitive styles and coping styles will be included as possible mediators. Assessments take place at baseline (T1), one week before the start of the program (T2), immediately after the program (T3), and at three months follow-up (T4). DISCUSSION: The program assets include its wide implementation possibilities due to low costs, the short duration of the program and the delivery by group care workers, and its suitability for adolescents with MID. Further strengths of the present study design include its robust method (RCT), the ecological validity, and the inclusion of possible mediators of treatment effect. The program emphasizes individual risk factors for depression rather than social and family factors. Implications for practice and future research are discussed. TRIAL REGISTRATION: Dutch Trial Register NTR4836.

Contains fulltext : 126067.pdf (Publisher’s version ) (Closed access) Introduction: The present study examined parents' and adolescents' perceptions of adolescent functioning after being discharged from residential treatment as well as the stability of functioning over time. Method: Data for the study were collected as a part of a continuous process of evaluating post-treatment functioning. Adolescents and their parents were interviewed at home at 3 months (T1), 6 months (12), and 18 months (T3) after discharge. Several outcomes were evaluated: living situation, contact with parents, social network, school/work, behavior problems, use of soft drugs, police contacts and well-being. The sample was divided into two subsamples: parents (n = 82) and adolescents (n = 75) participating in all three waves (sample 1) and parents (n = 288) and adolescents (n = 317) participating in at least one wave (sample 2). Results: Cautioned by the inevitable high rates of attrition and the risk of selective bias in this type of study, there is preliminary evidence showing that adolescents generally show positive outcomes after residential care. Moreover, the outcomes were stable over time: adolescents who showed positive outcomes directly after discharge also showed positive outcomes at 12 and T3, and vice versa. Parents reported less positive outcomes than adolescents did. Discussion: An important contribution of this study is that it provides longitudinal data supporting the notion that outcomes from residential treatment may be more sustainable over time than previously thought. Clinical and research implications are discussed.

Contains fulltext : 102869.pdf (Publisher’s version ) (Closed access) The present study examined the association between sexual behavior and treatment improvement of institutionalized girls. Treatment files of 174 girls (M age = 15.71, SD = 1.14) were analyzed to obtain information about the sexual behavior of girls before admission. Based on their sexual behavior, girls were classified into three subgroups: girls showing sexually normative behavior (29%), girls showing promiscuous behavior (43%), and girls with a history of forced prostitution (29%). A subsample of 95 girls was also asked to complete questionnaires to measure treatment improvement. The findings revealed no differences in self-reported problem behavior between the subgroups at entrance. Over time differences between the subgroups were found, indicating that the girls in the different subgroups might require a different treatment approach. Further research that would include larger samples is needed to explore specific treatment needs. 15 p.

Contains fulltext : 102944.pdf (Publisher’s version ) (Open Access) In 2005 a new compulsory residential treatment program was developed for adolescents in need for protection against themselves or their environment. The aim of the present study was to examine the association of structural treatment characteristics of this new residential treatment program (i.e., duration of treatment, discharge status, and group composition in terms of sex) with post-treatment functioning. Additionally, the number of pre-treatment risk factors was included in the model. A total of 301 adolescents (174 boys, 127 girls), with a mean age at time of admittance of 15.50 (SD = 1.26) participated in this study. The number of risk factors was derived from treatment files of the adolescents at time of entrance. Six months after discharge, adolescents participated in a telephone interview to measure ten post-treatment variables indicating how well they were doing. The results showed that duration of treatment was related to post-treatment living situation, in that adolescents who were in treatment for shorter durations were more likely to live on their own after treatment. For discharge status, findings suggested that adolescents who were regularly discharged had more frequent contact with their family; however, they also showed higher alcohol consumption 6 months after treatment. Group composition was related to the girls' official offending, indicating that girls placed in mixed-sex groups showed significantly fewer official police contacts than did girls in girls-only treatment groups. Overall, structural treatment characteristics were hardly related to the adolescents' functioning after treatment. Suggestions for future research are discussed. 20 p.

Contains fulltext : 99999.pdf (Publisher’s version ) (Closed access) The aim of the present study was to examine the treatment progress of both adolescent's and their families' functioning in a new compulsory residential treatment program. The sample consisted of 339 admitted adolescents (56.3% boys). The mean age at time of entry was 15.69 (SD = 1.30). Adolescents stayed on average 9.42 months (SD = 4.66) in a new residential treatment program. Data on adolescents' internalizing and externalizing problems were assessed using self-reports, parent reports, and group care worker reports. In addition, adolescents reported their substance use and delinquency and parents also reported family functioning and level of perceived parental stress. The findings revealed a significant decrease in adolescents' self-reported internalizing and externalizing problems, delinquency, and substance use. According to parent ratings, a significant improvement was found concerning adolescents' problem behaviors during treatment. However, according care worker ratings, adolescents showed no improvement on internalizing problems and showed an increase in externalizing problems. Concerning families, although there was no improvement in family functioning, parental stress significantly improved over time. Further research should examine whether improvements experienced during treatment are maintained after treatment. 7 p.

Contains fulltext : 90384.pdf (Publisher’s version ) (Closed access) The current study examined the role of friends' delinquency, in terms of violent and property offenses and vandalism. Data were collected from 1,025 adolescents and their best friends in 19 Dutch secondary schools. Concerning violent offenses, cross-sectional analyses showed that adolescents with a high-status friend were more likely to commit violent offenses themselves, whereas adolescents with a low-status friend engaging in vandalism had a greater likelihood of perpetrating vandalism than the adolescents with a high-status friend. The adolescent's violent delinquency and vandalism were positively related to the friend's delinquency only when the friendship was reciprocal. Longitudinally, adolescents with a high-status friend perpetrating vandalism were more likely to engage in vandalism, whereas those with a low-status vandalistic friend showed a decrease. Finally, having a reciprocal friend who committed property offenses increased the adolescent's risk of committing similar offenses, whereas adolescents with a unilateral friend showed a decreased risk over time.

Contains fulltext : 73201.pdf (Publisher’s version ) (Closed access) The present study investigated to what extent the frequency and seriousness of parental offending were related to their offspring offending. Police officers in one Dutch province completed a form to register risk factors and the actions undertaken when they came into contact with offenders aged 8–14 years. These juveniles were followed for 18 months to establish whether or not they committed more crimes. In addition, the parents of these children were traced in the police criminal record systems. Data were gathered from 577 children and their parents. Of these children, 34% were exposed to parental criminality, of which 33 delinquents had two criminal parents and 163 had one criminal parent. If both parents were criminal, the child had the highest frequency of offending. Further, the frequency of parental offending was positively related to the frequency of the child's offending. Concerning the seriousness of juvenile crimes, the seriousness of the committed offences of the father showed a positive relation with the seriousness of his child's offending. Unexpectedly, a negative association was found between the seriousness of maternal offending and the seriousness of her child offending. These results offered a better understanding of the influence that parents with a criminal history have on their children. Further research is needed to identify mechanisms underlying this relationship in order to provide appropriate prevention and intervention strategies. 16 p.

The present study examined the role of parenting styles in the experience and expression of homesickness, and the way of coping with the feelings involved. Using a sample of 670 first year college and university students, aged 16 to 25, we tested three hypotheses: (1) authoritarian, permissive as well as uninvolved parenting are associated with the experience of homesickness, contrary to students with authoritative parents who are less likely to have feelings of homesickness; (2) students with authoritarian, permissive or uninvolved parents show their homesickness by internalizing and externalizing problems; and (3) students raised by authoritative or permissive parents use more effective coping strategies to deal with homesickness. Results indicated that students raised by authoritative and permissive parents experienced more homesickness with stronger feelings of homesickness than students raised by authoritarian or uninvolved parents. However, they hardly express homesickness by internalizing or externalizing problems when they use effective ways of coping, namely support-seeking and/or problem-solving. Students with parents endorsing an authoritarian or uninvolved parenting style, on the other hand, showed more internalizing and externalizing problems in reaction to feelings of homesickness. They also use less effective coping strategies. The results revealed the importance of a loving and accepting home environment for the development and expression of homesickness, as well as the importance of the way in which students learn to cope with their problems.