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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 : 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.

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

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 : 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 : 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 : 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.