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Background: A large body of work has reported a link between prenatal exposure to infection and increased psychiatric risk in offspring. However, studies to date have focused primarily on exposure to severe prenatal infections and/or individual psychiatric diagnoses in clinical samples, typically measured at single time points, and without accounting for important genetic and environmental confounders. In this study, we investigated whether exposure to common infections during pregnancy is prospectively associated with repeatedly assessed child psychiatric symptoms in a large population‐based study. Methods: Our study was embedded in a prospective pregnancy cohort (Generation R; n = 3,598 mother–child dyads). We constructed a comprehensive prenatal infection score comprising common infections for each trimester of pregnancy. Child total, internalizing, and externalizing problems were assessed repeatedly using the parent‐rated Child Behavioral Checklist (average age: 1.5, 3, 6, 10, and 14 years). Linear mixed‐effects models were run adjusting for a range of confounders, including child polygenic scores for psychopathology, maternal chronic illness, birth complications, and infections during childhood. We also investigated trimester‐specific effects and child sex as a potential moderator. Results: Prenatal exposure to infections was associated with higher child total, internalizing, and externalizing problems, showing temporally persistent effects, even after adjusting for important genetic and environmental confounders. We found no evidence that prenatal infections were associated with changes in child psychiatric symptoms over time. Moreover, in our trimester‐specific analysis, we did not find evidence of significant timing effects of prenatal infection on child psychiatric symptoms. No interactions with child sex were identified. Conclusions: Our research adds to evidence that common prenatal infections may be a risk factor for psychiatric symptoms in children. We also extend previous findings by showing that these associations are present early on, and that rather than changing over time, they persist into adolescence. However, unmeasured confounding may still explain in part these associations. In the future, employing more advanced causal inference designs will be crucial to establishing the degree to which these effects are causal. [ABSTRACT FROM AUTHOR]

Background: Research on factors underlying socioeconomic status (SES)-related inequalities in child development mainly focuses on single countries and specific influential factors. Only few studies scrutinize to what extent differences in children's early behavioural outcomes vary across countries and whether the processes that account for them are common or context-specific. Objective: The aim of this study was to explore SES-related inequalities and explanatory factors in 3- to 4-year-old children's externalising behaviour as well as their generalisability across outcome variables (hyperactivity, conduct problems) and countries. Methods: The study uses harmonised data from three longitudinal large-scale studies conducted in the United Kingdom (UK), the United States (US), and the Netherlands and a decomposition method to comparatively analyse early SES-related gaps and explanatory factors. Results: Results show that the extent of parental education-related gaps varied across countries. The included explanatory factors accounted for significant amounts of gaps in hyperactivity and conduct problems. Yet, while family income and maternal depressive feelings significantly explained gaps in each facet of externalising behaviour across all three countries, other factors were country-specific. In the US and the UK, health-related factors were additionally relevant for explaining early gaps in both child outcomes; in the UK, also structural aspects of the family significantly explained gaps in conduct problems; no other factors contributed to the explanation of gaps in the Netherlands. Conclusions: Mechanisms that might reduce SES-related inequalities in child behaviour and that may be helpful when constructing appropriate interventions are partially similar, yet also significantly different between countries and child outcomes. [ABSTRACT FROM AUTHOR]

Parenting programs are effective for children with externalizing problems, but not always easily accessible for parents. In order to facilitate accessibility, we developed a self-help parenting program, consisting of a manual and online part. The efficacy of the program in reducing children's externalizing problems was compared to waitlist in a randomized controlled trial. In addition, two versions of the program were exploratively compared, one with and one without biweekly telephonic support. Candidate moderators (child and parent factors) and parental satisfaction were also examined. We randomly assigned 110 families to one of the following three conditions: the support condition, the no support condition, or the waitlist condition. Intervention duration was 15 weeks. Outcomes were collected at baseline (T0), 8 weeks (T1), 15 weeks (T2), and 28 weeks (T3) and included daily telephonic measurements of parent-rated externalizing behavior and the Intensity scale of the parent-rated Eyberg Child Behavior Inventory (ECBI). Main analyses compared outcomes at T2, using longitudinal regressions with T0 as fixed factor. Results showed that children improved significantly more on both outcomes in the intervention condition compared to waitlist, with small to medium effect sizes. Parental satisfaction was high. Neither differences in efficacy nor in parental satisfaction were found between the support and no support condition. No moderators were detected. The newly developed self-help parenting program is effective in reducing children's externalizing behavior problems and may help improve access to evidence-based care. [ABSTRACT FROM AUTHOR]

Objective: Externalizing behavior (i.e., conduct problems, hyperactivity) and executive function (EF) problems in children and adolescents with type 1 diabetes (T1D) have been associated with worse diabetes‐related and psychosocial outcomes but have not been examined in relationship to each other. We aimed to examine whether externalizing behavior is associated with HbA1c and whether this relationship is mediated by EF problems, specifically metacognition (i.e., ability to initiate, plan, organize and monitor behavior) and behavioral regulation (i.e., impulse control, regulation of emotion and behavior). Research design and methods: Cohorts of Belgian and Dutch parents of children and adolescents (6–18 years) with T1D filled out questionnaires on externalizing behavior (Strengths and Difficulties Questionnaire; SDQ) and EF (Behavior Rating Inventory of Executive Function; BRIEF) composite scales. Treating physicians collected HbA1c values. Mediation analyses were performed separately for the BRIEF composite Metacognition and Behavior Regulation scales, correcting for age, sex and diabetes duration. Results: The 335 parents of children and adolescents with T1D (mean age 12.3 ± 2.8 SD; mean HbA1c 7.6% ± 1.1 SD [60 mmol/mol ± 12.0 SD]; mean diabetes duration 5.3 ± 3.6 SD; 49.6% female) participated. Analyses showed that the association between externalizing behavior and HbA1c is mediated by metacognition (ab path Point estimate = 0.05 BCa CI 95% 0.02–0.08), and not behavioral regulation. Conclusions: Results uncovered the influence externalizing behavior may have on EF problems in the metacognition domain, which in turn seem to influence HbA1c. Clinicians should be mindful of these EF problems when working with children and adolescents displaying externalizing behavior, and not only target behavioral but also cognitive processes. [ABSTRACT FROM AUTHOR]

ThuisBest is a newly developed family focused treatment that combines secure residential youth care with multisystemic therapy (MST), allowing adolescents to return home after secure residential youth care more quickly. The purpose of this pilot study was to examine treatment outcomes for adolescents in ThuisBest (n = 86, Mage = 15.2 years, 63% boys) and to what degree those treatment outcomes could be predicted by client characteristics. The results showed that externalizing behavior problems and parenting stress had decreased at the end of treatment. After ThuisBest, 83% of the adolescents did not have new police contact, 72% lived at home, and 89% attended school or work. Almost none of the treatment outcomes could be predicted by any of the client characteristics. ThuisBest seems a promising trajectory, as it reduces the length of the stay in secure residential youth care, and may, therefore, be more cost-effective than standard secure residential youth care. However, given the lack of a control-group and follow-up data, findings must be interpreted as preliminary. [ABSTRACT FROM AUTHOR]

The present study examines the relation between classroom climate in schools for secondary special education and students' perceived social exclusion. A total of 401 Dutch adolescents (70.3% males) with conduct problems, attending schools for special education, filled out questionnaires on classroom climate, problems in social information processing, externalizing behavior and perceived social exclusion. Results showed that a positive classroom climate was associated with a reduction of students' externalizing behavior problems and perceived social exclusion, which was associated with improvements in social information processing. However, these relations were only found at the within group level of analysis (between students) and not at the between group level (between classes); thus contextual (class level) effects could not be demonstrated. It can be carefully stated that a positive classroom climate in secondary special education may protect against perceived social exclusion. Future research is required to examine whether our findings can be replicated in other schools for secondary special education or can be generalized to secondary education in general. • Results showed that a positive classroom climate was associated with a reduction of students' externalizing behavior problems and perceived social exclusion, which was associated with improvements in social information processing. • However, these relations were only found at the within group level of analysis (between students) and not at the between group level (between classes); thus contextual (class level) effects could not be demonstrated. • It can be carefully stated that a positive classroom climate in secondary special education may protect against perceived social exclusion. [ABSTRACT FROM AUTHOR]

The goal of this three-wave longitudinal study was to analyze foster parent stress and foster children’s internalizing and externalizing behaviors in a transactional framework. Participants in this study were 237 children in foster care in the Netherlands with, mostly, long placement durations (M = 56.86 months, SD = 49.10 months). We examined concurrent, prospective unidirectional and bidirectional relations between foster children’s behavior and foster parent stress by using cross-lagged structural equation modeling and examined whether the results were stable across different subgroups of foster children. In contrast to our hypothesis, we found no bidirectional relations. There were unidirectional prospective pathways from foster children’s internalizing and externalizing problems to foster parent stress, but no significant prospective pathways from foster parent stress to foster children’s internalizing and externalizing problems. The results were fairly stable across different subgroups of foster children. The lack of bidirectional relations was unexpected given the presence of transactional relations in biological parent-child dyads. Foster parents seem not to influence their foster children when it comes to regulating problem behavior. Therefore, the question is whether foster parents can, in more general terms, help their foster children benefit from their improved home environment. [ABSTRACT FROM AUTHOR]

In 2009 the Dutch legislator introduced a law that sought to encourage shared residence. We summarize key findings on shared residence from prior work in the Netherlands, and present new data. Previous research showed that shared residence has increased steadily in recent decades. Our recent estimates revealed that shared residence increased from nearly 20% in 2008 (prereform) to 28% in 2010 (postreform). Official court data showed a decline again to a little over 20% in 2013. We also found shared residence to be less a stable arrangement than mother or father residence. Consistent with earlier studies, parents with shared residence were found to be well-resourced parents with little conflict and few personal problems. These parents were also more likely to maintain this arrangement, but the instability of shared residence also appeared to be related to practical circumstances and to children's needs. Earlier findings on the consequences of shared residence for child and parent well-being were mixed, but suggest positive effects. [ABSTRACT FROM AUTHOR]

The present study examined the association between treatment fidelity during therapist initial training and subsequent treatment outcome of Parent Management Training - Oregon model (PMTO) in The Netherlands. Clinically referred children ( N = 86) aged 4 to 11 years and their parents received PMTO and were assessed at four time points: at baseline, and after 6, 12, and 18 months. Difference scores between baseline and follow-up assessments of externalizing behavior problems, parenting practices, and parental psychopathology and parents' overall ratings of working alliance, were correlated with treatment fidelity scores measured prior to the intervention. Furthermore, differences in therapists' fidelity scores between treatment completers and drop-outs were examined. Results showed that higher fidelity scores of PMTO therapists during initial training were associated with larger improvements in externalizing behavior, parenting practices, and parental psychopathology, especially after 18 months. In addition, parents who completed the treatment had a significantly more adherent therapist than families who dropped out. However, the correlations between treatment fidelity and working alliance were non-significant. These findings indicate that therapists' high adherence to the PMTO treatment principles during initial training decreases the chance of treatment drop-out and positively affects the longterm effectiveness of PMTO. [ABSTRACT FROM AUTHOR]

This study investigated whether children scoring higher on a polygenic plasticity index based on five dopaminergic genes (DRD4, DRD2, DAT1, MAOA, and COMT) benefited the most from the Incredible Years (IY) parent program. Data were used from a randomized controlled trial including 341 Dutch families with 4- to 8-year-old children (55.7% boys) showing moderate to high levels of problem behavior. IY proved to be most effective in decreasing parent-reported (but not observed) externalizing behavior in boys (but not girls) carrying more rather than fewer dopaminergic plasticity alleles; this Gene × Intervention effect was most pronounced in the case of boys whose parents' manifested the most positive change in parenting in response to the intervention. These results proved robust across a variety of sampling specifications (e.g., intention to treat, ethnicity). [ABSTRACT FROM AUTHOR]

The present study examined the effectiveness of parent management training-Oregon model (PMTO) as a treatment for children with externalizing behavior problems in The Netherlands. Clinically referred children (N = 146) aged 4-11 years and their parents were partly randomized to either PMTO (n = 91) or Care As Usual (CAU; n = 55). Families were assessed at four time points: at pretreatment, and after 6, 12, and 18 months. Results showed that both PMTO and CAU were effective in reducing child externalizing behavior, parenting stress and parental psychopathology, with no significant differences between the two treatment conditions. PMTO and CAU interventions also produced some improvements in self-reported parenting skills, but not in observed parenting skills. According to the Reliable Change Index, 16.9 and 45.8 % of the children within the PMTO group showed full recovery or improvement in externalizing behavior, respectively, versus 9.7 and 42.8 % in the CAU condition. Finally, the effect size of PMTO on parent-reported externalizing behavior problems as found in the present study was comparable to that found in previous studies evaluating PMTO as an intervention for this type of child psychopathology. [ABSTRACT FROM AUTHOR]

In this study, half of a cohort of adolescents referred to a secure residential youth care institution in The Netherlands was actually placed in the center where they received well-tested Multidimensional Family Therapy (MDFT). The others were offered outpatient MDFT in a last-minute effort to avert juvenile judge accorded out-of-home placement. All adolescents had problems with their family, and virtually all of them with school. Externalizing behavior problems were prevalent. As expected, both groups of adolescents benefited from MDFT on externalizing behavior, family, and school outcome measures. MDFT was well-liked by adolescents and parents. [ABSTRACT FROM PUBLISHER]

The current study focuses on the effects of sibling gender configuration on family processes during early childhood. In a sample of 369 two-parent families with two children (youngest 12 months, oldest about 2 years older), both siblings’ noncompliant and oppositional behaviors and fathers’ and mothers’ sensitivity and discipline strategies were observed. Both siblings’ aggressive behaviors and empathy of the oldest sibling were assessed with parent-reports. Children in families with two sons showed more problematic interaction patterns compared with children in families with an oldest girl. In families with two boys, older siblings were more aggressive and fathers were less sensitive toward their youngest child in comparison with families with two girls. Furthermore, in boy–boy families older siblings showed more oppositional behavior and younger siblings more noncompliance compared with girl–boy families. These findings highlight the importance of sibling gender configuration in the development of child behavior and parent–child interactions. [ABSTRACT FROM AUTHOR]

In this study we examined prosocial compensating behavior towards socially excluded ingroup and outgroup members by using a 'Prosocial Cyberball Game' in 9-17 year old Dutch adolescents (N = 133). Results showed that adolescents compensated for the social exclusion of an unknown peer in a virtual ball tossing game, by tossing the ball more often to that player in compensation conditions compared to the fair play condition. The proportion of tosses towards the excluded player did not significantly differ as a function of the group status of that player. Although compensating behavior towards ingroup versus outgroup members did not differ, the underlying motivation for this behavior may vary. More empathic concern was associated with more prosocial tosses towards an ingroup member, while more self-reported bullying behavior was associated with less compensating behavior in the outgroup condition. These findings may have practical implications for programs intending to change bystander behavior in bullying situations. [ABSTRACT FROM AUTHOR]

Adolescents who like each other may become more similar to each other with regard to internalizing and externalizing problems, though it is not yet clear which social mechanisms explain these similarities. In this longitudinal study, we analyzed four mechanisms that may explain similarity in adolescent peer networks with regard to externalizing and internalizing problems: selection, socialization, avoidance and withdrawal. At three moments during one school-year, we asked 542 adolescents (8th grade, M- age = 13.3 years, 51 % female) to report who they liked in their classroom, and their own internalizing and externalizing problems. Adolescents tend to prefer peers who have similar externalizing problem scores, but no significant selection effect was found for internalizing problems. Adolescents who share the same group of friends socialize each other and then become more similar with respect to externalizing problems, but not with respect to internalizing problems. We found no significant effects for avoidance or withdrawal. Adolescents may choose to belong to a peer group that is similar to them in terms of externalizing problem behaviors, and through peer group socialization (e.g., enticing, modelling, mimicking, and peer pressure) become more similar to that group over time. [ABSTRACT FROM AUTHOR]

A relationship-focused reflection program (RFRP) was developed that targeted teachers’ mental representations of relationships with specific children. Relative effectiveness was examined in a randomized comparative trial with repeated measures. Thirty-two teachers were assigned to the RFRP or the comparison intervention directly aimed at teacher behavior. Per teacher, two children (N = 64) were selected with above-median levels of externalizing behavior. Multilevel growth modeling was used to explore intervention effects on teacher-reported Closeness and Conflict, and observed Teacher Sensitivity and Behavior Management Quality. Teaching Efficacy was included as a moderator. The RFRP yielded changes over time in closeness for about half of the teacher–child dyads. In addition, teachers with high efficacy beliefs were more likely to report declines in conflict than low-efficacy teachers. Lastly, significant increases were found in observed sensitivity. These effects were different from those found in the comparison condition and provided preliminary evidence for the potential of in-depth reflection on specific relationships to promote teacher–child relationships. [ABSTRACT FROM PUBLISHER]

Children with poorer language skills are more likely to show externalizing behavior problems, as well as to become rejected by their peers. Peer rejection has also been found to affect the development of externalizing behavior. This study explored the role of peer rejection in the link between language skills and the development of externalizing behavior. Six hundred and fifteen (615) children were followed from kindergarten to grade 4. Receptive language skills were measured with the Peabody Picture Vocabulary Test in grade 2. Teachers reported externalizing behavior and peer reports of social rejection were measured annually. Children with poorer receptive language skills showed increasing externalizing behavior, while children with better receptive language skills showed decreases in externalizing behavior. Children with poorer receptive language skills experienced peer rejection most frequently. The link between receptive language skills and the development of externalizing behavior was mediated by the development of peer rejection. Findings suggested that this mediational link applied mostly to boys. Children with poorer language skills are at increased risk of becoming rejected by mainstream peers, which adds to the development of externalizing behavior. [ABSTRACT FROM AUTHOR]

The aim was to investigate the contribution of familial risk to externalizing behaviors (FR-EXT), perceived parenting styles, and their interactions to the prediction of externalizing behaviors in preadolescents. Participants were preadolescents aged 10–12 years who participated in TRAILS, a large prospective population-based cohort study in the Netherlands ( N = 2,230). Regression analyses were used to determine the relative contribution of FR-EXT and perceived parenting styles to parent and teacher ratings of externalizing behaviors. FR-EXT was based on lifetime parental externalizing psychopathology and the different parenting styles (emotional warmth, rejection, and overprotection) were based on the child’s perspective. We also investigated whether different dimensions of perceived parenting styles had different effects on subdomains of externalizing behavior. We found main effects for FR-EXT (vs. no FR-EXT), emotional warmth, rejection, and overprotection that were fairly consistent across rater and outcome measures. More specific, emotional warmth was the most consistent predictor of all outcome measures, and rejection was a stronger predictor of aggression and delinquency than of inattention. Interaction effects were found for FR-EXT and perceived parental rejection and overprotection; other interactions between FR-EXT and parenting styles were not significant. Correlations between FR-EXT and perceived parenting styles were absent or very low and were without clinical significance. Predominantly main effects of FR-EXT and perceived parenting styles independently contribute to externalizing behaviors in preadolescents, suggesting FR-EXT and parenting styles to be two separate areas of causality. The relative lack of gene–environment interactions may be due to the epidemiological nature of the study, the preadolescent age of the subjects, the measurement level of parenting and the measurement level of FR-EXT, which might be a consequence of both genetic and environmental factors. [ABSTRACT FROM AUTHOR]