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Although the percentage adolescent smokers in the Netherlands has gradually decreased over the past years, the number of daily smokers is still increasing rapidly, from 12% of 16-year-olds to 27% of 19-year-olds. Adolescents often make quit attempts within a very short period after taking up smoking. However, many adolescents fail in their quit attempts, because nicotine dependence is a major barrier to successful smoking cessation. To assist adolescents in their quit attempts, nicotine replacement therapy (NRT) was expected to be an effective intervention. Nicotine replacement therapy aims to reduce relapse by reducing withdrawal symptoms and craving and allows individuals to achieve (more) sustainable abstinence.Although NRT has been proven effective among adults by almost doubling the chance of quitting, to date, healthcare professionals do not advise that adolescents use NRT because of limited evidence for the efficacy of NRT among this age group. This study tested the efficacy of NRT among a large sample of Dutch adolescents. For the intervention, 265 adolescents aged 13-18, were placed in a double-blind randomized trial to either a nicotine patch or placebo patch group. We found that two weeks after the quit date, significantly more participants had quit smoking in the nicotine patch group (31.9%), compared to those in the placebo patch group (21.3%); however, no significant effects were found at the end of NRT treatment after 6 or 9 weeks (14.8% achieved abstinence in the nicotine patch group compared to 13.1% in the placebo patch group), and at 6- and 12-month follow-ups (percentages of quitters ranged from 5.7% to 8.2%). At end-of-treatment, the effect of NRT on smoking cessation was moderated by the level of NRT compliance, which indicates a greater likelihood to achieve abstinence in the nicotine patch group for those participants who reported higher compliance. Furthermore, three different compliance trajectories were found, all starting with high compliance levels at the beginning of the treatment, but differences in the extent of decline during treatment and characterized by different features. Compared to the compliers, the moderate decreasers were less conscientious and less educated. The strong decreasers were less conscientious and agreeable, and more extravert than were adolescents in the compliers trajectory. These findings imply that providing adolescents with NRT is not nearly as effective as it is for adults; that compliance levels appear to affect abstinences rates; and that personality tailored treatments might enhance compliance levels. We also found that positive effects of the nicotine patches (i.e., reductions in craving) were shown mainly on the quit day and seemed to disappear over time, and that the effect of nicotine patches on end-of-treatment smoking abstinence was not mediated by the course of craving or withdrawal symptoms. These findings imply that nicotine patches do not act exactly as they are supposed to act for adolescent smokers. Finally, we tested the effects of several non-smoking related protective and risk factors on smoking (re)lapse, but most potential predictors were not statistically related to smoking (re)lapse. Thus, little is known about the contextual predictors of (re)lapse among youngsters.

The objective of the current thesis was to increase our understanding of the ethnic differences in mental health service use for adolescents’ internalizing problems. In the first part of the thesis, we examined whether questionnaires assessing adolescents’ internalizing problems could be validly used across ethnic groups and more specifically whether the diagnostic utility of the instruments was comparable across four ethnic groups (i.e., native Dutch, Surinamese-Dutch, Turkish-Dutch, and Moroccan-Dutch). In the second part of the thesis, we focused specifically on the ethnic differences in mental health service use for adolescents’ internalizing problems and attempted to unravel the mechanisms underlying these differences following the steps toward mental health care proposed by Cauce and colleagues (2002; i.e., problem recognition, decision to seek help, service selection). In our study, we used a two-phase study design. In the first phase of the study adolescents were screened on internalizing problems to include sufficient adolescents at risk of internalizing problems in the second phase of the study. For the second phase of the study, adolescents from the four largest ethnic groups in the Netherlands were selected to participate. The final study sample of the second phase of the study consisted of 95 native Dutch, 85 Surinamese-Dutch, 87 Turkish-Dutch, and 82 Moroccan-Dutch parents and adolescents. In the four ethnic groups, about half of these adolescents scored in the borderline/clinical range on the internalizing problem scale during the screening, which indicates that adolescents in the four ethnic groups were similarly at risk of internalizing problems. Results of the first part of the thesis provided support for the validity and diagnostic utility of the instruments used to compare internalizing problems across ethnic groups among adolescents, whereas the results indicated that the diagnostic utility of these instruments was insufficient among immigrant parents, specifically among Moroccan-Dutch parents. Compared to native Dutch parents, Moroccan-Dutch parents not only reported lower levels of internalizing problems for their children than their child’s score would suggest, but they also – like Turkish-Dutch parents - tended to report more inconsistently on different instruments measuring the same constructs. The results of the second part of the current thesis showed that immigrant and specifically Moroccan-Dutch adolescents, are underrepresented in mental health care for internalizing problems. Several possible barriers toward mental health care were also revealed, such as immigrant parents’ difficulties identifying adolescents’ internalizing problems, immigrant parents’ attitudes toward mental health care, and difficulties encountered by Moroccan-Dutch adolescents in their pathway toward mental health care in the school context. These barriers offer possibilities for improvement in order to decrease the underrepresentation of immigrant and specifically of Moroccan-Dutch adolescents in mental health care. More attention – in research and clinical practice - is needed for this group of adolescents to be able to provide sufficient mental health care for all adolescents with internalizing problems, regardless of their ethnic background.

Background Although neighbourhood factors have been proposed as determinants of adolescent behaviour, few studies document their relative etiological importance. We investigated the relationship between neighbourhood crime and cannabis use in a nationally representative sample of Canadian adolescents. Methods Data from the 2009/10 Canadian Health Behaviour in School-aged Children (HBSC) survey ( n = 9134 14- and 15-year-olds) were combined with area-level data on crime and socioeconomic status of the neighbourhood surrounding the schools ( n = 218). Results Multilevel logistic regression analyses showed that after individual and contextual differences were held constant, neighbourhood crime related to cannabis use (OR 1.29, CI 1.12–1.47 per 1.0 SD increase in crime). This association was not moderated by parental support nor having cannabis-using friends. The amount of explained variance at the neighbourhood level was 19%. Conclusions Neighbourhood crime is an important factor to consider when designing interventions aimed at reducing adolescent cannabis use. Interventional research should examine the effectiveness of community-based interventions that target adolescents through parents and peers.

AimsTo examine whether early onset of tobacco or alcohol use, and continued use of tobacco or alcohol in early adolescence, are related to a higher likelihood of developing a cannabis use disorder during adolescence. Design and settingData were used from four consecutive assessment waves of the TRacking Adolescents' Individual Lives Survey (TRAILS), a general Dutch population study. TRAILS is an ongoing longitudinal study that will follow the same group of adolescents from the ages of 10 to 24 years. ParticipantsThe sample consisted of 1108 (58% female) adolescents (mean ages at the four assessment waves are 11.09, 13.56, 16.27 and 19.05 years, respectively) MeasurementsCannabis use disorders were assessed using the Composite International Diagnostic Interview 3.0 (CIDI). Adolescent tobacco and alcohol use were assessed using self-report questionnaires. FindingsEarly-onset tobacco use [odds ratio (OR)=1.82, confidence interval (CI)=1.05-3.14, P0.05), was associated with a higher likelihood of developing a cannabis use disorder. Similarly, adolescents who reported continued use of tobacco (OR=2.47, CI=1.02-5.98, P0.05), were more likely to develop a cannabis use disorder. ConclusionsEarly-onset and continued tobacco use appear to predict the development of a cannabis use disorder in adolescence, whereas early onset and continued alcohol use do not.

Experiment to test how sexualized media exposure affects later attention allocation.Participants watched a sexual or control video before completing dot and word tasks.All participants showed selective attention for explicitly displayed sexual cues.Participants in sexual video conditions were quicker to detect hidden sexual cues.Results may contribute to a better understanding of how sexual schemas are formed. This study examined whether exposure to sexualized media influences the subconscious process of attention allocation to subsequently encountered stimuli. One hundred twenty-three participants (61females) between 18 and 23years (Mage=19.99years) watched a 3-min video clip containing either neutral, sexually more explicit, or sexually less explicit imagery, before completing a dot detection task measuring selective attention for explicitly displayed sexual stimuli and a word search task measuring attention toward hidden sexual cues. Results of the dot detection task indicated that participants in all conditions were slower to detect the dot in trials including sexual stimuli, suggesting absorption by these stimuli. Results of the word search task indicated that participants in the two sexual video conditions, compared to participants in the neutral video condition, were quicker to detect a sexual word in the matrix, albeit only if they completed this task before the dot detection task. There were no differences in the number of sexual words found between video conditions. Our findings point out the importance of studying effects of sexualized media exposure on subconscious cognitive processes in young people, as such effects can provide us insights into how sexualized media content is processed and how sexual schemas are formed and strengthened.

Until recently, discussion of the criteria relevant to studying civilising processes focused mainly on the balance of controls (that is, between Fremdzwänge and Selbstzwänge). This paper starts by focusing on the ‘triad of controls’, a concept that Elias presents as one of the ‘criteria of social development’. It refers to ‘three fundamental controls of people in society – the control of humans over extra-human natural events, the control of people over each other, and the control of each person over him or herself.’ This triad has not received the acclaim it deserves, and it is brought to life only in the work of Johan Goudsblom. The paper shows and discusses how Elias himself presented the triad of controls in his work. It differentiates the triad by distinguishing seven different yet interconnected balances – the balances of competition and cooperation, power and control, formalisation and informalisation, the we–I balance, the balance of involvement and detachment, and the lust-balance. They are presented as universally applicable guidelines for analysing social and psychic processes. Together, the triad of control and the seven balances offer a research manual and summarise the theory of civilising processes as a ‘workable synthesis’

Aim: To evaluate the effectiveness of the Healthy School and Drugs programme on alcohol, tobacco and marijuana use among Dutch early adolescents. Design: Randomized clustered trial with two intervention conditions (i.e. e-learning and integral). Setting: General population of 11-15-year-old adolescents in the Netherlands. Participants: A total of 3784 students of 23 Dutch secondary schools. Measurements: Structured digital questionnaires were administered pre-intervention and at 32 months follow-up. The primary outcome measures were new incidences of alcohol (life-time and 1-month prevalence), tobacco (life-time and 1-month prevalence) and marijuana use (life-time prevalence). Findings: Main effect analyses showed no programme effects on incidences of alcohol consumption (life-time prevalence: e-learning condition: B=0.102, P=0.549; integral condition: B=-0.157, P=0.351; 1-month prevalence: e-learning condition: B=0.191, P=0.288; integral condition: B=-0.140, P=0.445), tobacco consumption (life-time prevalence: e-learning condition: B=0.164, P=0.444; integral condition: B=0.160, P=0.119; 1-month prevalence: e-learning condition: B=0.088, P=0.746; integral condition: B=0.261, P=0.093), or marijuana consumption (life-time prevalence: e-learning condition: B=0.070, P=0.732; integral condition: B=0.186, P=0.214). Conclusion: The non-significant impact of the Healthy School and Drugs programme (a Dutch school-based prevention programme for early adolescents) on incidences of alcohol, tobacco and marijuana use indicates that the programme is either ineffective or implemented inadequately.

Recent theories suggest that behavioral control is a very important aspect in the drinking behavior of adolescents, and differences in the capacity to control one’s own responses are assumed to underlie the escalation from relatively normal drinking patterns to more severe drinking in adults and adolescents. The development of the behavioral control coincides together with the maturation of the prefrontal cortex and it is not until late adolescence that these brain areas are fully grown. This ongoing maturation process during adolescence has been identified as vulnerable marker for the neurotoxic effects of alcohol. Alcohol use during adolescence could contribute to delay in development and impairment of cognitive functions and differences in brain functioning. At the same time, impairments in cognitive functioning have been found to predict increase in drinking behavior in adolescents. This raises the question of directionality of the relationship and suggests a bidirectional relation between cognitive functioning and adolescents’ drinking behavior. Some cognitive impairments might result from heavy alcohol use, while other cognitive impairments found in heavy drinking adolescents, have been present before adolescents started with drinking. In this thesis, the influence of executive functioning, important functions for behavioral control, have been examined in relation to adolescents’ alcohol use. Besides behavioral control, more automatic and motivational processes (e.g. wanting, craving, expectancies) also appear to play an important role in drinking behavior. These automatic processes can be assessed trough alcohol cognitions (e.g. implicit cognitions) or biases in attention (e.g. attentional bias) or motivational orientation (i.e. approach bias) towards alcohol. It is hypothesized that behavioral decisions to drink are influenced by the strength of automatic processes in combination with the ability and motivation to control these automatic processes. This theory has frequently been tested in adult drinkers and addicts, but less often in young adolescents who just start with drinking. Adolescents from mainstream education (a Dutch and English sample) as well as a high risk sample of adolescents (e.g. adolescents with externalizing behavior problems) were included in the studies and followed over a period of two years. Several measures of executive functioning and measures to assess automatic processes were completed by the participants. The findings of these thesis suggest that both controlled as well as automatic processes play a significant role in the drinking behavior of adolescents cross-sectionally as well as longitudinally. Impairments in executive functions predicted increase in, as well as the onset of, drinking behavior of adolescents. In addition, strong automatic processes also elevated alcohol use among at-risk adolescents, with even stronger influences when executive functions were relatively weak. In sum, weaknesses in executive functioning appear to precede the onset of drinking and heavy drinking in adolescents. Prolonged use of alcohol might further impair these functions, resulting in a vicious circle in which behavioral control problems, either by itself or in combination with automatic processes, increase alcohol use, and heavy drinking further impairs these cognitive functions.

This study investigated the age of onset of substance use among 536 students with mild academic disabilities and 906 students without academic disabilities, and the extent to which emotional, conduct, and hyperactivity problems explain the differences between these two groups. Using discrete-time survival analysis, the results of this study showed that students with a mild academic disability were not at higher risk for the onset of daily smoking, and were at a significantly lower risk for the onset of weekly alcohol use and cannabis use. Though students with a mild academic disability displayed higher scores on conduct, emotional, and hyperactivity problems compared with their counterparts without an academic disability, this was not reflected in an increased risk for early onset substance use.

Het gebruik van tabak, alcohol, cannabis en harddrugs onder Nederlandse adolescenten wordt al jarenlang onderzocht in verschillende grote landelijke studies onder scholieren in het regulier onderwijs. Recentelijk is het middelengebruik ook nagegaan in groepen die (deels) buiten deze studies vallen, namelijk: jongeren in een justitiële jeugdinrichting (JJI), in de niet-justitiële residentiële jeugdzorg (RJZ) en in het voorgezet speciaal onderwijs voor jongeren met gedragsproblemen (REC-4 scholen). Uit dit onderzoek bleek dat middelengebruik onder deze groepen jongeren veel vaker voorkomt dan onder jongeren in het regulier middelbaar onderwijs. Naast dit hoge middelengebruik komen bij deze groepen jongeren ook vaker dan in de algemene populatie internaliserende en externaliserende problemen voor, vertonen zij meer delinquent gedrag en hebben zij vaker een diagnose zoals ADHD, PTSS en depressie. Met name jongeren in de jeugdzorg en pleegzorg hebben vaker te maken gehad met gezinsproblematiek als verwaarlozing en misbruik. Ouders van deze kinderen hebben vaker dan in de gewone populatie een psychiatrische aandoening, een middelenverslaving of beiden. Bovendien beïnvloeden jongeren in deze settingen elkaar mogelijk in hun risicogedrag. Door deze bundeling van risicofactoren, dat wil zeggen het middelengebruik van jongeren, gedrag- en/of emotionele problemen, psychiatrische problematiek, deviante ‘peers’ en gezinsproblematiek, hebben jongeren in de genoemde settingen een verhoogd risico op problematisch middelengebruik, waaronder misbruik en afhankelijkheid.

It has been suggested that the adolescent brain is particularly vulnerable to the neurotoxic effects of alcohol because significant maturation of brain structure and corresponding cognitive control function takes place over the course of adolescence. However, research on this subject has remained inconclusive thus far due to numerous methodological pitfalls. Therefore, there is a need for a large longitudinal study on the precursors and outcomes of alcohol use related to cognitive and behavioural control. The main aim of the present thesis was to longitudinally investigate the effect of alcohol use in adolescence on cognitive functioning. To address this research question adequately, we first studied normal maturation of cognitive control. Next, answering the main research question, we assessed whether deviances from this normal maturation where found among heavy drinkers and adolescents with alcohol use disorder (AUD; adolescents who meet the criteria for alcohol abuse and alcohol dependence. ). Furthermore, we assessed cognitive and behavioural control as precursors of alcohol use in order to identify adolescents at risk for transitioning to heavy drinking and AUD. Cognitive control was found to mature significantly over the course of adolescence. However, no differences in this maturation were found between drinking and non-drinking adolescents, suggesting that heavy drinkers and alcohol abusers may not be at risk for a deviant maturation of such functions. Only the small and specific group of female alcohol dependents showed a distinct maturation of shift attention, but it is unclear whether this distinct maturational pattern reflects permanent irreversible damage. Nevertheless, heavy drinking and, more pronounced, AUD is prospectively related to increases in problematic behaviour reflecting diminished behavioural control. This implicates that even when the cognitive ‘hardware’ for being able to control and direct behaviour is intact, that is, cognitive control functions, actual behavioural control can be suboptimal, leading to adverse outcomes, such as heavy drinking and AUD. The present thesis is the first large longitudinal study on the effects of alcohol use in adolescence on cognitive functioning. It contributes to more insight into the complex reciprocal relationship between adolescent alcohol use with cognitive and behavioural control while simultaneously underlining the fact that much more research is necessary. No evidence for vast cognitive deficits as a result of alcohol use was found, and findings from this thesis indicate that the effects of alcohol on the developing brain might more subtle than has been assumed thus far. More research is needed to understand what influence alcohol has on the developing brain and how this would affect functioning in daily life.

In deze workshop spreken Jenneke van Ditzhuijzen en Marieke Brauer over hun onderzoek naar vrouwen en abortus. Jenneke heeft een kwantitatief gezondheidsonderzoek gedaan naar de psychiatrische voorgeschiedenis van vrouwen die abortus meemaken. Marieke heeft kwalitatief onderzoek gedaan bij vrouwen die gekozen hebben voor een abortus en bij vrouwen die ervoor gekozen hebben de zwangerschap uit te dragen. Hierbij komt naar voren hoe deze vrouwen tot een beslissing komen en wat daarin heeft meegespeeld.

Aims: To examine cross-national changes in frequent adolescent cannabis use (40+ times consumed over life-time at age 15) over time and relate these trends to societal wealth, family affluence and gender. Design: Data from three cycles (2002, 2006, 2010) of the Health Behaviour in School-aged Children (HBSC) Study were used for cross-sectional and trend analyses of adolescent cannabis use. Setting: Representative surveys in 30 European and North American countries. Participants: A total of 160606 15-year-old students. Measurements: Respondents' life-time cannabis use, demographics, family affluence (FAS) and frequency of peer contacts were measured individually. Indicators of wealth (gross domestic product per capita, GDP) and perceived availability of cannabis were obtained from national public data bases. Findings: The frequency of life-time cannabis use decreased over time among adolescents in Europe and North America, particularly in western European countries and the United States (relative risk (RR)=0.86: confidence interval (CI) 0.79-0.93). This trend was not observed consistently in rapidly developing countries in eastern, central and southern Europe. Over time (2002-10), cannabis use became: (i) less characteristic of high GDP countries in contrast to lower GDP countries (RR=0.74: CI 0.57-0.95); (ii) less characteristic of youth from high FAS families in contrast to youth from low FAS families (RR=0.83: CI 0.72-0.96); and (iii) characterized by an increasing gender gap, i.e. consumption was higher among males (RR 1.26: CI 1.04-1.53). Perceived availability of cannabis and peer contacts remained strong predictors of frequent cannabis use. Conclusions: Among 30 European and North American countries, cannabis use appears to have 'trickled down' over time, with developing countries taking on the former (heavier) use pattern of richer countries, and less affluent youth taking on the former (heavier) use pattern of more affluent youth. Cannabis use continues to be more common among adolescent males than females.

Several tobacco control measures are in place that aim to reduce the availability, accessibility and/or visibility of tobacco products at points of sale (POS). In response to a debate in the Dutch Parliament in October 2013, the Secretary of State for Health, Welfare and Sport agreed to review evidence on the impact of two of these measures, i.e., reducing the number of points of sale and restricting the display of tobacco products at points of sale. Special attention should be paid to tobacco vending machines. These data aim to support and facilitate a balanced discussion of different policy alternatives. This report synthesises data from a systematic review of research findings and information from grey literature and experts in a number of European countries to obtain a picture of the impact of the two measures.

Adolescents who attend special education for behavioural problems (SEB) and adolescents who live in a residential youth care institution (RYC) are characterised by behavioural disorders and problematic family backgrounds and have an increased risk for substance use. Though it is likely that the high rates of substance use in SEB/RYC settings might be inherent to the risk profile of these adolescents, little is known about the actual role the risk profile has in explaining substance use. The present study examined the extent to which the elevated risk of substance use in SEB/RYC can be explained by high levels of individual, family, and peer risk indicators that are known to characterise their risk profile. Self-report questionnaires from 531 adolescents in RYC (50 % male; mean age 14.7) and 603 adolescents in SEB (81 % male; mean age 14.1) were compared with information from 1,905 adolescents attending special education for students with learning disabilities (SEL) (56 % male; mean age 14.1). Results show that adolescents in SEB/RYC reported higher levels of daily smoking, weekly alcohol consumption, cannabis and hard drug use, as well as greater prevalence of individual, family and peer factors. Though individual, family and in particular peer risk indicators all explain some of the variance in substance use, the differences between adolescents in SEB/RYC compared with SEL remained significant and substantial, with the exception of heavy alcohol consumption. These findings suggest that deviant peer affiliation, in particular, plays a role in explaining high substance use levels in SEB/RYC and those factors relevant to the residential settings and special education schools might also contribute to substance use in these high-risk groups.

Aims: To analyse how adolescent drunkenness and frequency of drinking were associated with adult drinking patterns and alcohol control policies. Design, Setting and Participants: Cross-sectional survey data on 13- and 15-year-olds in 37 countries who participated in the Health Behaviour in School-Aged Children (HBSC) Study in 2010 (n=144788) were linked to national-level indicators on alcohol control policies and adult drinking patterns. Measurements: Outcome measures were self-reported weekly drinking and life-time drunkenness (drunk once or more). Data were analysed using multi-level logistic regression models. Findings: In the mutually adjusted models, adolescent drunkenness was associated significantly with high adult alcohol consumption [odds ratio (OR)=3.15 among boys, 95% confidence interval (CI)=2.13-4.64, OR girls=2.44, CI=1.57-3.80] and risky drinking patterns in the adult population (OR boys=2.02, CI=1.33-3.05, OR girls=1.61, CI=1.18-2.18). The level of abstainers in the adult population was also associated significantly with girls' drunkenness; a 10% increase in the number of abstainers in a country reduced the odds of drunkenness with 21% (OR=0.79, CI=0.68-0.90). Weekly drinking was associated significantly with weak restrictions on availability (OR boys=2.82, CI=1.74-4.54, OR girls=2.00, CI=1.15-3.46) and advertising (OR boys=1.56, CI=1.02-2.40, OR girls=1.79, CI=1.10-2.94). Conclusions: Comparing data cross-nationally, high levels of adult alcohol consumption and limited alcohol control policies are associated with high levels of alcohol use among adolescents.

Bij dezen plaatsen wij, auteurs van het artikel ‘Ontwikkelingstrajecten in en voorspellers voor het gebruik van seksueel expliciet internetmateriaal’, Kind en Adolescent, 33, 226-238, een rectificatie. Deze rectificatie betreft de uitkomsten van de in het artikel gepresenteerde analyses. Helaas ontdekten wij, nadat het artikel was gepubliceerd, een fout in de geanalyseerde datase

Adolescents attending special education for learning disabilities (SEL), special education for behavioural problems (SEB) and adolescents living in a residential youth care (RYC) institution present a complex risk profile including severe behavioural and emotional problems, deviant peer networks, and problematic family backgrounds. In addition to these problems, youth in these groups appear to be at higher risk for substance use compared to adolescents in the general population. Recent, representative studies on substance use levels and related risk indicators are however limited. The objectives of the present thesis are a) to examine prevalence and onset of daily use of cigarettes, alcohol consumption, and lifetime use of cannabis and hard drugs among adolescents in SEL/SEB/RYC compared to adolescents attending mainstream education, and b) to identify the extent to which the elevated risk of substance use among youth in SEL/SEB/RYC is explained by high levels of individual, family, and peer risk indicators that are known to characterize these adolescents. The cross-sectional part of the thesis includes information from 1,905 adolescents attending SEL, 603 adolescents attending SEB and 531 adolescents living in a RYC institution between 12 to 16 years of age. Self-report questionnaires are compared to those of a reference group consisting of 6,946 adolescents in the same age category attending mainstream education. The longitudinal part of the thesis includes youth in SEL (N = 536) and in RYC (N = 241). Results illustrate that in particular youth in RYC are a high risk group for substance use (onset). Also youth in SEB report very high levels of tobacco, alcohol, and drug use. Differences are especially large in the youngest age category (12-13 year olds), with more than twenty times as daily use tobacco users in RYC compared to their counterparts in mainstream education. Although adolescents attending SEL show higher levels of tobacco and hard drug use, having a learning disability does not seem to put adolescents at risk for substance use. In fact, adolescents with learning disabilities do not differ from their counterparts in mainstream education with respect to the onset of tobacco use and even have a smaller risk of alcohol and cannabis onset. Individual, family, and particularly peer risk indicators explain a substantial part of the elevated risk of substance use among adolescents in SEB and RYC. This implies that the high substance use levels within these settings partially need to be understood as a result of the selection of youth with a high-risk profile. SEB schools and RYC institutions therefore need to take into account that substance use belongs to the risk profile of these adolescents. However, the elevated risk of substance use can not be completely explained by the risk indicators. In particular the risk of starting to use hard drugs after one year residential care remains substantial when individual and family risk indicators are considered. This might suggest that processes and factors within SEB or RYC may provide an additional explanation for the high risk of substance in these settings.

Changes in social, cultural, economic, and governmental systems over time may affect adolescents' development. The present study examined 10-year trends in self-reported emotional and behavioral problems among 11- to 16-year-old adolescents in the Netherlands. In addition, gender (girls versus boys), ethnic (Dutch versus non western) and educational (vocational versus academic) differences in these trends were examined. By means of the Strengths and Difficulties Questionnaire, trends in emotional and behavioral problems were studied in adolescents belonging to one of five independent population representative samples (2003: n = 6,904; 2005: n = 5,183; 2007: n = 6,228; 2009: n = 5,559; 2013: n = 5,478). Structural equation models indicated rather stable levels of emotional and behavioral problems over time. Whereas some small changes were found between different time points, these changes did not represent consistent changes in problem levels. Similarly, gender, ethnic and educational differences in self-reported problems on each time point were highly comparable, indicating stable mental health inequalities between groups of adolescents over time. Future internationally comparative studies using multiple measurement moments are needed to monitor whether these persistent mental health inequalities hold over extended periods of time and in different countries.

Disempowered, narcissistic youth are prone to problematic disclosures on SNSs.Person-centered (Study 1) and experimental (Study 2) studies tested this hypothesis.High-Narcissism/Low-Power youths reported more problematic disclosures (Study 1).High-Narcissism/Low-Power youths viewed these disclosures as less risky (Study 2).Low social power might promote narcissistic youths' problematic SNS disclosures. From a self-image failure perspective, narcissistic adolescents who feel socially disempowered might engage in exhibitionistic disclosures on Social Networking Sites (SNSs). Two studies investigated this hypothesis regarding normative (day-to-day) and problematic (sexuality, drinking) disclosures. In Study 1, cluster analysis revealed four adolescent classes (N=471) with relatively higher/lower narcissism and power. Higher-Narcissism adolescents reported more normative SNS disclosures, but only Higher-Narcissism/Lower-Power youths reported more problematic disclosures. Study 2 adolescents (N=56) received a low- or high-power experimental prime and reported risk perceptions surrounding both disclosure types. Higher-Narcissism youths primed with low power perceived less risk for problematic (but not normative) disclosures. For high-narcissism youths, too little power promotes tendencies to share "too much information" on SNSs.

Differences in sexual functioning of adolescents with and without autism spectrum disorder (ASD) are understudied. In the current study, self-reported sexual behaviours, interests and attitudes of 50 adolescent boys, aged 15–18, with at least average intelligence and diagnosed with ASD, were compared with a matched general population control group of 90 boys. Results demonstrated substantial similarity between the groups in terms of sexual behaviours. The only significant difference was that boys with ASD reacted more tolerant towards homosexuality compared to the control group. Results reveal that sexuality is a normative part of adolescent development in high-functioning boys with ASD. Hence, attention should be given to this topic in education and mental health care.Keywords: Autism, Asperger’s disorder, Sexuality, Sexual behaviour

Item does not contain fulltext This study examined whether the development of sexualized media consumption and permissive sexual attitudes would be more strongly interrelated when adolescents perceived sexualized media images as highly realistic. We used data from a three-wave longitudinal sample of 444 Dutch adolescents aged 13-16 years at baseline. Results from parallel process latent growth modeling multigroup analyses showed that higher initial levels of sexualized media consumption were associated with higher initial level of permissive sexual attitudes. Moreover, increases of sexualized media consumption over time were associated with increases of permissive sexual attitudes over time. Considering the moderation by perceived realism, we found these effects only for those who perceived sexualized media as more realistic. Findings for male and female adolescents were similar except for the relations between initial levels and subsequent development. Among male adolescents who perceived sexualized media images to be realistic, higher initial levels of permissive sexual attitudes were related to subsequent less rapid development of sexualized media consumption. For male adolescents who perceived sexualized media to be less realistic, higher initial levels of sexualized media consumption were related to a subsequent less rapid development of permissive sexual attitudes. These relations were not found for female adolescents. Overall, our results suggest that, in male and female adolescents, those with a high level of perceived realism showed a correlated development of sexualized media consumption and permissive sexual attitudes. These findings point to a need for extended information on how to guide adolescents in interpreting and handling sexualized media in everyday life. 12 p.

Background Bipolar disorder is often underdiagnosed and undertreated. Its detection and correct diagnosis highly relies on the report of past hypomanic or manic episodes. We investigated the recognition and awareness of past hypomanic and manic episodes in a sample of respondents with bipolar disorder selected from a general population study. Methods In a reappraisal study from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), we further investigated 40 respondents with lifetime bipolar disorder confirmed by the structured clinical interview for DSM-IV (SCID). Respondents were asked about awareness of past depressive, manic and hypomanic episodes, illness characteristics and treatment history. Results Most respondents (82.5 %) recognized that they had experienced a depressive episode while 75 % had consulted a health professional for a depressive episode. Only a minority (22.5 %) recognized that they had experienced a (hypo)manic episode and only 17.5 % had consulted a health professional for a (hypo)manic episode. Only 12.5 % of the respondents reported having received a diagnosis of bipolar disorder. Recognition of previous (hypo)manic episodes was not related to severity of bipolar disorder. Conclusions In routine clinical practice history-taking on a syndromal level, i.e., only inquiring whether a patient presenting with depression ever experienced a hypomanic or manic episode or received treatment for such an episode, is not sufficient to confirm or exclude a diagnosis of bipolar disorder. Other efforts, such as an interview with a significant other and the use of self report questionnaires or (semi-)structured interviews may be needed to recognize previous manic symptoms in patients with depression.