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Aim: Although mental disorders often emerge early in life, only a minority of young people receive timely and appropriate mental health care. A worldwide youth mental health movement aims to prevent development and persistence of psychiatric disorders. As part of this movement, the first four @ease centres were opened in the Netherlands. @ease is a youth driven, professionally supported initiative, providing peer-to-peer counselling, anonymous and free of charge, for people aged 12–25. Methods: Data consist of a detailed description of the working method of @ease, combined with characteristics of all young people accessing the services between its inception (January 2018) and July 2020. Results: Young-adult peers, including experts by experience, served as counsellors after training in listening, motivational interviewing and solution-focused strategies. They were supervised by a diverse group of healthcare professionals. A total of 291 visitors, aged 21 on average, were satisfied to very satisfied with @ease's services. Psychosocial distress, social functioning and quality of life measures at first visit showed moderate to severe levels of impairment, and almost half of all visitors reported skipping classes. One third reported parental mental illness, 28% suicidal ideations, and 11% had made specific plans. Less than a third of visitors had received mental health care in the 3 months prior to their visit. Conclusion: This study showed the need for and feasibility of a youth driven, professionally supported organization offering peer-to-peer counselling in the Netherlands. Its flexible and individualized working method enables @ease to normalize problems when possible and intervene when necessary.

Aggression in adolescence is an important antecedent of an antisocial developmental pathway. Research on the stress responsivity system, specifically, the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS), has been instrumental in understanding the development of aggression, yet a recent overview of research on these bio-behavioral associations is currently lacking. We synthesized and analyzed literature since 2011 on HPA-axis (i.e., cortisol) and ANS (i.e., heart rate and skin conductance) measures during rest and stress, with aggression in adolescence (11–19 years). We considered general aggression as well as its subclassifications (e.g., proactive, reactive aggression), and included both self-/other-reports, and laboratory aggression. A literature search (PubMed, Embase, APA PsycINFO) was performed up to March 19, 2021. Sixteen-hundred-fourteen records were screened for eligibility, 28 articles were included in the final synthesis. Although base measures (lower basal cortisol and resting heart rate) related to higher levels of aggression fairly consistently, studies assessing HPAaxis and ANS reactivity yield mixed findings, possibly due to variations in tasks used to evoke reactivity. Furthermore, tentative evidence suggests that lowered arousal relates to proactive forms of aggression, while higher arousal relates to reactive forms of aggression. Finally, the studies show that psychological and social factors, in particular social adversity, internalizing problems, and empathy, impact the association between neurobiological measures and aggression. We recommend that future studies consider different types of aggression using multiple measurement instruments, multiple reactivity tasks, and include a psychosocial assessment. Together, we advocate for a comprehensive biopsychosocial approach to understand what drives aggression in adolescence

Self-concept is shaped by social experiences, but it is not yet well understood how the neural and behavioral development of self-concept is influenced by a history of antisocial behavior. In this pre-registered study, we examined neural responses to self-evaluations in young adults who engaged with antisocial behavior in childhood and either desisted or persisted in antisocial behavior. A self-concept task was performed by 94 young adults (age range 18–30 years). During the task, participants with a persistent or desistent antisocial trajectory (n = 54) and typically developing young adults (n = 40) rated whether positive and negative traits in different domains (prosocial and physical) described themselves. We examined both the effects of a history of antisocial behavior as well as current heterogeneity in psychopathic traits on self-concept appraisal and its neural underpinnings. Participants endorsed more positive trait statements than negative across domains, which did not differ between antisocial-history groups. However, current psychopathic traits were negatively associated with prosocial self-concept and medial prefrontal cortex activity during self-evaluation. Together, these findings suggest that antisocial tendencies might indeed be reflected in self-concept development of young adults, specifically in the prosocial domain.

Youth justice settings should provide a safe, therapeutic environment and tailored approach. Current custodial models rarely meet these aims; in part because a focus on security tends to outweigh an emphasis on care, which diminishes rather than encourages young people’s positive development. Drawing on the results of a three-year evaluation of reforms in the Netherlands, including small-scale, community-embedded facilities with a focus on relational security. By outlining the target population, key operational elements, and conditions for implementation, we provide guidance for custodial staff, and for managers and policymakers seeking to promote political and financial investment in effective youth justice strategies.

Aggression incidents are common in residential youth care, and impede treatment progress and the possibility of evolving into an independent healthy individual. Aggression incidents can lead to feelings of anxiety and unsafety in others, and can have major physical and/or traumatic impact for everyone involved. Current methods to prevent incidents are based on observations of increasing tension by professionals or adolescents themselves, however, they both might have difficulties recognizing these signals. A complementary and promising alternative might be the measurement of physiological reactivity to observe the stress response or increasing tension in adolescents. The present study used a wearable wireless device to examine patterns of physiological reactivity prior to aggression incidents in residential youth care. A total of 19 adolescents in residential youth care participated, who were involved in 87 aggression incidents during study participation. Participants wore a wearable wireless device to measure physiological stress response parameters (peaks per minute (PPM) , skin conductance (SCL), heart rate (HR)) during three, preferably consecutive, weeks, in which aggression incidents were accurately registered. Longitudinal multilevel models showed that PPM rose preceding incidents, but we failed to replicate previous SCL and HR findings in relation to incidents, as there was no significant effect for time, although both slopes did rise preceding aggression incidents. In sum, this study supports the idea that wearable devices measuring physiological stress reactivity might help in the prevention of aggression incidents. There is, however, high within-subject variation, which suggests that future studies should examine more personalized feedback and interventions to take this within-subject variation into account. To date, only a few tools adjusted the interface to this young (clinical) population, and store the data locally on the users’ phone.

Purpose During the COVID-19 pandemic in the Netherlands, governmental regulations resulted in a lockdown for adults as well as children/adolescents. Schools were closed and contact with other people was limited. In this cross-sectional, population-based study, we aimed to investigate the mental/social health of children/adolescents during COVID-19 lockdown. Methods Two representative samples of Dutch children/adolescents (8–18 years) before COVID-19 (2018, N = 2401) and during lockdown (April 2020, N = 844) were compared on the Patient-Reported Outcomes Measurement Information System (PROMIS) domains: global health, peer relationships, anxiety, depressive symptoms, anger, sleep-related impairment by linear mixed models and calculating relative risks (RR (95% CI)) for the proportion of severe scores. Variables associated with worse mental/social health during COVID-19 were explored through multivariable regression models. The impact of COVID-19 regulations on the daily life of children was qualitatively analyzed. Results Participants reported worse PROMIS T-scores on all domains during COVID-19 lockdown compared to before (absolute mean difference range 2.1–7.1 (95% CI 1.3–7.9). During lockdown, more children reported severe Anxiety (RR = 1.95 (1.55–2.46) and Sleep-Related Impairment (RR = 1.89 (1.29–2.78) and fewer children reported poor Global Health (RR = 0.36 (0.20–0.65)). Associated factors with worse mental/social health were single-parent family, ≥ three children in the family, negative change in work situation of parents due to COVID-19 regulations, and a relative/friend infected with COVID-19. A large majority (> 90%) reported a negative impact of the COVID-19 regulations on daily life. Conclusion This study showed that governmental regulations regarding lockdown pose a serious mental/social health threat on children/adolescents that should be brought to the forefront of political decision-making and mental healthcare policy, intervention, and prevention.

Conscience is a diagnostically relevant concept in forensic psychiatry, but often misinterpreted as an all-or-none phenomenon. We conceptualize the conscience as a psychic function in which elements like empathy, self-conscience emotions such as shame, guilt and pride, and moral orientation work together. The differences in conscience functioning can be described in terms of developmental levels of integration. We conducted network analyses on data collected via a questionnaire survey held among 52 offending and 243 non-offending juveniles. We displayed two networks: One representing the non-offenders’ normative and one representing the offenders’ defiantly maturing conscience. As was hypothesized, in the non-offenders network, almost all elements clustered into one clinically meaningful network, indicating integration of the different elements of the normative maturing conscience. In the offenders network, the correlations between the elements were sporadic, indicating a lack of integration of the defiantly maturing conscience. The difference between the two networks was more prominent for empathy and moral orientation than for self-conscious emotions. This research supports the theory of differences in maturation of conscience instead of being an all-or-none phenomenon and calls for further research, taking a deeper look at the significance of integration of the conscience and its implications for offending behaviour.

It remains unclear which functional and neurobiological mechanisms in childhood and adolescence are associated with persistent and desistant antisocial behavior in early adulthood. We reviewed the empirical literature and propose a neurocognitive social information processing model for early onset persistent and desistant antisocial behavior in early adulthood, focusing on how young adults evaluate, act upon, monitor, and learn about their goals and self traits. Based on the reviewed literature, we propose that persistent antisocial behavior is characterized by domain-general impairments in self-relevant and goal-related information processing, regulation, and learning, which is accompanied by altered activity in fronto-limbic brain areas. We propose that desistant antisocial development is associated with more effortful information processing, regulation and learning, that possibly balances self-relevant goals and specific situational characteristics. The proposed framework advances insights by considering individual differences such as psychopathic personality traits, and specific emotional characteristics (e.g. valence of social cues), to further illuminate functional and neural mechanisms underlying heterogenous developmental pathways. Finally, we address important open questions and offer suggestions for future research to improve scientific knowledge on general and context-specific expression and development of antisocial behavior in early adulthood

Self-concept is shaped by social experiences, but it is not yet well understood how the neural and behavioral development of self-concept is influenced by a history of antisocial behavior. In this pre-registered study, we examined neural responses to self-evaluations in young adults who engaged with antisocial behavior in childhood and either desisted or persisted in antisocial behavior. A self-concept task was performed by 94 young adults (age range 18–30-yrs). During the task, participants with a persistent or desistent antisocial trajectory (N = 54), and typically developing young adults (N = 40) rated whether positive and negative traits in different domains (prosocial, physical) described themselves. We examined both the effects of a history of antisocial behavior as well as current heterogeneity in psychopathic traits. Participants endorsed more positive than negative trait statements across domains, which did not differ between antisocial-history groups. However, current psychopathic traits were negatively associated with prosocial self-concept and mPFC activity during self-evaluation. Together, these findings suggest that antisocial tendencies might indeed be reflected in self-concept development of young adults, specifically in the prosocial domain.

Introduction: For youth with psychiatric conditions, sexual and gender identity development can be challenging. Mental health care professionals (MHPs) often avoid communication about sexuality, sexual side effects, and gender diversity with youth. The aim of this study is to gain insight into the perspectives of youth in mental health care and professionals about sexuality and gender diversity communication. Methods: In-depth interviews with 21 adolescent patients (aged 15–22 years) and focus groups were conducted with 20 MHPs (aged 26–55 years) at a mental health care institution in Amsterdam. During analysis, the experiences, needs, and underlying inhibiting and facilitating factors of both groups were derived and analyzed. Results: Both youth patients and MHPs stated that sexuality and gender identity should be a part of mental health care. Youth described the impact and interplay between mental health, sexuality (e.g., sexual experiences, romantic relations, sexual orientation), and gender identity. Both groups want sexual side effects of psychotropic medication to be addressed when prescribing medication. Cultural and faith-based factors should be considered, especially for LGBT+ youth. Conclusion: Youth patients and MHPs feel that sexuality and gender identity should be a standard part of youth mental health care. Confidential conversation with an MHP can provide a designated place to talk about these sensitive subjects. Mental health care institutions should implement sexuality and gender diversity communication in clinical practice.

In residential settings for juveniles with Mild Intellectual Disability (MID) employees have to face tough work conditions, because of frequent aggressive incidents Eventually, this might result in a negative work climate, high staff-turnover and absenteeism. In turn, it hampers a positive therapeutic environment for youngsters. A method that may endorse a better work climate is Non-violent Resistance (NVR). As earlier research suggests that the residential NVR, adjusted for juveniles with MID, is successful in diminishing aggressive incidents and improving group climate, we hypothesize that NVR-MID will be also effective in enhancing work climate. We investigated the perception of work climate by staff of three residential settings before, during and after implementation of NVR-MID. Work climate was assessed both quantitatively and qualitatively. Outcomes were subsequently integrated. Quantitative data was collected using the Living Group Working Climate Inventory (LGWCI). Multilevel analyses were carried out to analyse the development of work climate over time. Qualitative data were collected via semi-structured interviews with NVR-MID trained staff and analysed through qualitative coding. Quantitative results showed that Job Satisfaction decreased after NVR-MID implementation. However, within qualitative reports, staff members experienced a positive influence on work climate of NVR-MID.

Conduct Disorder (CD) is characterized by severe aggressive and antisocial behavior. The stress hormone system has frequently been investigated as a neurobiological correlate of CD, while other interacting neuroendocrine biomarkers of sex hormone or neuropeptide systems have rarely been studied, especially in females. We examined multiple basal neuroendocrine biomarkers in female and male adolescents with CD compared to healthy controls (HCs), and explored whether they mediate effects of environmental risk factors on CD. Within the FemNAT-CD study, salivary cortisol, alpha-amylase, testosterone, dehydroepiandrosterone-sulfate (DHEA-S), estradiol, progesterone, oxytocin, and arginine-vasopressin were measured under basal conditions in 166 pubertal adolescents with CD, and 194 sex-, age-, and puberty-matched HCs (60% females, 9–18 years). Further, environmental risk factors were assessed. Single hormone analyses showed higher DHEA-S, and lower estradiol and progesterone levels in both females and males with CD relative to HCs. When accounting for interactions between neuroendocrine systems, a male-specific sex hormone factor (testosterone/DHEA-S) predicted male CD, while estradiol and a stress-system factor (cortisol/alpha-amylase) interacting with oxytocin predicted female CD. Estradiol, progesterone, and oxytocin partly explained associations between early environmental risk and CD. Findings provide evidence for sex-specific associations between basal neuroendocrine measures and CD. Especially altered sex hormones (androgen increases in males, estrogen reductions in females) robustly related to CD, while basal stress-system measures did not. Early environmental risk factors for CD may act partly through their effects on the neuroendocrine system, especially in females. Limitations (e.g., basal neuroendocrine assessment, different sample sizes per sex, pubertal participants, exploratory mediation analyses) are discussed.

BackgroundThe COVID-19 pandemic has had an acute impact on child mental and social health, but long-term effects are still unclear. We examined how child mental health has developed since the start of the COVID-19 pandemic up to two years into the pandemic (April 2022).MethodsWe included children (age 8-18) from two general population samples (N = 222-1,333 per measurement and N = 2,401-13,362 for pre-covid data) and one clinical sample receiving psychiatric care (N = 334-748). Behavioral questionnaire data were assessed five times from April 2020 till April 2022 and pre-pandemic data were available for both general population samples. We collected parent-reported data on internalizing and externalizing problems with the Brief Problem Monitor and self-reported data on Anxiety, Depressive symptoms, Sleep-related impairments, Anger, Global health, and Peer relations with the Patient-Reported Outcomes Measurement Information System (PROMIS®).ResultsIn all samples, parents reported overall increased internalizing problems, but no increases in externalizing problems, in their children. Children from the general population self-reported increased mental health problems from before to during the pandemic on all six PROMIS domains, with generally worst scores in April 2021, and scores improving towards April 2022 but not to pre-pandemic norms. Children from the clinical sample reported increased mental health problems throughout the pandemic, with generally worst scores in April 2021 or April 2022 and no improvement. We found evidence of minor age effects and no sex effects.ConclusionsChild mental health in the general population has deteriorated during the first phase of the COVID-19 pandemic, has improved since April 2021, but has not yet returned to pre-pandemic levels. Children in psychiatric care show worsening of mental health problems during the pandemic, which has not improved since. Changes in child mental health should be monitored comprehensively to inform health care and policy.

To improve medical care for young people in the Netherlands, various professional groups representing physicians who provide medical care to children have developed a vision called ‘strengthening medical care for young people’. The purpose of this viewpoint is to reflect on the implementation of proposals to augment cooperation and coordination between the professional groups involved. Our reflection demonstrates that additional action regarding cooperation and coordination is still necessary to strengthen this care for young people. First, regarding the practical implementation of collaboration, the guidelines are unclear, and many are out-of-date. Second, adequate structured interdisciplinary training and intervision are lacking for physicians frequently collaborating in the care of young people. Third, interdisciplinary access to patient files is too complex and time-consuming. We recommend structured monitoring of the implementation of all improvement proposals, regarding both processes and outcomes. In addition, we recommend collaboration with physicians treating mentally disabled individuals to improve medical care for this group.

This study examines the relationship between criminal history and adverse childhood experiences (ACEs) and how they collectively predict (a) recidivism and (b) positive social functioning among multi-problem young adults. Criminal records and self-report data regarding ACEs and adult education/employment and quality of life (QoL) were collected for 692 multiproblem young adults (18–27 years). Results indicated that an extensive criminal history was related to non-violent and violent recidivism and lack of involvement in education/employment in young adulthood. On the contrary, a higher number of ACEs was related to lower QoL later in life, while this was not associated with recidivism or education/employment. These findings highlight again that past criminal behavior is a strong predictor of future criminality, particularly within this group of young adults with multiple problems. Furthermore, experiencing negative events in childhood shows to have long-term negative effects on QoL even for these individuals who already experience multiple life problems. Implications are discussed.

Background: Neurobiological measures have been associated with delinquent behaviour, but little is known about the predictive power of these measures for criminal recidivism and whether they have incremental value over and above demographic and behavioural measures. This study examined whether selected measures of autonomic functioning, functional neuroimaging and electroencephalography predict overall and serious recidivism in a sample of 127 delinquent young adults. Methods: We assessed demographics; education and intelligence; previous delinquency and drug use; behavioural traits, including aggression and psychopathy; and neurobiological measures, including heart rate, heart rate variability, functional brain activity during an inhibition task and 2 electroencephalographic measures of error-processing. We tested longitudinal associations with recidivism using Cox proportional hazard models and predictive power using C-indexes. Results: Past offences, long-term cannabis use and reactive aggression were strongly associated with recidivism, as were resting heart rate and error-processing. In the predictive model, demographics, past delinquency, drug use and behavioural traits had moderate predictive power for overall and for serious recidivism (C-index over 30 months [fraction of pairs in the data, where the higher observed survival time was correctly predicted]: C30 = 0.68 and 0.75, respectively). Neurobiological measures significantly improved predictive power (C30 = 0.72 for overall recidivism and C30 = 0.80 for serious recidivism). Limitations: Findings cannot be generalized to females, and follow-up was limited to 4 years. Conclusion: Demographic and behavioural characteristics longitudinally predicted recidivism in delinquent male young adults, and neurobiological measures improved the models. This led to good predictive function, particularly for serious recidivism. Importantly, the most feasible measures (autonomic functioning and electroencephalography) proved to be useful neurobiological predictors.

Multiproblem young adults present with major problems across key life domains, but empirical studies investigating the nature of multiproblem behavior in accordance to ecobiodevelopmental theory are scarce. To address this gap, we performed a cluster analysis on indicators spanning the key life domains addiction, mental health, social network, and justice. In a large sample (N = 680) of multiproblem young adults, we identified five subgroups labeled “severe with alcohol and cannabis problems” (4.3%), “severe with cannabis problems” (25.6%), “severe without alcohol or drug problems” (33.2%), “moderate with mental health problems” (22.9%), and “moderate without mental health problems” (14.0%). There were large differences between the severe and moderate groups in terms of childhood risk factors such as emotional and physical abuse, concerning baseline functioning such as comorbid disorders and aggressive behavior, and in the outcome measure of violent offending. Our findings indicate that multiproblem young adult behavior clusters within profiles that differ according to the severity and nature of problems. Investing in screening for clustered problems may be beneficial for early problem differentiation and selection of appropriate intervention before and during treatment programs.

Contains fulltext : 234918.pdf (Publisher’s version ) (Open Access) In this study, we examined the feasibility and added value of including peer informants in a psychological autopsy study of youth suicides. Peer semi-structured interview data from 16 cases were analyzed qualitatively and compared to parent data. Results show that peers added information to parents' narratives in general and particularly on social relationships, bullying, school experiences, social media, and family relations. Peers also provided additional information on the presence of certain issues (such as social media contagion) as well as on the emotional impact from certain adverse events that seemed to have functioned as precipitating factors. We conclude that including peers in psychological autopsy studies of youth suicides is feasible and of added value but that more research is desirable. The results initially can be used in the design of psychological autopsies so that the maximum amount of information about each suicide will be learned. 13 p.

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.

Purpose: Early medical treatment for transgender adolescents should contribute to healthy psychological development, including the development of positive self-perception. However, at present, there are no longitudinal studies that have examined whether current treatment approaches meet this expectation. Therefore, the aim of this single-arm retrospective study was to examine transgender adolescents' self-perception changes over the course of irreversible medical gender-affirming treatment. Methods: The total study sample consisted of 70 adolescents (49 trans men and 21 trans women). Self-perception was assessed before the start of gender-affirming hormone treatment (mean age = 14.65, standard deviation (SD) = 2.08) and at least 6 months after gender-affirming surgeries (mean age = 20.70, SD = 1.49) by Self-Perception Profile for Adolescents (SPPA). The SPPA is a self-report measure that examines self-perception on seven different domains: Scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct, close friendship, and global self-worth. Multilevel modeling (random intercepts model) was conducted to determine the effect of time for all domains of self-perception. Results: It was found that the domains of physical appearance and global self-worth improved significantly over the course of treatment. No domain worsened significantly over the course of treatment. The domains of scholastic competence, social acceptance, athletic competence, and close friendship remained stable over time. Conclusion: This study provides the first suggestive evidence that irreversible gender-affirming treatment for adolescents could contribute to the development of a more positive self-perception.

Objective: Conduct disorder (CD) involves aggressive and antisocial behavior and is associated with blunted cortisol stress response in male youths. Far less is known about cortisol stress responsivity in female youths with CD or other neuroendocrine responses in both sexes. Although CD is linked to early adversity, the possibility that neuroendocrine alterations may mediate the relationship between early adversity and CD has not been systematically investigated. Method: Within the European FemNAT-CD multi-site study, salivary cortisol, testosterone, the testosterone/cortisol ratio, oxytocin, and psychological stress response to a standardized psychosocial stress test (the Trier Social Stress Test [TSST]), together with common pre- and postnatal environmental risk factors, were investigated in 130 pubertal youths with CD (63% female, 9-18 years of age) and 160 sex-, age-, and puberty-matched healthy controls (HCs). Results: The TSST induced psychological stress in both CD and HCs. In contrast, female and male youths with CD showed blunted cortisol, testosterone, oxytocin, and testosterone/cortisol stress responses compared to HCs. These blunted stress responses partly mediated the relationship between environmental risk factors and CD. Conclusion: Findings from this unique sample, including many female youths with CD, provide evidence for a widespread attenuated stress responsivity of not only stress hormones, but also sex hormones and neuropeptides in CD and its subgroups (eg, with limited prosocial emotions). Results are the first to demonstrate blunted neuroendocrine stress responses in both female and male youths with CD. Early adversity may alter neuroendocrine stress responsivity. Biological mechanisms should be investigated further to pave the way for personalized intervention, thereby improving treatments for CD.

The aim of the study was to assess internalizing problems before and during the pandemic with data from Dutch consortium Child and adolescent mental health and wellbeing in times of the COVID-19 pandemic, consisting of two Dutch general population samples (GS) and two clinical samples (CS) referred to youth/psychiatric care. Measures of internalizing problems were obtained from ongoing data collections pre-pandemic (NGS = 35,357; NCS = 4487) and twice during the pandemic, in Apr–May 2020 (NGS = 3938; clinical: NCS = 1008) and in Nov–Dec 2020 (NGS = 1489; NCS = 1536), in children and adolescents (8–18 years) with parent (Brief Problem Monitor) and/or child reports (Patient-Reported Outcomes Measurement Information System®). Results show that, in the general population, internalizing problems were higher during the first peak of the pandemic compared to pre-pandemic based on both child and parent reports. Yet, over the course of the pandemic, on both child and parent reports, similar or lower levels of internalizing problems were observed. Children in the clinical population reported more internalizing symptoms over the course of the pandemic while parents did not report differences in internalizing symptoms from pre-pandemic to the first peak of the pandemic nor over the course of the pandemic. Overall, the findings indicate that children and adolescents of both the general and clinical population were affected negatively by the pandemic in terms of their internalizing problems. Attention is therefore warranted to investigate long-term effects and to monitor if internalizing problems return to pre-pandemic levels or if they remain elevated post-pandemic.

UNSTRUCTURED This is a corrigendum for original article ms# 33555.

Theoretical and empirical accounts suggest that adolescence is associated with heightened reward learning and impulsivity. Experimental tasks and computational models that can dissociate reward learning from the tendency to initiate actions impulsively (action initiation bias) are thus critical to characterise the mechanisms that drive developmental differences. However, existing work has rarely quantified both learning ability and action initiation, or it has tested small samples. Here, using computational modelling of a learning task collected from a large sample (N=742, 9-18 years, 11 countries), we tested differences in reward and punishment learning and action initiation from childhood to adolescence. Computational modelling revealed that whilst punishment learning rates increased with age, reward learning remained stable. In parallel, action initiation biases decreased with age. Results were similar when considering pubertal stage instead of chronological age. We conclude that heightened reward responsivity in adolescence can reflect differences in action initiation rather than enhanced reward learning.

Previous research has shown an association between cognitive control deficits and problematic behavior such as antisocial behavior and substance use, but little is known about the predictive value of cognitive control for treatment outcome. The current study tests whether selected markers of baseline cognitive control predict (1) treatment completion of a day treatment program involving a combination of approaches for multiproblem young adults and (2) daytime activities a year after the start of treatment, over and above psychological, social, and criminal characteristics. We assessed individual, neurobiological, and neurobehavioral measures, including functional brain activity during an inhibition task and two electroencephalographic measures of error processing in 127 male multiproblem young adults (age 18–27 years). We performed two hierarchical regression models to test the predictive power of cognitive control for treatment completion and daytime activities at follow-up. The overall models did not significantly predict treatment completion or daytime activities at follow-up. However, activity in the anterior cingulate cortex (ACC) during response inhibition, years of regular alcohol use, internalizing problems, and ethnicity were all significant individual predictors of daytime activity at follow-up. In conclusion, cognitive control could not predict treatment completion or daytime activities a year after the start of treatment over and above individual characteristics. However, results indicate a direct association between brain activity during response inhibition and participation in daytime activities, such as work or school, after treatment. As adequate baseline inhibitory control is associated with a positive outcome at follow-up, this suggests interventions targeting cognitive control might result in better outcomes at follow-up.

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.

Purpose: Transgender adolescents are at risk for internalizing and externalizing problems, along with high suicidality rates, and poor peer relations. The present study compared transgender adolescents before and after gender-affirmative care with a sample of nonclinical age-equivalent cisgender adolescents from the general population on psychological well-being and aimed to investigate the possible effect of transgender care involving puberty suppression.Methods: In this cross-sectional study, emotional and behavioral problems were assessed by the Youth Self-Report in a sample of 272 adolescents referred to a specialized gender identity clinic who did not yet receive any affirmative medical treatment and compared with 178 transgender adolescents receiving affirmative care consisting of puberty suppression and compared with 651 Dutch high school cisgender adolescents from the general population.Results: Before medical treatment, clinic-referred adolescents showed more internalizing problems and reported increased self-harm/suicidality and poorer peer relations compared with their age-equivalent peers. Transgender adolescents receiving puberty suppression had fewer emotional and behavioral problems than the group that had just been referred to transgender care and had similar or fewer problems than their same-age cisgender peers on the Youth Self-Report domains.Conclusions: Transgender adolescents show poorer psychological well-being before treatment but show similar or better psychological functioning compared with cisgender peers from the general population after the start of specialized transgender care involving puberty suppression.

The background of this article is to examine whether consecutively transgender clinic-referred adolescents between 2000 and 2016 differ over time in demographic, psychological, diagnostic, and treatment characteristics. The sample under study consisted of 1072 adolescents (404 assigned males, 668 assigned females, mean age 14.6 years, and range 10.1–18.1 years). The data regarding the demographic, diagnostic, and treatment characteristics were collected from the adolescents’ files. Psychological functioning was measured by the Child Behaviour Check List and the Youth Self-Report, intensity of gender dysphoria by the Utrecht Gender Dysphoria Scale. Time trend analyses were performed with 2016 as reference year. Apart from a shift in sex ratio in favour of assigned females, no time trends were observed in demographics and intensity of dysphoria. It was found, however, that the psychological functioning improved somewhat over time (CBCL β − 0.396, p β − 0.278, p

A retrospective chart study of patients on open-label aripiprazole treatment was conducted in the Netherlands to add to the knowledge of aripiprazole in children and young adults with mild and borderline intellectual disabilities (IDs). Fifty-three youths, mean age 14.7 ± 3.4 years and mean IQ 64.5 ±13.8, were included. Treatment responders were defined as “much improved” or “very much improved” based on the Clinical Global Impression -Improvement scale. For 83% of the patients, disruptive behavior was the main target symptom. The overall response rate was 30% after 1–4 weeks and 69% after 5–8 weeks. The 5–8 weeks responders showed a response rate of 64% at 22–26 weeks. Mild adverse events were observed in 53% of the patients of which fatigue and weight gain were the most common. Seven patients (13.2%) discontinued because of adverse events. In 53 children and young adults with mild and borderline IDs, aripiprazole was effective in both the short and the long term. No serious adverse events were observed.

This study aimed to explore the impact of the COVID-19 restrictions on social relationships of forensic psychiatric outpatients with preexisting social network-related problems. Data from 70 participants of an ongoing randomized controlled trial, investigating the effectiveness of a social network intervention among forensic psychiatric outpatients, were examined. Demographic characteristics, quality of social relationships, loneliness, and social support were assessed at baseline. During the COVID-19 pandemic, an additional questionnaire that contained quantitative and qualitative questions regarding the impact of COVID-19 restrictions on social relationships was administered. Participants showed high levels of loneliness and dissatisfaction with social relationships before COVID-19. The majority of forensic outpatients perceived no changes on social relationships due to the COVID-19 restrictions. Qualitative results revealed some participants already lived socially isolated. Negative changes on social relationships were related to deterioration of social contacts, interruption of daytime activities, changed mental health care, and well-being. Emotional loneliness predicted deteriorated general and romantic relationships. These findings suggest that social relationships of forensic patients with preexisting social network-related problems remain of concern throughout the COVID-19 pandemic.

Transgender adolescents may present to gender identity specialty services earlier or later in adolescence. The aim of this study was to examine whether, 'younger' and 'older' presenters could be identified in a large cohort of transgender adolescents and if differences exist between the two groups. The study sample consisted of 1487 adolescents (506 birth-assigned males, 981 birth-assigned females) referred between 2000 and 2018. The distribution of age at intake was evaluated. Demographic, diagnostic, and treatment characteristics, the Recalled Childhood Gender Identity/Gender Role Questionnaire (RCGI) to measure childhood gender nonconformity and the Body Image Scale (BIS) to measure body image were collected. Based on a stem-and-leaf plot and a histogram, two groups were identified: adolescents presenting at ≤ 13.9 years ('younger presenters') and adolescents presenting at 14 years or older ('older presenters'). The sex ratio was more extreme in the group of older presenters favoring birth-assigned females (Χ

Transgender adolescents may present to gender identity specialty services earlier or later in adolescence. The aim of this study was to examine whether, ‘younger’ and ‘older’ presenters could be identified in a large cohort of transgender adolescents and if differences exist between the two groups. The study sample consisted of 1487 adolescents (506 birth-assigned males, 981 birth-assigned females) referred between 2000 and 2018. The distribution of age at intake was evaluated. Demographic, diagnostic, and treatment characteristics, the Recalled Childhood Gender Identity/Gender Role Questionnaire (RCGI) to measure childhood gender nonconformity and the Body Image Scale (BIS) to measure body image were collected. Based on a stem-and-leaf plot and a histogram, two groups were identified: adolescents presenting at ≤ 13.9 years (‘younger presenters’) and adolescents presenting at 14 years or older (‘older presenters’). The sex ratio was more extreme in the group of older presenters favoring birth-assigned females (Χ2(1, N = 1487) = 19.69, p Χ2(1, N = 1427) = 24.78, p Χ2(1, N = 1404) = 4.60, p = 0.032 and Χ2(1, N = 1487) = 29.16, p β 0.315, p 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.

Background Juvenile delinquents constitute a heterogeneous group, which complicates decision-making based on risk assessment. Various psychosocial factors have been used to define clinically relevant subgroups of juvenile offenders, while neurobiological variables have not yet been integrated in this context. Moreover, translation of neurobiological group differences to individual risk assessment has proven difficult. We aimed to identify clinically relevant subgroups associated with differential youth offending outcomes, based on psychosocial and neurobiological characteristics, and to test whether the resulting model can be used for risk assessment of individual cases. Methods A group of 223 detained juveniles from juvenile justice institutions was studied. Latent class regression analysis was used to detect subgroups associated with differential offending outcome (recidivism at 12 month follow-up). As a proof of principle, it was tested in a separate group of 76 participants whether individual cases could be assigned to the identified subgroups, using a prototype ‘tool’ for calculating class membership. Results Three subgroups were identified: a ‘high risk—externalizing’ subgroup, a ‘medium risk—adverse environment’ subgroup, and a ‘low risk—psychopathic traits’ subgroup. Within these subgroups, both autonomic nervous system and neuroendocrinological measures added differentially to the prediction of subtypes of reoffending (no, non-violent, violent). The ‘tool’ for calculating class membership correctly assigned 92.1% of participants to a class and reoffending risk. Conclusions The LCRA approach appears to be a useful approach to integrate neurobiological and psychosocial risk factors to identify subgroups with different re-offending risk within juvenile justice institutions. This approach may be useful in the development of a biopsychosocial assessment tool and may eventually help clinicians to assign individuals to those subgroups and subsequently tailor intervention based on their re-offending risk.

Background The ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and a predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges. Objective The aim of this study is to explore whether a new technology-based biocueing intervention, the Sense-IT app, can be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT app, which provides the user with real-time physiological feedback and behavioral support, is developed to strengthen emotional awareness and facilitate real-life practice. In this study, we aim to develop and evaluate an updated version of the Sense-IT app that is suitable for forensic outpatients with aggressive behavior. Methods First, we conducted a design study to assess the attitudes of forensic professionals and patients toward biocueing and to collect requirements for a biocueing app for this specific population. On the basis of this information, we developed an updated version of the Sense-IT app. In an evaluation study, 10 forensic outpatients used the app for 2 weeks. The app’s acceptability, usability, and clinical outcomes (aggression, anger, and recognition of bodily signals related to anger) were measured before and after the intervention using both quantitative and qualitative measures. Results The design study revealed a cautiously positive attitude toward the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability for the new version of the Sense-IT app. Exploratory analysis revealed a significant decrease in trait aggression postintervention; no significant changes were found in other anger-related clinical outcomes. To further increase acceptability and usability, a stable functioning app with self-adjustable settings, the use of smartwatches with a longer battery life, and the use of the patient’s own smartphone devices were recommended. Conclusions This study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single-case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude toward new technology, allowing exploration of the potential benefits of the Sense-IT app case-by-case, and training of therapists in using the app are expected to facilitate its integration in therapy.

Prior research has implicated the medial and lateral prefrontal cortex (PFC) in processing evaluations from the perspective of self (self-traits) and evaluations from others (peer feedback), suggesting that these areas form a neural substrate that serves an intertwined function in monitoring self in relation to others. To test this possibility, we examined neural activation overlap in medial and lateral PFC after processing self- and other-informed evaluations. Young adults (age range 18–30-yrs, n = 40) performed two fMRI tasks. The self-concept task involved rating whether positive and negative traits described themselves. The Social Network Aggression Task involved processing positive, neutral or negative feedback from others, with the possibility to retaliate by blasting a loud noise following feedback. The results show that rating positive self traits and receiving positive peer feedback was associated with increased activity in an overlapping region in medial PFC. There were no significant correlations on a behavioral level and medial PFC activity for self-versus-other evaluations. The study further replicated the finding from previous research showing that higher activity in dorsolateral PFC (dlPFC) when receiving negative social feedback was associated with reduced noise blast aggression. Finally, during retaliatory responses after receiving positive feedback, participants showed increased activity in the dlPFC. Together these findings suggest that medial PFC is more strongly involved in protecting positive self-views from both internal (self traits) and external (peer feedback) points of view, whereas dlPFC is more strongly involved in regulating retaliatory responses following social rejection, and actively inhibiting aggressive behavior after receiving positive peer feedback.

The aim of the study was to assess internalizing problems before and during the pandemic with data from Dutch consortium Child and adolescent mental health and wellbeing in times of the COVID-19 pandemic, consisting of two Dutch general population samples (GS) and two clinical samples (CS) referred to youth/psychiatric care. In each sample, measures of internalizing problems were obtained from ongoing data collections pre-pandemic (NGS= 35,357; NCS= 4,487) and twice during the pandemic, in Apr.–May 2020 (NGS= 3,938; clinical: NCS= 1,008) and in Nov.–Dec. 2020 (NGS= 1,489; NCS= 1,536), in children and adolescents (8-18 years) with parent- (Brief Problem Monitor) and/or child reports (Patient-Reported Outcomes Measurement Information System®). Results show significantly greater proportions of worrisome internalizing problems (based on validated cut-offs) and significantly higher internalizing problems mean levels from pre-pandemic to pandemic measurements in the general population. These levels stabilized or decreased over the course of the pandemic. In the clinical sample, we found an increase in child-reported internalizing problems measures over the course of the pandemic, but parents reported no differences in internalizing problems measures over the course of the pandemic, nor from pre-pandemic to during the pandemic. Overall, the findings indicate that children and adolescents of both the general and clinical population were affected negatively by the pandemic in terms of their internalizing problems. Attention is therefore warranted to investigate what long-term effects this may cause and to monitor if internalizing problems return back to pre-pandemic levels or if they remain elevated post-pandemic.