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Prevention studies typically focus on outcome variables such as reductions in problem behavior, rather than targeted factors (e.g., cognitions), or the relation between change in targeted factors and outcomes. Therefore, the current study examined the effect of a targeted prevention program for childhood disruptive behavior on targeted factors (i.e., perspective taking and self-control) and associations between change in targeted factors and outcomes (i.e., aspects of disruptive behavior). The sample consisted of 173 children (Mage = 10.2 years) who were randomly assigned to an intervention condition (n = 70) or waitlist control condition (n = 103). Assessment took place at pre-, post- and follow-up measurements. For ethical considerations, follow-up data was not available for children on the waitlist. Findings revealed a direct intervention effect on self-control. From pre-test to follow-up, children who received the intervention improved in perspective taking and self-control. Moreover, improvements in self-control were associated with and predicted reductions in teacher-reported symptoms of oppositional defiant disorder. No associations were found between changes in perspective taking and disruptive behavior. These findings suggest that self-control may be an important target factor in reducing childhood disruptive behavior in targeted prevention.

Externaliserend probleemgedrag bij jonge kinderen komt veel voor en heeft grote korte- en langetermijngevolgen voor kinderen en hun omgeving. Pittige Jaren (PJ) is een bewezen effectieve interventie voor ouders om gedragsproblemen bij hun kinderen van tussen 3 en 8 jaar te verminderen middels het versterken van opvoedvaardigheden. De verandering in opvoedvaardigheden is echter beperkt onderzocht en bovendien was het nog niet bekend of deze effecten ook bereikt kunnen worden door buurtteams in de getransformeerde zorg voor jeugd. De training is inmiddels in verschillende buurtteams in de stad Utrecht geïmplementeerd. In de huidige studie worden veranderingen in externaliserende gedragsproblemen bij kinderen en veranderingen in opvoeddimensies (supervisie of monitoring, inconsistente disciplinering, fysiek straffen, positieve betrokkenheid en positieve opvoedtechnieken) van ouders voor en na de training en bij follow-up middels vragenlijsten onderzocht. Voor 77 unieke ouder-kindcombinaties waren gegevens compleet voor zowel voor- als nameting. Na deelname aan PJ blijken gedragsproblemen, inconsistente disciplinering en fysiek straffen significant te verminderen en positieve betrokkenheid en positieve opvoedtechnieken significant toe te nemen. De toename in positieve opvoedtechnieken hangt samen met een vermindering in gedragsproblemen. Deze studie laat zien dat PJ goed past in de getransformeerde praktijk van de jeugdzorg en maakt aannemelijk dat verandering bij PJ bewerkstelligd wordt door het veronderstelde werkingsmechanisme.

De afgelopen vijftig jaar zijn interventieonderzoekers en behandelaren er niet in geslaagd om de bescheiden uitkomsten van psychotherapie voor kinderen en jeugdigen te verbeteren, concluderen Weisz en collega's op basis van tijdtrends in een recent verschenen meta-analyse (2019). Deze teleurstellende bevindingen onderstrepen de noodzaak voor interventieonderzoekers en therapeuten om samen te werken aan nieuwe invalshoeken voor interventieonderzoek en zo bij te dragen aan het optimaliseren van behandeling. Dit kan door handelingsgerichte strategieën voor therapeuten te formuleren, te toetsen of die daadwerkelijk leiden tot effectiever behandelen en deze op te nemen in master- en postmasteropleidingen. Als aanzet daartoe wordt in dit artikel een theoretische, modelmatige weergave besproken van de werking van therapie voor kinderen en adolescenten. De wetenschappelijke bevindingen wat betreft de rol van therapeutische alliantie voor het optimaliseren van het behandelproces worden ook weergegeven en besproken. Betoogd wordt hoe modelmatig denken betere handelingsadviezen kan bieden. Empirische ondersteuning voor het model wordt besproken. Daarbij is expliciet aandacht voor internaliserende versus externaliserende problemen, voor de rol van de therapeutische alliantie en empirisch ondersteund effectief handelen.

Previous studies examining the relationship between emotion dysregulation and externalizing behavior problems have, so far, focused on using general screening questionnaires capturing a wide range of externalizing behaviors and emotion dysregulation has mostly been assessed through direct observation using negative mood induction and behavioral tasks. The purpose of this study was to explore this relationship using a multi-informant rated clinical questionnaires. Parents and teachers of 609 5-6-year-old children (46% girls, 54% boys) completed the ERC, DBRS, and SDQ. ODD symptoms/conduct problems and lability/negativity were more severe among boys but girls had better emotion regulation. The results also showed a significant main effect for emotion dysregulation and ODD symptoms/conduct problems and that gender had no moderating effect on the relationship. These findings show a strong association between emotion dysregulation and concurrent ODD symptoms/conduct problems and suggest that emotional difficulties should be considered when exploring causes of behavior difficulties in daily life.

Cognitive behavioral therapy (CBT) is a psychosocial treatment with strong scientific evidence supporting its use with youth for a variety of emotional and behavioral problems. This chapter provides a broad overview of CBT with youth divided into three sctions. In the first section, the behavioral and cognitive theories that underlie the CBT approach are described. We also discuss how the two theories have been integrated into theories used to guide CBT. In the second section, a description of specific techniques commonly found in CBT is provided along with a review of the typical modalities employed to deliver CBT. Finally, the third section focuses on the delivery of CBT.

Background Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap. Question Does age moderate CBT effect size, measured by a clinically and statistically significant interaction between age and CBT exposure? Methods All English language RCTs of CBT for anxiety in 6-19 year olds were identified using systematic review methods. Investigators of eligible trials were invited to submit their individual patient data. The anxiety disorder interview schedule (ADIS) primary diagnosis severity score was the primary outcome. Age effects were investigated using multilevel modeling to account for study level data clustering and random effects. Results Data from 17 of 23 eligible trials were obtained (74%); 16 studies and 1,171 (78%) cases were available for the analysis. No interaction between age and CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and comorbid depression diagnosis (power ≥ 80%). Sensitivity analyses, including modeling age as both a categorical and continuous variable, revealed this result was robust. Conclusions Adolescents who receive CBT in efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development. © 2013 Wiley Periodicals, Inc.

Uit meta-analyses is gebleken dat er een positief verband is tussen therapeutische alliantie en behandelresultaat, met name uit studies naar de effecten van behandeling van disruptief gedrag bij kinderen. Een therapeutische alliantie vormt zich mede onder invloed van persoonlijkheidstrekken, terwijl ook is gebleken dat bijvoorbeeld psychopathische trekken behandeluitkomsten negatief beïnvloeden. Kinderen met disruptieve gedragsproblemen laten in het algemeen sterkere psychopathische trekken zien dan kinderen zonder deze problemen. Dit onderzoek met 44 kinderen beoogt de vraag te beantwoorden of de therapeutische alliantie een mediërende factor is tussen de mate waarin psychopathische trekken aanwezig zijn en de effectiviteit van een evidence-based CGT-behandeling van disruptief gedrag. Middels multipele regressie is onderzocht of deze trekken de afname van disruptief gedrag na behandeling voorspelden en of de therapeutische alliantie deze relatie medieert. Ouders en leerkrachten rapporteerden een significante afname van disruptief gedrag bij de na- en follow-upmeting (gemiddelde effect size (Cohen's d) = 0.31). Er werd geen significante relatie gevonden tussen enerzijds het niveau van psychopathische trekken en anderzijds de kwaliteit van de vroege therapeutische alliantie en afname in disruptief gedrag. Therapeutische alliantie bleek de mate waarin kinderen profiteren van de behandeling marginaal te voorspellen. Concluderend kan worden gesteld dat kinderen met disruptief gedrag kunnen profiteren van CGT, ongeacht de mate waarin ze psychopathische trekken vertonen. Aandacht voor de therapeutische relatie met de behandelaar kan mogelijk helpen het behandelresultaat te optimaliseren.

This chapter reviews the empirical literature on factors that might influence the development and maintenance of the alliance and client involvement in youth therapy. Thus, our review of the literature is conducted through the lens of the evidence-based practice movement, which emphasizes the importance of tailoring the delivery of evidence-based treatments to individual clients. We present a conceptual model designed to explain how therapy produces change in youth, focusing on process and outcome through therapeutic interventions hypothesized to strengthen the alliance and maximize client involvement Then we use the model as a framework for reviewing the empirical evidence demonstrating that therapist characteristics, therapeutic interventions, and therapist competence influence the therapist–client alliance and client involvement. The chapter concludes with clinical implications and suggested future research directions.

Objective: In this randomized controlled trial, we investigated the effectiveness of a school-based targeted intervention program for disruptive behavior. A child-focused cognitive behavioral therapy (CBT) program was introduced at schools in disadvantaged settings and with active teacher support (ATS) versus educational teacher support (ETS) (CBT + ATS vs. CBT + ETS). Method: Screening (n = 1,929) and assessment (n = 224) led to the inclusion of 173 children ages 8-12 years from 17 elementary schools. Most of the children were boys (n = 136, 79%) of low or low-to-middle class socioeconomic status (87%); the sample was ethnically diverse (63% of non-Western origin). Children received CBT + ATS (n = 29) or CBT + ETS (n = 41) or were entered into a waitlist control condition (n = 103) to be treated afterward (CBT + ATS, n = 39, and CBT + ETS, n = 64). Effect sizes (ES), clinical significance (reliable change), and the results of multilevel modeling are reported. Results: Ninety-seven percent of children completed treatment. Teachers and parents reported positive posttreatment effects (mean ES =.31) for CBT compared with the waitlist control condition on disruptive behavior. Multilevel modeling showed similar results. Clinical significance was modest. Changes had remained stable or had increased at 3-months follow-up (mean ES =.39). No consistent effect of teacher condition was found at posttreatment; however, at follow-up, children who received ETS fared significantly better. Conclusions: This study shows that a school-based CBT program is beneficial for difficult-to-reach children with disruptive behavior: The completion rate was remarkably high, ESs (mean ES =.31) matched those of previous studies with targeted intervention, and effects were maintained or had increased at follow-up. © 2013 American Psychological Association.

In dit onderzoek is het resultaat van individuele cognitieve gedragstherapie voor kinderen met angststoornissen vergeleken met dat van groepsgewijze cognitieve gedragstherapie. Het onderzoek werd uitgevoerd bij voor klinische behandeling verwezen kinderen met een primaire diagnose separatieangststoornis (n = 52), gegeneraliseerde angststoornis (n = 37), sociale fobie (n = 22) of specifieke fobie (n =16). Achtereenvolgens werden telkens zes kinderen aan individuele (n = 65) dan wel groepsgewijze (n = 62) behandeling toegewezen. Het behandelresultaat werd gedefinieerd in termen van diagnostische status, betrouwbare verandering en klinisch relevant herstel. De vergelijkingen omvatten chi-kwadraattoetsen, effectgrootten en (logistische) regressieanalyses met behandelconditie als voorspeller. De analyses wezen uit dat de resultaten van beide behandelmodaliteiten niet significant verschilden: kinderen profiteerden van beide behandelvormen.

The present dissertation had as its central focus the prediction of outcome of the treatment of childhood anxiety disorders. In the present study a selection of variables that were thought to have prognostic validity for successful cognitive behavioral treatment (CBT) outcome were explored in a population of children with anxiety disorders. Eligible for participation were children aged 8-12 years (n = 133) attending primary education and diagnosed with Separation Anxiety Disorder (SAD), Generalized Anxiety Disorder (GAD), Social Phobia (SOP) or Specific Phobia (SP). Participants were referred to the anxiety and depression outpatient clinics of the Child and Adolescent Psychiatry Department, Leiden University Medical Center and Erasmus Medical Center, Sophia Children's Hospital in Rotterdam, in the Netherlands. Children were treated with a standardized and manualized CBT protocol (FRIENDS). Treatment outcome was assessed from a multi-informant perspective and determined with a method that addresses not only statistical significance but also clinically meaningful change. Variables that showed a significant predictive value were paternal anxiety and depressive symptoms, paternal rejection, maternal emotional warmth, comorbidity status, social performance, child-therapist alliance. Treatment format did not improve the prediction of treatment outcome. Clinical implications and recommendations for future research are discussed.