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Item does not contain fulltext, Background: Post-traumatic stress disorder (PTSD) is common in adults with intellectual disabilities. Often there are additional disorders such as substance use, mood and anxiety disorders. The current study focuses on the feasibility and initial efficacy of prolonged exposure (PE) for PTSD in adults with mild intellectual disabilities. The secondary effect of PE on additional mood, anxiety and substance use disorders is also examined. Methods: A single case experimental design (N = 12) with an A (baseline)-B (intervention) phase including a follow-up measurement after 3 months was conducted. Time series and single time points measurements were performed. Results: Six participants dropped-out. The results showed a significant decrease in PTSD symptoms and a significant decrease in additional symptoms (social avoidance, anxiety and stress), among participants who completed treatment. Conclusion: PE appears to be a feasible and effective treatment for PTSD in some adults with mild intellectual disabilities. Suggestions emerge from this study to make standard PE treatment more appropriate for adults with mild intellectual disabilities. Further research is needed to reduce drop-out in trauma treatment. Some suggestions for this are made in this study. Treatment of PTSD with PE did not appear to affect comorbid mood disorders. Further research is needed., 11 p.

Contains fulltext : 293195.pdf (Publisher’s version ) (Open Access), Background: Adolescent suicidal behavior, including non-suicidal self-injury, is increasingly prevalent in Secure Residential Youth Care (SRYC) in the Netherlands. Group workers play a vital role in the well-being and functioning of adolescents in SRYC as they interact with adolescents on a daily basis. However, we have little understanding of how adolescents perceive group workers’ responses to suicidal behavior and we lack knowledge about the impact of these responses on adolescents and the group climate. Aim: The aim of this study is to explore (a) how adolescents value group workers responses towards suicidal behavior and (b) the impact of these responses on adolescents, as well as (c) on the group climate. The results can be used to develop care-policy to improve care for suicidal adolescents in SYRC. Method: Eleven suicidal female adolescents residing in SRYC were interviewed. All adolescents had previously displayed suicidal behavior, including non-suicidal self-injury. Interviews were analyzed using grounded theory. Conclusion: This study presents the perceptions of suicidal female adolescents residing in SRYC about group workers’ responses on suicidal behavior. Adolescents prefer group workers who react responsive to suicidal behavior. Responsive care, trust and connectedness help adolescents disclose their suicidal thoughts. Participants criticize group workers who are non-responsive as being distant, and their relationship with these group workers lacked trust, communication, a sense of connection, or personal depth. All adolescents underline the devastating impact of involuntary seclusion, and stress the importance of being able to disclose without fear of coercive consequences. Findings indicate that non-responsive reactions contribute to an increase in suicidal distress as well as a closed group climate.

16 augustus 2023, Contains fulltext : 295673.pdf (Publisher’s version ) (Closed access), Many adolescents in residential care have experienced traumatic events and suffer from posttraumatic stress. This study examined the effectiveness of Muse, a game-based meditation intervention played with guidance, as an addition to treatment as usual (TAU) for adolescents with posttraumatic symptoms in residential care. Seventy-seven adolescents with posttraumatic symptoms (10?18?years old) received either Muse and TAU (n = 37) or treatment as usual (n = 40). TAU consisted of evidence-based treatments that did not specifically target posttraumatic symptoms. Outcomes were measured at T1, T2, and two-months follow-up (FU). Primary outcomes were posttraumatic symptoms (self-report and mentor-report) and stress (self-report) at T2. The Muse group showed significantly greater improvements than the control group at T2 regarding self-reported posttraumatic symptoms, stress, anxiety, depression, and aggression. Mentor reports showed marginally significant decreases in posttraumatic stress at T2. There were no differences between the groups at FU, except for a marginally significant difference in self-reported posttraumatic symptoms, where the Muse participants showed larger decreases. This study showed that game-based meditation therapy is a promising intervention that is more effective than TAU alone. Yet, further studies on its immediate and long-term effects, and mechanisms of change are warranted. Implications are discussed.

Item does not contain fulltext, Professionals in secure residential youth care (SRYC) in the Netherlands are regularly confronted with suicides of adolescents and can be referred to as secondary victims. However, little is known about the impact of suicides on these professionals. This study explores the impact of suicides on professionals working in SRYC. Semi-structured interviews (n = 14) were conducted with professionals from several SRYC institutions. A thematic analysis of the material yielded four main themes: i) impact of suicide on a personal level, ii) impact of suicide on a vocational level, iii) impact of suicide on professional responses, and iv) facilitators and barriers that facilitated or obstructed professional resilience and the prevention of future suicides. The experience of suicide is extremely distressing for professionals. Some interviewees were traumatized by the impact. The findings suggest that most professionals draw on coercive measures for other youngsters sooner and more often after being exposed to suicide. The most commonly reported reason for doing so was the fear of experiencing a fatal incident. Professionals in SRYC require skilled and dedicated support (postvention) following a suicide to minimize its detrimental effects on personal, professional, and team functioning. Further implications for daily practice and policymaking are discussed. Create an organizational culture in which professionals feel supported to discuss fear and uncertainties in balancing safety and accountability when working with suicidal adolescents.Postvention is needed for professionals and teams exposed to suicide.Train and facilitate professionals in nonviolent resistance to prevent coercion and suicide.The need for more trained personnel and increased knowledge of suicide prevention is highlighted.The use of experiential knowledge from lived experience experts could be a valuable additional resource to improve care., 07 september 2023, 28 p.

Item does not contain fulltext, In the last decade, living groups in residential youth care facilities in The Netherlands have gradually grown in size with eight to twelve adolescents per group, which is related to an increase in workload and overburdened personnel. Research suggests that a smaller group size of up to six adolescents can have a positive impact on the living and working environment, and therefore small-scale facilities are advocated as a an alternative for regular residential youth care. Little is known about the experiences of residential care personnel working in these small-scale facilities. The aim of this study is to examine the impact of the transformation toward small-scale facilities from the perspective of residential care personnel. The results show, in line with previous studies, that professionals working in small-scale facilities experience a safer and more positive group climate and that they are more able to invest in a positive therapeutic relationship with the adolescents, than working on regular residential groups. Moreover, working on a group with fewer adolescents affects the working climate in a positive way. Recommendations for practice and further research are proposed., 19 p.

Item does not contain fulltext, In the past decades, awareness of the harmful effects of seclusion has led to a strong desire to reduce its use in child and adolescent residential care settings. As a response, various seclusion reduction interventions have been developed and implemented in practice. These interventions consist of both methods as well as more practice-based and ad hoc actions. Identification of common elements within this wide variety of seclusion reduction interventions would be beneficial for the further understanding and implementation of these interventions, training of staff, and research aimed at the reduction of seclusion. Therefore, the objective of this study was to identify the common elements of both methods and practice-based actions to reduce seclusion in child and adolescent residential care settings. A literature review and semi-structured interviews with experienced professionals involved in child and adolescent residential care were used to determine the common elements of seclusion reduction interventions. In total, 21 studies and 11 interviews were assessed. This led to the identification of two domains with six common elements each. Further investigation of how these common elements influence the reduction of seclusion could potentially build strong universal methods and training modules for the reduction of seclusion in a broad range of child and adolescent residential care settings., 12 p.

Radboud University, 28 oktober 2022, Promotores : Scholte, R.H.J., Otten, R., Popma, A. Co-promotor : Nijhof, K.S., Contains fulltext : 283568.pdf (Publisher’s version ) (Open Access)

10 augustus 2022, 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.

Item does not contain fulltext, In 2018 hebben de JeugdzorgPlus-instellingen de beweging in gang gezet naar vermindering van gedwongen afzonderingen. Actieonderzoek laat zien dat er verbetering in de instellingen is. Maar om het aantal naar nul terug te brengen, is een cultuurverandering nodig.

Item does not contain fulltext, 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.

Item does not contain fulltext, Using seclusion in youth mental health care is controversial, as it can have physical and psychological consequences for youth and professionals. Notably, there is a wide disparity in how seclusion is defined in literature and practice. This leads to a diffuse image of what seclusion comprises, complicates measuring its prevalence, and hampers initiatives to reduce its use. Therefore, the objective of this study was to establish an unambiguous and measurable definition of seclusion supported by youth and professionals in secure residential youth care in the Netherlands. A qualitative multiphase approach was used to examine which elements of the definition are essential and receive consensus among youth and professionals. After a brief literature review, a Delphi survey and focus groups were performed. In total, 11 (ex-)clients and 33 professionals with extensive experience in secure residential youth care participated. Youth and professionals arrived at the following definition: ?an involuntary placement in a room or area the client is not allowed or able to leave? During the implementation process, observations showed broad support for the definition by youth and professionals. With this, a foundation has been provided to monitor and reduce the use of seclusion in secure residential youth care in the Netherlands.

Item does not contain fulltext, Alterations in neurobiological stress systems such as the autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis contribute to the development and maintenance of psychological and behavioral problems after traumatic experiences. Investigating neurobiological parameters and how these relate to each other may provide insight into the complex mechanisms at play. Whereas the preponderance of studies focuses on either the ANS or the HPA axis separately, the current study is the first to evaluate relations between posttraumatic stress and both basal activity during rest and stress reactivity of the ANS as well as the HPA axis in a sample of traumatized adolescents and healthy controls. The traumatized sample (n = 77), based on clinical levels of posttraumatic stress, was a convenience sample that was recruited within residential institutions, was compared to a healthy control sample (n = 48) recruited within the general community. For the ANS, we expected increased SNS and decreased PNS activity during rest and increased SNS and decreased PNS reactivity to social stress among traumatized adolescents compared to healthy controls. Regarding the HPA axis, we expected increased basal cortisol levels and decreased cortisol reactivity to stress in the traumatized sample. Compared to healthy controls, traumatized adolescents exhibited significantly higher sympathetic and lower parasympathetic activation during rest and increased sympathetic reactivity to acute stress (ANS parameters). Outcomes on the HPA axis (i.e. cortisol) indicated that traumatized adolescents showed increased cortisol levels during rest and blunted cortisol reactivity to acute stress. Implications for clinical relevance and trauma-focused treatment purposes are discussed.

Contains fulltext : 225716.pdf (publisher's version ) (Open Access), Background: Many adolescents in residential care have been exposed to prolonged traumatic experiences such as violence, neglect, or abuse. Consequently, they suffer from posttraumatic stress. This not only negatively affects psychological and behavioral outcomes (eg, increased anxiety, depression, and aggression) but also has adverse effects on physiological outcomes, in particular on their neurobiological stress systems. Although current evidence-based treatment options are effective, they have their limitations. An alternative to traditional trauma treatment is meditation-based treatment that focuses on stress regulation and relaxation. Muse is a game-based meditation intervention that makes use of adolescents’ intrinsic motivation. The neurofeedback element reinforces relaxation abilities. Objective: This paper describes the protocol for a randomized controlled trial in which the goal is to examine the effectiveness of Muse (InteraXon Inc) in reducing posttraumatic stress and normalizing neurobiological stress systems in a sample of traumatized adolescents in residential care. Methods: This will be a multicenter, multi-informant, and multimethod randomized controlled trial. Participants will be adolescents (N=80), aged 10 to 18 years, with clinical levels of posttraumatic symptoms, who are randomized to receive either the Muse therapy sessions and treatment as usual (intervention) or treatment as usual alone (control). Data will be collected at 3 measurement instances: pretest (T1), posttest (T2), and at 2-month follow-up. Primary outcomes will be posttraumatic symptoms (self-report and mentor report) and stress (self-report) at posttest. Secondary outcomes will be neurobiological stress parameters under both resting and acute stress conditions, and anxiety, depression, and aggression at posttest. Secondary outcomes also include all measures at 2-month follow-up: posttraumatic symptoms, stress, anxiety, depression aggression, and neurobiological resting parameter

Contains fulltext : 222315.pdf (publisher's version ) (Open Access), Wearable monitoring devices are an innovative way to measure heart rate (HR) and heart rate variability (HRV), however, there is still debate about the validity of these wearables. This study aimed to validate the accuracy and predictive value of the Empatica E4 wristband against the VU University Ambulatory Monitoring System (VU-AMS) in a clinical population of traumatized adolescents in residential care. A sample of 345 recordings of both the Empatica E4 wristband and the VU-AMS was derived from a feasibility study that included fifteen participants. They wore both devices during two experimental testing and twelve intervention sessions. We used correlations, cross-correlations, Mann-Whitney tests, difference factors, Bland-Altman plots, and Limits of Agreement to evaluate differences in outcomes between devices. Significant correlations were found between Empatica E4 and VU-AMS recordings for HR, SDNN, RMSSD, and HF recordings. There was a significant difference between the devices for all parameters but HR, although effect sizes were small for SDNN, LF, and HF. For all parameters but RMSSD, testing outcomes of the two devices led to the same conclusions regarding significance. The Empatica E4 wristband provides a new opportunity to measure HRV in an unobtrusive way. Results of this study indicate the potential of the Empatica E4 as a practical and valid tool for research on HR and HRV under non-movement conditions. While more research needs to be conducted, this study could be considered as a first step to support the use of HRV recordings provided by wearables.

Contains fulltext : 221889.pdf (Publisher’s version ) (Closed access), In Nederland werden in 2018 bijna 43.000 jongeren onder de 18 jaar uit huis geplaatst (CBS, 2019). Hiervan kwamen ongeveer 18.000 jongeren in de residentiële jeugdhulp terecht, doorgaans op grotere leefgroepen van acht tot tien jongeren. Er is echter toenemende maatschappelijke aandacht voor het ontwikkelen van kleinschalige groepen. Kleinschalige groepen kenmerken zich door maximaal 4 jongeren met een beperkt aantal professionals en kennen hierdoor meer mogelijkheden om een goed en veilig pedagogisch basisklimaat te bieden dat aansluit bij de complexe problematiek die kenmerkend is voor uithuisgeplaatste jongeren. De huidige studie verkent de eerste ervaringen van jongeren en professionals met kleinschalige groepen binnen de residentiële jeugdhulp. Via interviews met jongeren (n = 9) en professionals (n = 11) en leefklimaatonderzoek (n = 754) bij twee instellingen voor residentiële jeugdhulp (n = 6 kleinschalige groepen) wordt verkend hoe het is om op een kleinschalige groep te wonen en te werken, en wat potentieel werkzame elementen en knelpunten zijn. De resultaten laten zien dat kleinschalige groepen een veelbelovende vorm van zorg lijken te zijn met betere mogelijkheden om een veilig en goed pedagogisch basisklimaat te bieden. In vergelijking met grotere residentiële groepen komen enkele potentieel werkzame elementen naar voren: 1) er is meer ruimte voor het opbouwen van een vertrouwensband tussen professionals en jongeren en tussen jongeren onderling, 2) de afstemming tussen professionals en met jongeren verloopt beter en soepeler, 3) jongeren en professionals ervaren meer veiligheid en rust op de groep, 4) er zijn meer mogelijkheden tot normaliseren, en 5) er is sprake van een positiever leefklimaat. Desondanks ervaren de instellingen spanning tussen enerzijds het streven naar zo min mogelijk professionals op de groep en anderzijds de haalbaarheid, kwetsbaarheid en betaalbaarheid van kleinschalige groepen.

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 trau

Contains fulltext : 205889.pdf (publisher's version ) (Closed access), Oppositional defiant disorder, conduct disorder (ODD/CD), and autism spectrum disorder (ASD) share poor empathic functioning and have been associated with impaired emotional processing. However, no previous studies directly compared similarities and differences in these processes for the two disorders. A two-choice emotional valence detection task requiring differentiation between positive, negative, and neutral IAPS pictures was administered to 52 adolescents (12-19 years) with ODD/CD, 52 with ASD and 24 typically developing individuals (TDI). Callous–unemotional (CU) traits were assessed by self- and parent reports using the Inventory of callous–unemotional traits. Main findings were that adolescents with ODD/CD or ASD both performed poorer than TDI in terms of accuracy, yet only the TDI - not both clinical groups - had relatively most difficulty in discriminating between positive versus neutral pictures compared to neutral-negative or positive-negative contrasts. Poorer performance was related to a higher level of CU traits. The results of the current study suggest youth with ODD/CD or ASD have a diminished ability to detect emotional valence which is not limited to facial expressions and is related to a higher level of CU traits. More specifically, youth with ODD/CD or ASD seem to have a reduced processing of positive stimuli and/or lack a 'positive perception bias' present in TDI that could either contribute to the symptoms and/or be a result of having the disorder and may contribute to the comorbidity of both disorders.

Radboud University, 5 maart 2018, Promotor : Buitelaar, J.K. Co-promotores : Nijhof, K.S., Vermaes, I.P.R., Contains fulltext : 183425.pdf (publisher's version ) (Open Access)

Contains fulltext : 191435.pdf (publisher's version ) (Open Access), Residential care is among the most intensive forms of treatment in youth care. It serves youths with severe behavioral problems and is primarily focused on targeting externalizing problems. Despite best efforts, effect sizes remain moderate, which may be due to the disregarding of internalizing symptoms - in particular anxiety - and to limitations regarding the delivery model of interventions. This initial randomized controlled trial (n = 37) aimed to examine the effectiveness of a biofeedback videogame intervention (Dojo) as an addition to treatment as usual for youths with and without intellectual disability (ID) in residential care with clinical levels of anxiety and externalizing problems. Dojo targets both anxiety and externalizing problems, and incorporates the principles of conventional treatment, while addressing its limitations. Youths were randomly assigned to play Dojo (eight 30-min gameplay sessions) or to treatment as usual (TAU). Measurements of anxiety and externalizing problems were conducted at baseline, posttreatment, and 4-months follow-up through youths’ self-report and mentor-report. Completers-only analyses revealed decreases in self-reported anxiety and externalizing problems, and mentor-reported anxiety at posttreatment for participants in the Dojo condition compared to the control condition. Only mentor-reported anxiety was maintained at follow-up. No effect was found for mentor-reported externalizing problems. These findings provided preliminary evidence that Dojo is a promising, innovative intervention that engages high-risk youths. Practical implications are discussed.

Contains fulltext : 195177.pdf (publisher's version ) (Open Access), Autism Spectrum Disorder (ASD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) are often associated with emotion recognition difficulties. This is the first eye-tracking study to examine emotional face recognition (i.e., gazing behavior) in a direct comparison of male adolescents with Autism Spectrum Disorder or Oppositional Defiant Disorder/Conduct Disorder, and typically developing (TD) individuals. We also investigate the role of psychopathic traits, callous–unemotional (CU) traits, and subtypes of aggressive behavior in emotional face recognition. A total of 122 male adolescents (N = 50 ASD, N = 44 ODD/CD, and N = 28 TD) aged 12-19 years (M = 15.4 years, SD= 1.9) were included in the current study for the eye-tracking experiment. Participants were presented with neutral and emotional faces using a Tobii 1750 eye-tracking monitor to record gaze behavior. Our main dependent eye-tracking variables were: (1) fixation duration to the eyes of a face and (2) time to the first fixation to the eyes. Since distributions of eye-tracking variables were not completely Gaussian, non-parametric tests were chosen to investigate gaze behavior across the diagnostic groups with Autism Spectrum Disorder, Oppositional Defiant Disorder/Conduct Disorder, and Typically Developing individuals. Furthermore, we used Spearman correlations to investigate the links with psychopathy, callous, and unemotional traits and subtypes of aggression as assessed by questionnaires. The relative total fixation duration to the eyes was decreased in both the Autism Spectrum Disorder group and the Oppositional Defiant Disorder/Conduct Disorder group for several emotional expressions. In both the Autism Spectrum Disorder and the Oppositional Defiant Disorder/Conduct Disorder group, increased time to first fixation on the eyes of fearful faces only was nominally significant. The time to first fixation on the eyes was nominally correlated with psychopathic traits and proactive aggression. The

Contains fulltext : 175507.pdf (publisher's version ) (Closed access), Aim: This study tests the validity of Beck’s cognitive theory and Nolen-Hoeksema's response style theory of depression in adolescents with and without MBID. Methods: The relationship between negative cognitive errors (Beck), response styles (Nolen-Hoeksema) and depressive symptoms was examined in 135 adolescents using linear regression. Results: The cognitive error ‘underestimation of the ability to cope’ was more prevalent among adolescents with MBID than among adolescents with average intelligence. This was the only negative cognitive error that predicted depressive symptoms. There were no differences between groups in the prevalence of the three response styles. In line with the theory, ruminating was positively and problem-solving was negatively related to depressive symptoms. Distractive response styles were not related to depressive symptoms. The relationship between response styles, cognitive errors and depressive symptoms were similar for both groups. Conclusion: The main premises of both theories of depression are equally applicable to adolescents with and without MBID. The cognitive error 'Underestimation of the ability to cope' poses a specific risk factor for developing a depression for adolescents with MBID and requires special attention in treatment and prevention of depression. What this paper adds? Despite the high prevalence of depression among adolescents with MBID, little is known about the etiology and cognitive processes that play a role in the development of depression in this group. The current paper fills this gap in research by examining the core tenets of two important theories on the etiology of depression (Beck's cognitive theory and Nolen-Hoeksema's response style theory) in a clinical sample of adolescents with and without MBID. This paper demonstrated that the theories are equally applicable to adolescents with MBID, as to adolescents with average intellectual ability. However, the cognitive bias 'underestimation of the ability to cope

Contains fulltext : 179426.pdf (publisher's version ) (Closed access), This study examines the external validity of a nationwide dataset, considering the fact that clients can refuse the extraction of their clinical information to aggregate datasets. Data of 949 youths (56% boys, mean age 15.6 years, Sd = 1.49) from six Dutch residential institutions were included. An individual-variables and a person-oriented approach were applied to examine the extent to which the group giving permission to the use of their data for aggregate purposes (66%) is representative for the total population in secure residential youth care. Both static, non-changeable client information as well as dynamic, changeable client information were gathered. Youths who assented to the use of their information were overrepresented amongst the population of some of the participating institutions, and were more often Caucasian. Three start profiles based on the dynamic variables were distinguished. Youths who assent were overrepresented in the most problematic profile, whereas youth who did not assent were overrepresented in the least problematic profile. To improve the external validity and the value of the monitor, it is important to achieve more uniformity between institutions as far as the procedures are concerned, and to find creative ways to increase assent levels, particularly among ethnic minorities.

Contains fulltext : 143437.pdf (publisher's version ) (Closed access), OBJECTIVE: Externalizing problems, which are the main reason for youth referrals to mental health agencies, are highly persistent and predict a range of negative outcomes. Youths with externalizing problems are also frequently comorbid with anxiety. Among the most widely recognized evidence-based treatments is cognitive behavioral therapy (CBT). Although CBT principles seem to be sound, effect sizes remain moderate, suggesting improvements could be made to this conventional treatment approach. The main premise of the current pilot study is to investigate the feasibility of implementing a videogame intervention ("Dojo" [Gamedesk, Los Angeles, CA]) that incorporates CBT principles and aims to address the limitations of conventional CBT delivery models, with the ultimate goal of improving outcomes for this difficult-to-treat population. MATERIALS AND METHODS: "Dojo" is an emotion management game that helps youths to recognize and control their physiological and emotional arousal. We explored the implementation and user experience of "Dojo" in a sample of eight adolescents in residential treatment for both externalizing and anxiety problems. RESULTS: Participants attended all sessions without complaints. They evaluated "Dojo" very positively and exhibited high compliance during the training sessions. We encountered some problems with session scheduling and obtaining mentor reports. Quantitative data show the predicted decrease in three out of four measurements. CONCLUSIONS: The smooth implementation, high user satisfaction, high self-reported compliance during training sessions, and initial outcome results all indicate the high potential "Dojo" holds as an innovative intervention. If additional rigorously designed randomized controlled trials prove to be successful, "Dojo" can be a cost-effective way to engage high-risk youths in effective intervention.

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Contains fulltext : 154017.pdf (publisher's version ) (Open Access), BACKGROUND: Although adolescents are often referred to residential treatment centres because of severe externalizing behaviours, a vast majority demonstrated comorbid symptoms of depression and anxiety. Covert internalizing symptoms in these adolescents might be easily unrecognized and therefore untreated. Adolescents with mild intellectual disability (MID) are overrepresented among youth with both externalizing and internalizing problems. There are yet few treatment programs available for adolescents with both externalizing and internalizing problems. METHODS/DESIGN: The CBT-based resiliency program, Op Volle Kracht (OVK), which is based on the US Penn Resiliency Program (PRP), was adapted to suit the needs of adolescents with both externalizing and internalizing problems, either with or without MID, in Dutch residential treatment centres. The effectiveness of this group intervention program of eight sessions will be tested in a randomised controlled trial (RCT) with N = 182 adolescents aged 12-16, allocated to either the target intervention plus treatment as usual (OVK + TAU) or treatment as usual only (TAU). The main outcome variables include depressive symptoms (primary), anxiety, behavioural problems, and group therapeutic climate. Cognitive styles and coping styles will be included as possible mediators. Assessments take place at baseline (T1), one week before the start of the program (T2), immediately after the program (T3), and at three months follow-up (T4). DISCUSSION: The program assets include its wide implementation possibilities due to low costs, the short duration of the program and the delivery by group care workers, and its suitability for adolescents with MID. Further strengths of the present study design include its robust method (RCT), the ecological validity, and the inclusion of possible mediators of treatment effect. The program emphasizes individual risk factors for depression rather than social and family factors. Implications for practice a

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Contains fulltext : 126067.pdf (publisher's version ) (Closed access), Introduction: The present study examined parents' and adolescents' perceptions of adolescent functioning after being discharged from residential treatment as well as the stability of functioning over time. Method: Data for the study were collected as a part of a continuous process of evaluating post-treatment functioning. Adolescents and their parents were interviewed at home at 3 months (T1), 6 months (12), and 18 months (T3) after discharge. Several outcomes were evaluated: living situation, contact with parents, social network, school/work, behavior problems, use of soft drugs, police contacts and well-being. The sample was divided into two subsamples: parents (n = 82) and adolescents (n = 75) participating in all three waves (sample 1) and parents (n = 288) and adolescents (n = 317) participating in at least one wave (sample 2). Results: Cautioned by the inevitable high rates of attrition and the risk of selective bias in this type of study, there is preliminary evidence showing that adolescents generally show positive outcomes after residential care. Moreover, the outcomes were stable over time: adolescents who showed positive outcomes directly after discharge also showed positive outcomes at 12 and T3, and vice versa. Parents reported less positive outcomes than adolescents did. Discussion: An important contribution of this study is that it provides longitudinal data supporting the notion that outcomes from residential treatment may be more sustainable over time than previously thought. Clinical and research implications are discussed.

Contains fulltext : 102692.pdf (publisher's version ) (Closed access), Background By interacting with children, group care workers shape daily living environments to influence treatment. Current literature provides little knowledge about the content of youth residential care. Objective In this study, a questionnaire called the Group care worker Intervention Checklist was developed. Method Group care workers completed the questionnaires for 212 children placed in youth residential care in the Netherlands. Results Factor analyses revealed three constructs: controlling, warmth/support, and autonomy granting. Reliability of these scales proved to be good. Controlling was associated with Externalizing Behavior Problems while both Warmth/Support and Autonomy Granting were associated with Internalizing Behavior Problems. Conclusions These findings imply that group care worker interventions can be reliably measured and are related to child problem behavior.

Contains fulltext : 102869.pdf (publisher's version ) (Closed access), The present study examined the association between sexual behavior and treatment improvement of institutionalized girls. Treatment files of 174 girls (M age = 15.71, SD = 1.14) were analyzed to obtain information about the sexual behavior of girls before admission. Based on their sexual behavior, girls were classified into three subgroups: girls showing sexually normative behavior (29%), girls showing promiscuous behavior (43%), and girls with a history of forced prostitution (29%). A subsample of 95 girls was also asked to complete questionnaires to measure treatment improvement. The findings revealed no differences in self-reported problem behavior between the subgroups at entrance. Over time differences between the subgroups were found, indicating that the girls in the different subgroups might require a different treatment approach. Further research that would include larger samples is needed to explore specific treatment needs.

Contains fulltext : 102944.pdf (publisher's version ) (Open Access), In 2005 a new compulsory residential treatment program was developed for adolescents in need for protection against themselves or their environment. The aim of the present study was to examine the association of structural treatment characteristics of this new residential treatment program (i.e., duration of treatment, discharge status, and group composition in terms of sex) with post-treatment functioning. Additionally, the number of pre-treatment risk factors was included in the model. A total of 301 adolescents (174 boys, 127 girls), with a mean age at time of admittance of 15.50 (SD = 1.26) participated in this study. The number of risk factors was derived from treatment files of the adolescents at time of entrance. Six months after discharge, adolescents participated in a telephone interview to measure ten post-treatment variables indicating how well they were doing. The results showed that duration of treatment was related to post-treatment living situation, in that adolescents who were in treatment for shorter durations were more likely to live on their own after treatment. For discharge status, findings suggested that adolescents who were regularly discharged had more frequent contact with their family; however, they also showed higher alcohol consumption 6 months after treatment. Group composition was related to the girls' official offending, indicating that girls placed in mixed-sex groups showed significantly fewer official police contacts than did girls in girls-only treatment groups. Overall, structural treatment characteristics were hardly related to the adolescents' functioning after treatment. Suggestions for future research are discussed.