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Doel. Het onderzoeken van de effectiviteit van twee executieve functietrainingen bij kinderen met autisme. Methode. Honderdeenentwintig kinderen in de leeftijd van 8-12 jaar met een IQ boven de 80 werden willekeurig toegewezen aan één van drie trainingscondities van Braingame Brian, een executieve functietraining met game-elementen; 1) een werkgeheugen training; 2) een cognitieve flexibiliteittraining; of 3) een placebo training, waarin geen executieve functies werden getraind. De training bestond uit 25 sessies en werd gedurende 6 weken thuis uitgevoerd. We onderzochten de effecten van de training op werkgeheugen, cognitieve flexibiliteit, inhibitie, aandacht, en dagelijks gedrag (executieve functies, sociaal gedrag, ADHD-kenmerken en kwaliteit van leven). Resultaten. Hoewel op bijna alle maten (behalve inhibitie) vooruitgang werd gezien na alle drie de trainingscondities, werd alleen een aanwijzing gevonden dat de werkgeheugen training zorgde voor meer verbetering op een werkgeheugentaak dan de andere trainingscondities. Op de overige maten werden geen verschillen tussen de trainingscondities gevonden. Bovendien maakte 26 % van de kinderen de training niet af. Conclusie. De executieve functietraining met game-elementen lijkt in zijn huidige vorm geen geschikte interventie te zijn voor kinderen met autisme.

This chapter is an introduction to the book Moderators and Mediators of Youth Treatment Outcomes. The chapter provides definitions and a graphical representation of the so-called “third variables” thought to alter associations between youth treatments and treatment outcomes. Predictors, moderators, and mediators are discussed, as well as the most important conceptual issues related to the investigation of moderating and mediating variables in the context of youth psychotherapy research. Challenges associated with design and statistical issues are outlined and solutions provided. The chapter concludes with descriptions of more complex moderation and mediation models, and research designs that can be implemented and that have the potential of enhancing treatment outcomes.

Excessive use of psychoactive substances during adolescence poses a serious health risk. It can lead to cognitive impairment, as well as addictive problems later in life. Dual process models of addiction suggest that to counter this development, the overdeveloped automatic reactions to drug-related cues should be tempered and cognitive control functions should be strengthened. Recently, several training paradigms have been developed to (re)train these processes. While effective in long time users, most adolescents lack a motivation to train. To motivate them we have developed several serious games that incorporate these evidence-based training paradigms. This paper will present some of them and describe how they work.

There are few studies assessing moderation and mediation of behavioral treatment and cognitive training outcome in children with ADHD. Only two studies have assessed moderation of treatment outcome. For behavioral treatment outcome, comorbid anxiety, parental self-efficacy, paternal ADHD, and no or single comorbidity are significant moderators. Parents with high self-efficacy, fathers with high levels of ADHD symptoms, and children with comorbid anxiety and only one or no comorbid condition are most likely to benefit from behavioral interventions. The few mediation studies showed ineffective and negative parenting as a significant mediator of behavioral treatment outcome: the more reduction of negative and ineffective parenting, the more effective the treatment is. For cognitive training there is no empirical research on moderation and mediation of treatment outcome within ADHD samples. Given the documented heterogeneity within ADHD and ADHD treatments, more research is needed into moderation and mediation of treatment outcome.

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.

Objective: In the present randomized controlled trial, the effectiveness of multisystemic therapy (MST) in The Netherlands was examined. Moderator tests were conducted for ethnicity, age and gender. Methods: The sample consisted of N = 256 adolescents, referred because of conduct problems, and randomized to MST or treatment as usual (TAU). Assessments (questionnaires and observational ratings) took place before and immediately after the treatment. Results: MST was more effective than TAU in decreasing externalizing behavior, ODD, CD and property offences, but not for violence. Findings were mixed for adolescents' and parental cognitions: the MST group, compared to TAU, showed an improvement in parental sense of competence, and a decrease in adolescents' hostility, but no change in self-esteem and an increase in personal failure. MST was effective for positive dimensions of parenting and associations with prosocial peers, but not for relationships with deviant peers. MST was equally effective for adolescents of different ages and with different ethnicities. However, MST showed larger (and more positive) effects for adolescent cognitions for boys than for girls. Conclusions: Effects of MST in The Netherlands are generally comparable to the positive findings reported in American and Norwegian trials. MST seems equally effective across age and ethnic minority groups, but some gender moderator effects were found for adolescent cognitions. © 2012 Springer Science+Business Media Dordrecht.

Objective: Children with attention deficit hyperactivity disorder (ADHD) who participated in a randomized clinical trial, which compared a brief intensive multimodal behaviour therapy combined with optimally titrated methylphenidate to optimally titrated methylphenidate alone (n?=?45), were re-assessed at adolescence in a naturalistic follow-up 4.5 to 7.5?years after treatment. Also a matched normal control group was recruited (n?=?23). Methods: Assessments at follow-up included diagnostic status, ADHD symptoms, oppositional and conduct behaviour, substance abuse symptoms and parenting stress. Results: Of the 24 adolescents participating in the follow-up study, 50% still met diagnostic criteria for ADHD. There were no significant differences between adolescents at follow-up and those lost for follow-up. At follow-up, adolescents in the combined treatment condition used significantly less medication than children in the methylphenidate condition; there were no other significant differences between the treatment conditions. The adolescents showed a significant decline in hyperactivity/impulsivity, oppositional and conduct disorder symptoms from post-test to follow-up. Only inattention symptoms increased from post-test to follow-up but not to pre-test levels. The adolescents originally diagnosed with ADHD fared significantly worse than the matched controls on all outcomes, except on conduct disorder and substance abuse symptoms. Conclusions: Our study shows in adolescents, diagnosed with ADHD in childhood, age-dependent decline of ADHD symptoms, although they still fared significantly worse than matched normal controls. Implications of results are restricted by small samples size, and the results may be subject to chance findings and need replication before firm conclusions can be drawn. Copyright (c) 2011 John Wiley & Sons, Ltd

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In deze studie onderzochten we sommige aspecten van de kwaliteit van de implementatie van MST in Nederland. Zowel de invloed van behandelintegriteit als van nonspecifieke factoren van MST op de verandering in een primaire uitkomst (externaliserend probleemgedrag) en secundaire uitkomsten (positieve discipline, negatieve discipline, kwaliteit van de ouder-kind relatie, prosociale vrienden en deviante vrienden) werden onderzocht. De deelnemers waren 147 jongeren (en hun gezinnen) die werden verwezen naar Multisysteem Therapie (MST). Het betrof jongeren (71% jongens) met een gemiddelde leeftijd van 15.9 jaar (van 12 tot 18 jaar). Jongeren en hun ouders werd gevraagd vragenlijsten in te vullen voor en na MST. Behandelintegriteit werd gemeten met de Treatment Adherence Measure (TAM). We vonden dat de behandelintegriteit gemeten met de TAM even hoog is als in Amerikaanse studies. Opmerkelijk is dat behandelintegriteit alleen verandering in positieve discipline bleek te voorspellen. Daarnaast werd een positief effect gevonden van de relatie met de therapeut op verandering in positieve discipline en van tevredenheid over de behandeling op verandering in prosociale vrienden. Tot slot bleek een lage sociaal economische status meer behandelintegriteit te voorspellen.

Self-control refers to the regulation of one's own behavior, including the pursuit of long-term goals and the inhibition of unwanted behaviors. In the present, complex society, self-control appears to be overshadowed by external control. For children, the development of self-control is a major developmental task. Failing on this task results in internalizing or externalizing problems. The social-cognitive treatment Self-Control has been designed to train aggressive children to control their aggressive feelings, thoughts and behaviors. The theoretical foundation of the program and its treatment-outcome results are presented. Implications for the training of self-control in children are being discussed.

In this review, we examine the recent cognitive behavior therapy (CBT) outcome literature with anxiety-disordered children and, specifically, explore the status of cognitive change and increased coping ability as (1) specific treatment effects, and (2) possible mediators of the efficacy of CBT. In the past decade, the number of controlled CBT studies with clinically diagnosed anxiety-disordered children has increased substantially. CBT aims to restructure distorted or maladaptive cognitions and teach the anxious child to effectively use diverse coping strategies. Our review shows that in recent CBT research with anxiety-disordered children the use of domain-specific measures like cognitive and coping measures is, unfortunately, not common practice. Furthermore, only one study examined the issue of treatment mediation. Generally, recent CBT research has not been designed to test mediational issues and does not clarify whether cognitive change and enhanced coping--the presumed central components of CBT--are in fact responsible for its efficacy. Implications for the direction of future CBT research with anxiety-disordered children are discussed.

The aim of the present study was to assess the structure of childhood dental fear, using the Dutch parent's version of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) and to report on its validity. MATERIALS AND METHODS: Factor analysis (principal components, varimax rotation) was performed using the scores of a group of high fearful children (n=322). Results were compared with those from a previous study among low fearful children, also using the parent's version of the CFSS-DS. In addition, mean item scores between the samples were compared to examine specific differences. RESULTS: Factor analysis resulted in a stronger factor pattern than that found in previous research. Four factors accounting for 60% of the variance were found: 1) fear of general, less invasive aspects of dental treatment; 2) fear of medical aspects; 3) fear of drilling; 4) fear of strangers. CONCLUSION: It was concluded that with increasing fear levels, underlying factors of dental fear can be distinguished more clearly. The CFSS-DS was indicated to be a reliable and valid measure of dental fear.

OBJECTIVE: This study aimed to present normative data on dental fear for the Dutch child population, by identifying not only highly fearful children but also children at risk for developing this high dental fear. METHODS: Fear distribution of samples of high and low fearful children was studied, using the Dutch parent's version of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Total fear scores were calculated for both samples, for different age levels and for boys and girls separately. To establish cut-off scores, mean CFSS-DS scores were associated with dentists' clinical fear ratings and, in addition, were transformed into stanines. RESULTS: Scores between 32 and 38 were found to represent a borderline area for dental fear, and scores of 39 and higher to represent high dental fear. CONCLUSION: The results have shown 6% of the Dutch child population to be highly fearful, while another 8% may be at risk to develop high dental fear. By providing extra attention for these children, the development of high dental fear or phobia may be prevented

Examined whether negative thoughts are different in anxious, depressed, and chronically ill children. Screening of 1,316 children on anxiety, depression, and asthma resulted in the selection of 118 children (aged 12-15 yrs). Four groups were formed: (1) a high anxiety group, (2) a high anxiety/depression group, (3) an asthma group, and (4) a low anxiety, low depression, and no chronic disease (control) group. The data yielded no pure depression group. Subsequently, the Negative Affectivity Self-Statement Questionnaire and a Worry scale were administered. Results showed that cognitive scores were different in all groups. Highest scores were obtained from the high anxiety/depression group, and lowest from the control group. Children with asthma scored high on anxiety, not on depression. High correlations between scores on negative thoughts and conventional measures of negative emotions suggested that negative thoughts provided no unique information about the problems underlying emotional states in different groups of children. Implications for cognitive assessment in emotionally disturbed children are discussed.