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Aggressive behavior problems in school-aged children are of high concern, given the high prevalence and risk for adverse outcomes later in life. Intervention programs therefore target these problems as they arise in childhood, however, treatment effects are modest and do not benefit all children. The overall aim of this dissertation was to enhance and better understand treatment effects for children with aggressive behavior problems. The first part of this dissertation focuses on whether treatment effects for children with aggressive behavior problems can be enhanced using interactive virtual reality. The new cognitive behavioral therapy ‘YourSkills’ was developed, in which children actively practice new skills. Findings indicate that virtual reality can be an effective method to enhance treatment outcomes. Practicing in an emotionally emerging and immersive real-life environment yielded not only improvements in effectiveness but also higher levels of children’s treatment appreciation. In the second part of this dissertation, we aimed to increase our understanding of potential treatment mechanisms. Findings provided within-person evidence for anger regulation and hostile intent attribution as treatment mechanisms to reduce aggressive behavior problems. In conclusion, this dissertation showed that a new treatment using active practice is effective for children with aggressive behavior problems. In addition, virtual reality enabled children to enjoy practicing their new skills within the intervention.

AchtergrondDe eerste lockdown van 2020 vanwegede Covid-19 pandemie had ingrijpende gevolgen voor dereguliere zorgverlening aan mensen met verstandelijkebeperkingen. Eerder onderzoek naar indirecte gevolgenvia incidentmeldingen toonde een scherpe daling envervolgens een stijging van meldingen van agressie.Meldingen van incidenten met medicatie lagen tijdensde eerste lockdown echter op een lager niveau dan voorde pandemie. Om antwoord te geven op de vraag wat deimpact was van de versoepelingen na de eerste lockdownen de gedeeltelijke herinvoering van maatregelen in devervolgfase van de pandemie zijn de incidentmeldingengevolgd tot begin 2021.MethodenDe weektotalen van incidentmeldingenbij zorgorganisatie ‘s Heeren Loo werden aan tijdserieanalyse onderworpen over de periode van medio 2016 totfebruari 2021, rekening houdend met seizoensinvloeden.Resultaten.De versoepeling van de maatregelen per 1 juli2020 markeerde een overgang van stijging in meldingenvan agressie naar daling. De wekelijkse meldingen keerdenterug op het niveau van voor de pandemie. Incidentenwaarbij bewoners zonder verklaring afwezig waren blevenna de versoepelingen stabiel. Meldingen van incidentenmet medicatie begonnen geleidelijk weer te stijgen nade versoepelingen.ConclusieUit de incidentmeldingen rijst het beeld vaneen tijdelijk schokeffect tijdens de eerste lockdown eneen normalisatie qua incidenten tijdens de vervolgfasevan de pandemie. Deze bevindingen sluiten aan bijander onderzoek gebaseerd op ervaringsverhalen tijdensde pandemie. Tijdige en toegankelijke communicatievanuit overheid en zorginstellingen naar mensen metverstandelijke beperking, naasten en professionalsalsmede continuïteit van zorgteams verdienen aandachtmet het oog op toekomstige crisissituaties.

The present dissertation aimed to provide empirical grip on the conceptualization of hate across interpersonal and intergroup targets, by employing insights and methods from emotion research, social psychology, and political psychology. This general goal was addressed in three empirical chapters focused on: a) the unique features of hate, and how hate differs from other negative emotions (Chapter 2); b) the effects of threat perception on the development of hate and its association with aggressive behaviors (Chapter 3); and c) the influence of political worldviews on the development of hate over time (Chapter 4). The research program advanced in the present dissertation contributes to the scientific inquiry on feelings of hate. It provides empirical ground to the notion that hate is a unique feeling distinct from other negative emotions, deeply ingrained in perceived differences in core moral values and identity traits with its targets, and associated with aggressive behaviors intended to eliminate them physically or symbolically from one’s life.The present research also illustrates how the central themes of particular political worldviews match exceptionally well with core features of hate, promoting the rise of strong negative feelings among people and fostering social division and conflict. The present dissertation is not only intended to contribute to the growing field of empirical research on hate, but also to make a contribution to the reduction of human suffering and the promotion of more trusting and secure societies through a better understanding of the dynamics underlying the feelings of hate.

The present dissertation aimed to provide empirical grip on the conceptualization of hate across interpersonal and intergroup targets, by employing insights and methods from emotion research, social psychology, and political psychology. This general goal was addressed in three empirical chapters focused on: a) the unique features of hate, and how hate differs from other negative emotions (Chapter 2); b) the effects of threat perception on the development of hate and its association with aggressive behaviors (Chapter 3); and c) the influence of political worldviews on the development of hate over time (Chapter 4). The research program advanced in the present dissertation contributes to the scientific inquiry on feelings of hate. It provides empirical ground to the notion that hate is a unique feeling distinct from other negative emotions, deeply ingrained in perceived differences in core moral values and identity traits with its targets, and associated with aggressive behaviors intended to eliminate them physically or symbolically from one’s life.The present research also illustrates how the central themes of particular political worldviews match exceptionally well with core features of hate, promoting the rise of strong negative feelings among people and fostering social division and conflict. The present dissertation is not only intended to contribute to the growing field of empirical research on hate, but also to make a contribution to the reduction of human suffering and the promotion of more trusting and secure societies through a better understanding of the dynamics underlying the feelings of hate.

The main aim of the studies in this dissertation was to assess the feasibility and effects of a wearable biocueing intervention as an addition to aggression regulation therapy (ART) in forensic psychiatric outpatients. In sum, this dissertation reveals a positive attitude towards biocueing as an additive intervention in forensic psychiatry. Results demonstrated adequate usability, however, further development and refinement remain necessary. Furthermore, although some indications of positive changes associated with the use of the Sense-IT app were found, no firm conclusion regarding the effects can be drawn to date. Effectivity should therefore be further investigated in future research. More specifically, and in line with the shift toward developing more personalized treatment interventions, research should aim to identify which patients are actually supported by (which components of) a biocueing intervention, and, if applicable, when and how behavioral support could be provided in the most efficacious way. Since development and use of personalized treatment interventions are only expected to grow in the coming years, improving usability, tailoring the intervention to individual needs, enhancing integration in therapy and increasing affinity with the intervention, in continuous co-creating efforts with patients and therapists, are highly recommended for future-proof forensic care.

The main aim of the studies in this dissertation was to assess the feasibility and effects of a wearable biocueing intervention as an addition to aggression regulation therapy (ART) in forensic psychiatric outpatients. In sum, this dissertation reveals a positive attitude towards biocueing as an additive intervention in forensic psychiatry. Results demonstrated adequate usability, however, further development and refinement remain necessary. Furthermore, although some indications of positive changes associated with the use of the Sense-IT app were found, no firm conclusion regarding the effects can be drawn to date. Effectivity should therefore be further investigated in future research. More specifically, and in line with the shift toward developing more personalized treatment interventions, research should aim to identify which patients are actually supported by (which components of) a biocueing intervention, and, if applicable, when and how behavioral support could be provided in the most efficacious way. Since development and use of personalized treatment interventions are only expected to grow in the coming years, improving usability, tailoring the intervention to individual needs, enhancing integration in therapy and increasing affinity with the intervention, in continuous co-creating efforts with patients and therapists, are highly recommended for future-proof forensic care.

The PhD thesis Genetics and epigenetics of early life development by Veronika Odintsova (VU, Amsterdam) concerns traits and exposures associated with early life development. It contains a series of studies that have as a background the role of nature and nurture in human development. In these studies, the author used contemporary genetic epidemiological methods and the latest molecular biology advances, and applied these to early life traits in two large cohorts in the Netherlands and UK—the Netherlands Twin Register (NTR) and the Avon Longitudinal Study of Parents and Children (ALSPAC). The NTR samples comprises twins, which is a valuable resource in research on early life development and biomarkers, because the twin design allows one evaluate genetic and environmental influences on the phenotypes of interest. Studying early life outcomes and traits, such as a newborn state at birth assessed with Apgar scores (i.e., scores based on newborn appearance, pulse, grimace, activity, and respiration) or handedness, the author found a very small contribution of genetic influences to those traits, and hypothesized that epigenetic modifications could play a role. Most epigenetic programming is thought to take place within the first 1000 days of life. Epigenetic mechanisms are mechanisms that influence gene expression throughout the lifespan. Some epigenetic changes, such as DNA methylation, which are attributable to early life factors and exposures, can persist throughout childhood and into adulthood. This thesis focused on DNA methylation, as a source of variation, in addition to the genetic and environmental sources. It focused, inter alia, on epigenetic differences related to early life exposures – prenatal maternal smoking and breastfeeding – and complex traits – birth weight, BMI, left-handedness, and aggression. The research described in this thesis demonstrates that epigenetic data are a valuable addition to the genetic data, and which can play an important role in improving multi-omics prediction of health outcomes. Whereas DNA-based predictors are static and solely capture genomic information, epigenetic biomarkers are dynamic, and may capture both genetic and environmental information. The research in this thesis identified several promising new epigenetic signatures related to breastfeeding and handedness. Furthermore, it showed that epigenetic data summarized in epigenetic scores explained more variance in prenatal maternal smoking, current smoking, and in BMI than polygenic scores. Finally, this work identified novel methodologies associated with epigenetic and twin data in population-based and biomarker studies, and offered guidance on establishing a research twin register. The findings in this thesis contribute to the developing field of personalized medicine and epigenomics.

The PhD thesis Genetics and epigenetics of early life development by Veronika Odintsova (VU, Amsterdam) concerns traits and exposures associated with early life development. It contains a series of studies that have as a background the role of nature and nurture in human development. In these studies, the author used contemporary genetic epidemiological methods and the latest molecular biology advances, and applied these to early life traits in two large cohorts in the Netherlands and UK—the Netherlands Twin Register (NTR) and the Avon Longitudinal Study of Parents and Children (ALSPAC). The NTR samples comprises twins, which is a valuable resource in research on early life development and biomarkers, because the twin design allows one evaluate genetic and environmental influences on the phenotypes of interest. Studying early life outcomes and traits, such as a newborn state at birth assessed with Apgar scores (i.e., scores based on newborn appearance, pulse, grimace, activity, and respiration) or handedness, the author found a very small contribution of genetic influences to those traits, and hypothesized that epigenetic modifications could play a role. Most epigenetic programming is thought to take place within the first 1000 days of life. Epigenetic mechanisms are mechanisms that influence gene expression throughout the lifespan. Some epigenetic changes, such as DNA methylation, which are attributable to early life factors and exposures, can persist throughout childhood and into adulthood. This thesis focused on DNA methylation, as a source of variation, in addition to the genetic and environmental sources. It focused, inter alia, on epigenetic differences related to early life exposures – prenatal maternal smoking and breastfeeding – and complex traits – birth weight, BMI, left-handedness, and aggression. The research described in this thesis demonstrates that epigenetic data are a valuable addition to the genetic data, and which can play an important role in improving multi-omics prediction of health outcomes. Whereas DNA-based predictors are static and solely capture genomic information, epigenetic biomarkers are dynamic, and may capture both genetic and environmental information. The research in this thesis identified several promising new epigenetic signatures related to breastfeeding and handedness. Furthermore, it showed that epigenetic data summarized in epigenetic scores explained more variance in prenatal maternal smoking, current smoking, and in BMI than polygenic scores. Finally, this work identified novel methodologies associated with epigenetic and twin data in population-based and biomarker studies, and offered guidance on establishing a research twin register. The findings in this thesis contribute to the developing field of personalized medicine and epigenomics.

To investigate the biological etiology of human aggressive behavior through biomarker discovery and to explore the genetic etiology of variation in blood metabolite levels in humans, I analyzed twin-family data collected by the Netherlands Twin Register (NTR) and data of children referred to an academic centrum for child- and adolescent psychiatry. In my thesis, I argue for combining the classical twin design with genome-wide SNP (Single-Nucleotide Polymorphism) data to simultaneously estimate the total and SNP-based heritability. When analyzing 361 blood metabolites measured in a cohort of 5117 twin-family members, I applied this approach and found a stronger contribution of metabolite loci to lipids than to organic acids, and showed that the variance explained by metabolite loci differs significantly among metabolite classes and lipid species. These approaches based on measured SNPs are unsuitable for investigating the contribution of shared environmental factors. Therefore, I applied the classic twin design to 237 blood metabolite levels in 886 monozygotic (MZ) and 601 dizygotic (DZ) adult twin pairs, and reported significant estimates of the shared environment for only 6 out of 237 metabolites. To conclude, additive genetic factors contribute to approximately 50% of the individual variance in blood metabolites levels in adults. To look at aggression and biochemical biomarkers, I began with reviewing the existing literature for human aggression and related traits and found associations with biomarkers of multiple classes, including inflammation markers, neurotransmitters, lipoproteins, and thyroid and steroid hormones. However, I did not replicate the associations of lipid, inflammation, and related biomarkers with adult aggression in a twin-family cohort (N=5588), but found differences in glucose, fibrinogen, C-reactive protein, interleukin-6, and low-density lipoprotein cholesterol levels in the extremely discordant MZ twin pairs (12 pairs). I also tested the hypothesis that lipid CpG sites are differentially methylated in adult aggression, but this hypothesis was not supported. I coordinated the large-scale collection of urine and buccal-cell samples for (epi)genomic and metabolomic measurements in young twin pairs selected on aggression in the NTR, and share the protocols in my thesis. When analyzing these data, I observed associations of the urinary metabolites o-phosphoserine and gamma-L-glutamyl-L-alanine with childhood aggression in the discovery twin cohort (N=783). These findings did not replicate in an independent sample of discordant twin pairs (N=378) or in a cohort of clinical cases and matched twin controls (N=367). The top associated metabolites hint at a role of metabolic dysregulation of neurotransmission, energy metabolism, and oxidative stress in childhood aggression. Next, I performed an integrated multi-omics analysis of childhood aggression based on urinary metabolites, genome-wide DNA methylation, and SNP-based transmitted and non-transmitted polygenic scores for aggression and correlated traits. The metabolite data included a new platform targeting steroid hormones. Training of multi-omics models for childhood aggression showed good in-sample prediction through cross-validation (N=645), but out-of-sample prediction in hold-out (N=277) and clinical samples (N=142) was poor. The high correlations among the omics traits selected in the multi-omics models confirmed associations of childhood aggression with known risk factors and provided novel insight into the correlational structure of omics traits from different omics layers. For example, we showed that indirect genetic effects correlate most strongly with DNA methylation and amino acid levels, suggesting that parental genotypes influence offspring omics traits through the rearing environments parents create for their offspring. In summary, genetic factors influence on blood metabolite levels, and the shared environment contributes marginally to familial resemblance in blood metabolites. For childhood aggression, heritability is around 50%. When combining aggression and biomarker information, we see broad biological pathways that appear to play a role in human aggressive behavior, including dysregulation of neurotransmission, inflammation, and lipid, steroid hormone, and energy metabolism pathways.

To investigate the biological etiology of human aggressive behavior through biomarker discovery and to explore the genetic etiology of variation in blood metabolite levels in humans, I analyzed twin-family data collected by the Netherlands Twin Register (NTR) and data of children referred to an academic centrum for child- and adolescent psychiatry. In my thesis, I argue for combining the classical twin design with genome-wide SNP (Single-Nucleotide Polymorphism) data to simultaneously estimate the total and SNP-based heritability. When analyzing 361 blood metabolites measured in a cohort of 5117 twin-family members, I applied this approach and found a stronger contribution of metabolite loci to lipids than to organic acids, and showed that the variance explained by metabolite loci differs significantly among metabolite classes and lipid species. These approaches based on measured SNPs are unsuitable for investigating the contribution of shared environmental factors. Therefore, I applied the classic twin design to 237 blood metabolite levels in 886 monozygotic (MZ) and 601 dizygotic (DZ) adult twin pairs, and reported significant estimates of the shared environment for only 6 out of 237 metabolites. To conclude, additive genetic factors contribute to approximately 50% of the individual variance in blood metabolites levels in adults. To look at aggression and biochemical biomarkers, I began with reviewing the existing literature for human aggression and related traits and found associations with biomarkers of multiple classes, including inflammation markers, neurotransmitters, lipoproteins, and thyroid and steroid hormones. However, I did not replicate the associations of lipid, inflammation, and related biomarkers with adult aggression in a twin-family cohort (N=5588), but found differences in glucose, fibrinogen, C-reactive protein, interleukin-6, and low-density lipoprotein cholesterol levels in the extremely discordant MZ twin pairs (12 pairs). I also tested the hypothesis that lipid CpG sites are differentially methylated in adult aggression, but this hypothesis was not supported. I coordinated the large-scale collection of urine and buccal-cell samples for (epi)genomic and metabolomic measurements in young twin pairs selected on aggression in the NTR, and share the protocols in my thesis. When analyzing these data, I observed associations of the urinary metabolites o-phosphoserine and gamma-L-glutamyl-L-alanine with childhood aggression in the discovery twin cohort (N=783). These findings did not replicate in an independent sample of discordant twin pairs (N=378) or in a cohort of clinical cases and matched twin controls (N=367). The top associated metabolites hint at a role of metabolic dysregulation of neurotransmission, energy metabolism, and oxidative stress in childhood aggression. Next, I performed an integrated multi-omics analysis of childhood aggression based on urinary metabolites, genome-wide DNA methylation, and SNP-based transmitted and non-transmitted polygenic scores for aggression and correlated traits. The metabolite data included a new platform targeting steroid hormones. Training of multi-omics models for childhood aggression showed good in-sample prediction through cross-validation (N=645), but out-of-sample prediction in hold-out (N=277) and clinical samples (N=142) was poor. The high correlations among the omics traits selected in the multi-omics models confirmed associations of childhood aggression with known risk factors and provided novel insight into the correlational structure of omics traits from different omics layers. For example, we showed that indirect genetic effects correlate most strongly with DNA methylation and amino acid levels, suggesting that parental genotypes influence offspring omics traits through the rearing environments parents create for their offspring. In summary, genetic factors influence on blood metabolite levels, and the shared environment contributes marginally to familial resemblance in blood metabolites. For childhood aggression, heritability is around 50%. When combining aggression and biomarker information, we see broad biological pathways that appear to play a role in human aggressive behavior, including dysregulation of neurotransmission, inflammation, and lipid, steroid hormone, and energy metabolism pathways.

The goal of the research described in this dissertation was to investigate the importance of family factors in explaining individual differences in levels of aggression, in explaining whether individuals conform or desist from the overall downward trend we see in aggression over time and across the life-course, and in explaining the continuity of relative aggression levels across the life-course and across generations. Most of the work described in this dissertation is based on data that was collected by the Netherlands Twin Registry (NTR) from 1991 onwards. In total, 360,801 aggression observations of 83,027 individuals from 33,653 families were used in the analyses. Observations came from multiple raters, i.e. teachers, parents and self-reports, and multiple instruments, the majority of which ASEBA questionnaires. Aggression runs in the family. This implies that risk factors for aggression reside in families. From 1991 to 2015, aggression levels slightly declined in our sample. However, not all individuals follow this overall observed trend. In a novel mixed effects approach, we showed that not only the propensity for aggression, but also changes over time cluster within families. Aggression not only decreases over time, but also across the life-course. However, there is some relative stability: the most aggressive children are likely to become the most aggressive adults. In a novel 'rolling weights' approach, we show that genetic influences in childhood, measured with a polygenic score, continue to affect aggression until around age 40. These results were found in the Dutch NTR sample, but did not replicate in an Australian sample. The results in the Dutch cohort are the first indication from a molecular genetic perspective that genes drive part of the stability in aggression across the life-course. The fact that parents and offspring are similar in their propensity for aggression can have two causes: genetic transmission or cultural transmission. Genetic transmission occurs through the inheritance of genes from parents, while cultural transmission occurs through the process of passing on knowledge, norms, and values. We showed with a twin study that the shared environment, which leads to similarities in outcomes in families, only explains a negligible amount of variance in rule-breaking behaviour. Genetic effects explained 60 percent of the variance in rule-breaking behaviour. Because cultural transmission is part of the shared environment, we concluded that the main drivers of intergenerational continuity of aggression are genetic influences. These findings were supported by a following study of direct and indirect polygenic effects on aggression. Direct polygenic effects reflect a direct effect of a genotype on aggression. If there are genotype-environment correlation mechanisms, however, genetic influences may in part reflect environmental influences. Such indirect genetic effects may arise, for example, by environmental manifestations of parental and sibling genotypes. We found no evidence for contributions of such indirect genetic effects on aggression. Polygenic scores of early-life aggression, educational attainment, and ADHD, solely had direct genetic effects, both in a within-/ between-family design and in a transmitted/non-transmitted PGSs design. The studies bundled in this dissertation show that familial clustering of aggression is mainly driven by genetic factors. Additionally, we show that family factors, most notably genetic factors, drive changes in aggression over time and across the life-course. These results do not mean that the environment is not important. The environment does not contribute significantly to similarities within families, but it does contribute significantly to observed differences.

AchtergrondDe eerste lockdown van 2020 vanwegede Covid-19 pandemie had ingrijpende gevolgen voor dereguliere zorgverlening aan mensen met verstandelijkebeperkingen. Eerder onderzoek naar indirecte gevolgenvia incidentmeldingen toonde een scherpe daling envervolgens een stijging van meldingen van agressie.Meldingen van incidenten met medicatie lagen tijdensde eerste lockdown echter op een lager niveau dan voorde pandemie. Om antwoord te geven op de vraag wat deimpact was van de versoepelingen na de eerste lockdownen de gedeeltelijke herinvoering van maatregelen in devervolgfase van de pandemie zijn de incidentmeldingengevolgd tot begin 2021.MethodenDe weektotalen van incidentmeldingenbij zorgorganisatie ‘s Heeren Loo werden aan tijdserieanalyse onderworpen over de periode van medio 2016 totfebruari 2021, rekening houdend met seizoensinvloeden.Resultaten.De versoepeling van de maatregelen per 1 juli2020 markeerde een overgang van stijging in meldingenvan agressie naar daling. De wekelijkse meldingen keerdenterug op het niveau van voor de pandemie. Incidentenwaarbij bewoners zonder verklaring afwezig waren blevenna de versoepelingen stabiel. Meldingen van incidentenmet medicatie begonnen geleidelijk weer te stijgen nade versoepelingen.ConclusieUit de incidentmeldingen rijst het beeld vaneen tijdelijk schokeffect tijdens de eerste lockdown eneen normalisatie qua incidenten tijdens de vervolgfasevan de pandemie. Deze bevindingen sluiten aan bijander onderzoek gebaseerd op ervaringsverhalen tijdensde pandemie. Tijdige en toegankelijke communicatievanuit overheid en zorginstellingen naar mensen metverstandelijke beperking, naasten en professionalsalsmede continuïteit van zorgteams verdienen aandachtmet het oog op toekomstige crisissituaties.

Achtergrond: De eerste lockdown van 2020 vanwege de Covid-19 pandemie had ingrijpende gevolgen voor de reguliere zorgverlening aan mensen met verstandelijke beperkingen. Eerder onderzoek naar indirecte gevolgen via incidentmeldingen toonde een scherpe daling en vervolgens een stijging van meldingen van agressie. Meldingen van incidenten met medicatie lagen tijdens de eerste lockdown echter op een lager niveau dan voor de pandemie. Om antwoord te geven op de vraag wat de impact was van de versoepelingen na de eerste lockdown en de gedeeltelijke herinvoering van maatregelen in de vervolgfase van de pandemie zijn de incidentmeldingen gevolgd tot begin 2021. Methoden: De weektotalen van incidentmeldingen bij zorgorganisatie ‘s Heeren Loo werden aan tijdserie analyse onderworpen over de periode van medio 2016 tot februari 2021, rekening houdend met seizoensinvloeden. Resultaten: De versoepeling van de maatregelen per 1 juli 2020 markeerde een overgang van stijging in meldingen van agressie naar daling. De wekelijkse meldingen keerden terug op het niveau van voor de pandemie. Incidenten waarbij bewoners zonder verklaring afwezig waren bleven na de versoepelingen stabiel. Meldingen van incidenten met medicatie begonnen geleidelijk weer te stijgen na de versoepelingen. Conclusie: Uit de incidentmeldingen rijst het beeld van een tijdelijk schokeffect tijdens de eerste lockdown en een normalisatie qua incidenten tijdens de vervolgfase van de pandemie. Deze bevindingen sluiten aan bij ander onderzoek gebaseerd op ervaringsverhalen tijdens de pandemie. Tijdige en toegankelijke communicatie vanuit overheid en zorginstellingen naar mensen met verstandelijke beperking, naasten en professionals alsmede continuïteit van zorgteams verdienen aandacht met het oog op toekomstige crisissituaties.

This thesis investigated whether social, cognitive, and contextual factors influence communication between young people with mild intellectual disability and behavioral problems (MID/BP youth), and their youth care workers in an orthopedagogical treatment centre. The results presented in this dissertation demonstrate that, amongst MID/BP youth, many incidents of aggression result from negative treatment by their youth care workers. Aggression is a characteristic of MID/BP youth, culminating from other traits such as earlier and easier display of emotions (in comparison with average gifted young people), weaker executive functions, and problems in the social information processes. Youth care workers play an important role in channeling this aggression. To facilitate more effective communication with MID/BP youth, training for youth care workers, referred to as ‘The Dialogue’, was developed. Although the training has resulted in more subjectively perceived competence amongst the youth care workers in their interaction with MID/BP youth, the results to date do not indicate any reduction of incidents of aggression. This may be due to youth care workers experiencing stress on the work floor due to, amongst other things, organizational/non-pedagogical factors, in addition to methodological issues, which in turn possibly contribute to their negative interaction with MID/BP youth. The findings of this thesis also underline the importance of more generous financing of, and lessening the administrative burden on, youth care workers, to enable them to interact more effectively with MID/BP youth under ‘The Dialogue’. The conclusion is also a flag to management and treatment managers of the orthopedagogical treatment centre to constantly look for solutions that deal with miscommunication and stress, to replace the ‘screw you’ attitude with ‘looking out for you’

Achtergrond In de psychiatrie zijn er nog té weinig aandacht voor en kennis over lichte verstandelijke beperking (lvb). Agressieproblemen komen regelmatig voor bij patiënten met een lvb die in de ggz behandeld worden en/of opgenomen zijn. Doel Verhelderen van achtergronden van agressieproblemen en adviezen voor voorkómen ervan. Methode Bespreken literatuur en praktijkervaring. Resultaten Agressieproblemen worden niet alleen veroorzaakt door factoren die te maken hebben met de lvb of met psychische stoornissen, maar ook door factoren in de therapeutische context van de patiënt. Dit betreft bijvoorbeeld de bejegeningsstijl van de begeleider en diens persoonlijke kenmerken, het behandelklimaat, en het werk- en organisatieklimaat. Conclusie De behandeling van opgenomen agressieve patiënten met een lvb kan effectiever worden als gericht aandacht wordt besteed aan het herkennen van de lvb en aan de kwaliteit van de pedagogische bejegening door de begeleiders, aan het vormgeven van een open leefklimaat en door te investeren in een goed werkklimaat.

Achtergrond In de psychiatrie zijn er nog té weinig aandacht voor en kennis over lichte verstandelijke beperking (lvb). Agressieproblemen komen regelmatig voor bij patiënten met een lvb die in de ggz behandeld worden en/of opgenomen zijn. Doel Verhelderen van achtergronden van agressieproblemen en adviezen voor voorkómen ervan. Methode Bespreken literatuur en praktijkervaring. Resultaten Agressieproblemen worden niet alleen veroorzaakt door factoren die te maken hebben met de lvb of met psychische stoornissen, maar ook door factoren in de therapeutische context van de patiënt. Dit betreft bijvoorbeeld de bejegeningsstijl van de begeleider en diens persoonlijke kenmerken, het behandelklimaat, en het werk- en organisatieklimaat. Conclusie De behandeling van opgenomen agressieve patiënten met een lvb kan effectiever worden als gericht aandacht wordt besteed aan het herkennen van de lvb en aan de kwaliteit van de pedagogische bejegening door de begeleiders, aan het vormgeven van een open leefklimaat en door te investeren in een goed werkklimaat.

In deze factsheet vindt u een greep uit de gegevens die er in de NEA 2018 te vinden zijn.

In dit rapport staan de uitkomsten van verdiepend onderzoek naar thema’s zoals arbeidsmarkt, werkdruk, agressie, verzuim, en technologie en domotica in de sector . Aanleiding voor het onderzoek was de Werkgeversenquête 2018. Sommige resultaten van dat onderzoek waren opvallend en vroegen om verder onderzoek. In opdracht van AZW hebben TNO en bureau HHM daarom in 2019 verdiepend onderzoek gedaan dat de dialoog over het arbeidsmarktbeleid in Zorg en Welzijn kan ondersteunen. Om de onderzoeksvragen te beantwoorden, is kwantitatief en kwalitatief onderzoek uitgevoerd. Inclusief de bijlagen: Verantwoording en onderzoek. Resultaten NEA totaal en primair proces. Vragenlijst NEA-herbenadering en Vragenlijst WEA-herbenadering.

In deze factsheet vindt u een greep uit de gegevens die er in de NEA 2018 te vinden zijn.

In dit rapport staan de uitkomsten van verdiepend onderzoek naar thema’s zoals arbeidsmarkt, werkdruk, agressie, verzuim, en technologie en domotica in de sector . Aanleiding voor het onderzoek was de Werkgeversenquête 2018. Sommige resultaten van dat onderzoek waren opvallend en vroegen om verder onderzoek. In opdracht van AZW hebben TNO en bureau HHM daarom in 2019 verdiepend onderzoek gedaan dat de dialoog over het arbeidsmarktbeleid in Zorg en Welzijn kan ondersteunen. Om de onderzoeksvragen te beantwoorden, is kwantitatief en kwalitatief onderzoek uitgevoerd. Inclusief de bijlagen: Verantwoording en onderzoek. Resultaten NEA totaal en primair proces. Vragenlijst NEA-herbenadering en Vragenlijst WEA-herbenadering.