The present dissertation investigated adolescents’ overall stress and perceived stressors, the effectiveness of a universal psychoeducational program about stress, the Stress Lessons, and... Show moreThe present dissertation investigated adolescents’ overall stress and perceived stressors, the effectiveness of a universal psychoeducational program about stress, the Stress Lessons, and adolescents’ self-referral to a targeted school-based intervention. Another aim was to examine whether adolescents from different demographic groupings vary in their experience of stressors and the effect of psychoeducation. A large and heterogeneous sample was recruited from schools with variation in educational tracks and self-perceived ethnic backgrounds. The sample consisted of 1613 predominantly young adolescents with an average age of 13 years old. Most adolescents have to maneuver through a world of stressors, mostly related to the school environment, their health, and future uncertainty, while adolescents experience less stress from social pressure and financial pressure. Furthermore, our results indicate that the Stress Lessons were effective regarding improving adolescents’ knowledge about stress, but not in terms of stress levels. Finally, we found that adolescents who reported higher levels of test anxiety were generally more likely to show interest in an intervention targeting reduction of performance anxiety after the Stress Lessons. However, we did not find that adolescents with lower levels of social skills were more interested in an intervention targeting improvement of social skills. Show less
The overarching goal of this dissertation was to investigate parenting processes in relation to affective well-being in families in the daily flow of life from different perspectives (i.e.,... Show moreThe overarching goal of this dissertation was to investigate parenting processes in relation to affective well-being in families in the daily flow of life from different perspectives (i.e., adolescent, mother, father), on different levels (i.e., objective, momentary, and daily), and in a clinical sample (families with an adolescent with a depression) in addition to community samples. Our findings underline the importance of daily parental warmth and criticism of mothers and fathers for adolescents’ well-being. In addition, we showed that adolescents, parents, and their perceptions of parenting influence each other and that becoming more attuned to each other’s intention and needs is essential. Importantly, we consistently demonstrated that not only the extent and direction of the dynamic processes between parenting and affect in daily life differs between, but also within persons and families. This stresses the need for research focusing on individual processes and combining quantitative with qualitative measures. The use of more idiographic approaches would not only enable gaining more insight into these differences between individuals, but also contribute to identifying parenting practices that work for almost all adolescents. This would facilitate the development of interventions combining universal parenting principles with suggestions for tailoring it to individual- or family-specific situations. Show less
This dissertation focuses on the overall study, as well as the nuances, of bullying behaviours among school-going youth in India. A systematic review of past literature from India is presented by... Show moreThis dissertation focuses on the overall study, as well as the nuances, of bullying behaviours among school-going youth in India. A systematic review of past literature from India is presented by synthesizing 37 empirical studies examining psychometric properties of the instruments adopted, methodological characteristics, sample size and procedures, and characteristics of bullying behaviour. Results show that bullying is widely spread, and certain factors, like caste and religion, and their association with bullying behaviours are typical to the Indian culture. This dissertation also examines if dimensions of psychopathy, namely callous-unemotional traits, narcissism, and impulsivity, can differentiate between, bullies, victims, and bully-victims in a longitudinal capacity. Using a multi-informant approach and multinomial logistic regression analyses, it was found that psychopathy dimensions taken together provide a better fit in predicting bullying than the independent psychopathic subscales. The dissertation further investigates the structure and context of the relationship between victimization and Body Mass Index through a transactional model. Key results of structural equation modeling analyses yielded mainly concurrent relations between BMI and victimization, emphasizing that results from western countries may not generalize to India. Finally, bullying behaviours among youth as a function of their socio-economic status (SES) in classroom and self-perceptions of minority status are examined using a moderated-mediation growth model. Results show classroom level SES plays a significant role in predicting victimization cross-sectionally, and is mediated through perceptions of self. However, in the long run, being part of a minority, and perceiving self as such, leads to decreased victimization among youth in India. Show less
In this thesis a literature review was conducted to map the results of earlier neuroimaging studies in minors who experienced childhood psychological trauma. Next, three different structural... Show moreIn this thesis a literature review was conducted to map the results of earlier neuroimaging studies in minors who experienced childhood psychological trauma. Next, three different structural neuroimaging techniques were employed to study the effects of childhood sexual trauma in youth .Main findings:1. Neuroimaging studies in traumatised children and adolescents are scarce and heterogeneous in design, in particular with regard to the sample studied and type of trauma.2. The results of structural neuroimaging studies in traumatised minors differ from those in adult populations, in particular with regard to findings on hippocampus and corpus callosum (CC).3. Paralleling the inconsistent findings on hippocampal volume reduction in traumatised minors, our VBM-study did not show differences between groups for hippocampal volume.4. VBM showed smaller volumes of key regions of the limbic system (ACC, amygdala) in the CSA-related PTSD group compared to controls.5. Adolescents with sexual abuse-related PTSD show no abnormalities in cortical thickness, in line with findings in adults. 6. Adolescents with CSA-related PTSD show less integrity of parts of the CC compared to healthy non-traumatised controls.7. Our structural neuroimaging studies showed limited associations with trauma symptomatology, in line with findings in studies in minors. Show less
The most difficult target group in mental health care for youth, is recognizable from social debates: An alarming example of a suicide or severe non-suicidal self-injury illustrates the... Show moreThe most difficult target group in mental health care for youth, is recognizable from social debates: An alarming example of a suicide or severe non-suicidal self-injury illustrates the vulnerability of these adolescents and underlines a powerless society. Notably, this target group is often excluded from scientific research. Hauber attributes this exclusion on the many psychiatric problems young people face and a rigid classification system. Theoretical models do not accommodate overlapping problems, despite the most serious conditions being characterized by such an overlap. Hauber described the need for a dimensional classification system to enable care providers to assess serious problems, such as an overlap of personality disorder, insecure attachment and non-suicidal self-injury. The influences of puberty, attachment insecurity and the adolescent’s social dynamics should be included in such a model. By having young people reflect in writing on their treatment, relevant information can be obtained to tailor personalized care, and drop-out can be minimized. New developments suggest improving resilience and connection with others, rather than just reducing symptoms. Hauber's research similarly showed the importance of connecting with others to grow emotionally in adolescence. This is a challenge in modern society, with loneliness being the highest mortality risk for humans. Show less
Although the outcomes of our daily-life risky decisions are often unknown (e.g., receiving or not receiving a fine after running a red light), the probabilities of these outcomes may also vary in... Show moreAlthough the outcomes of our daily-life risky decisions are often unknown (e.g., receiving or not receiving a fine after running a red light), the probabilities of these outcomes may also vary in uncertainty. That is, the probabilities may be known (risk) or unknown (ambiguity), which influences risk taking behavior to a great extent. A developmental phase associated with heightened risk taking is adolescence, yet how adolescents process risk and ambiguity, and the relation with real-life risk taking, remain elusive. Moreover, individual differences in observed risk taking behavior remain largely overlooked. In this PhD thesis risk and ambiguity processing in adolescents were decomposed using behavioral economics and fMRI, and related to real-life risk taking. The results indicated that risk and ambiguity differentially impact risk-taking behavior, and are processed by different neural mechanisms. In addition, individual variation in task-related and real-life risk taking highlighted that adolescence is not a phase of heightened risk taking for everyone. Moreover, it was found that real-life risk-taking and prosocial tendencies were both predicted by fun seeking, suggesting this trait may make individuals differentially susceptible to positive or negative outcomes. Together, this thesis points towards a more nuanced perspective on adolescent risk taking and its underlying components. Show less
Adolescents with delinquency and cannabis abuse, primarily boys, are predisposed to a variety of comorbid psychiatric psychopathology and form an intricate subgroup which is difficult to treat ... Show more Adolescents with delinquency and cannabis abuse, primarily boys, are predisposed to a variety of comorbid psychiatric psychopathology and form an intricate subgroup which is difficult to treat (Merikangas et al., 2010; Zahn-Waxler, Shirtcliff, & Marceau, 2008). Systemic treatments are considered the type of treatment which renders the most promising results in addressing the complex taxonomy of adolescents’ problem behaviours (Carr, 2009; Von Sydow, Retzlaff, Beher, Haun, & Schweitzer,2013; Waldron & Turner, 2008). Clinicians working with this group of adolescents have to deal, on a daily basis, with serious issues and have to make difficult decisions, impacting the adolescent, his/her family, and society as a whole. For the forensic research field, comprehending and grasping the complexity of these adolescents, which could generate insights and practical advises leading to improvement of care, is a tough and demanding task. This dissertation tries to inform clinical and research practice by providing insight and knowledge concerning: the common elements of systemic treatment, the effectiveness of Multidimensional Family Therapy (MDFT), and the predictive value on treatment outcome of baseline characteristics of the adolescent. This to better understand systemic treatments and to be better able to match a treatment with the individual adolescent’s psycho-social make-up. Show less
Increasingly, pleas are made for extending the involvement of minors in decision-making about participation in pediatric research. However, a number of issues arise from this desired... Show more Increasingly, pleas are made for extending the involvement of minors in decision-making about participation in pediatric research. However, a number of issues arise from this desired participation of minors. First, involvement in decision-making requires children and adolescents to be adequately informed about what participation in research entails. Second, the plea for increased involvement in decision-making requires further investigation whether children indeed can, should and want to play a role in the decision about research participation. This thesis addresses these issues and thereby contributes to insights in how to empower minors in the context of informed consent for research participation. New informed consent material was developed in close cooperation with children and other end-users, the process of which is described and evaluated. Also, insights in the role that minors can, should and want to play in the informed consent procedure are described. These insights were obtained by reviewing multidisciplinary scientific evidence on the competence of minors, by an ethical reflection on the view on children that we should adopt, and by consulting minors themselves about the perspectives on their role in decision-making. Finally, based on this research, recommendations are provided on how to empower minors in decision-making about research participation. Show less
This thesis describes the potential role of non-invasive measurement of pharmacokinetics (pk) and pharmacodynamics (pd) in the research and development of central nervous system (cns) stimulants or... Show moreThis thesis describes the potential role of non-invasive measurement of pharmacokinetics (pk) and pharmacodynamics (pd) in the research and development of central nervous system (cns) stimulants or depressants for children and adolescents. First, we evaluated the feasibility of using saliva as an alternative to plasma in two studies on psychostimulants (caffeine and methylphenidate). Second, neuropsychological and neurophysiological functions were measured longitudinally using the NeuroCart, a battery of tests developed at the Centre for Human Drug Research (chdr, Leiden, The Netherlands) that includes non-invasive tests for alertness, visuomotor coordination, motor control, memory, and subjective drug effects. Using a non-invasive approach, age-dependent differences in alcohol pk and pd were evaluated between healthy adolescents and adults. This thesis concludes with the report of two clinical trials that were designed to evaluate age-appropriate formulations of sedative drugs that have the potential for use in children. Show less
Depressie en angststoornissen, zoals major depressive disorder, paniekstoornis, sociale angststoornis en gegeneraliseerde angststoornis, vallen onder de meest voorkomende psychiatrische... Show moreDepressie en angststoornissen, zoals major depressive disorder, paniekstoornis, sociale angststoornis en gegeneraliseerde angststoornis, vallen onder de meest voorkomende psychiatrische ziektebeelden. Door middel van neuroimaging onderzoek zoals structurele en functionele MRI (fMRI) is het mogelijk om op een non-invasieve manier de onderliggende neurobiologie van deze stoornissen in kaart te brengen. Op basis van dergelijk onderzoek werden ruim 15 jaar geleden enkele neurobiologische modellen opgesteld waarin werd voorgesteld dat het goed of juist niet goed hersengebieden een belangrijke bijdrage leverde aan het ontstaan en/of instandhouden van depressie en angst. In de loop der jaren zijn nieuwe MRI technieken ontwikkeld. Met behulp van structurele MRI en resting-state fMRI, waarmee connectiviteit tussen hersengebieden onderzocht kan worden, heb ik gekeken naar anatomische en functionele hersenafwijkingen bij volwassenen en jongeren met depressie en/of angststoornissen. Doel was te bepalen of de reeds bestaande neurobiologische modellen bevestigd danwel aangepast of aangevuld zouden kunnen worden met recent ontwikkelde onderzoeksmethoden. De resultaten van mijn studies bevestigden grotendeels de betrokkenheid van de hersengebieden in de modellen, maar wezen tevens op een rol voor uitgebreidere netwerken van hersengebieden dan in de modellen werd verondersteld. Show less
Improving survival rates in children and adolescents with malignant bone tumours, paved the way to the application of new surgical extremity-salvage techniques. For the surgical treatment of... Show moreImproving survival rates in children and adolescents with malignant bone tumours, paved the way to the application of new surgical extremity-salvage techniques. For the surgical treatment of malignant bone tumours of the lower extremity, there are a number of resection options (amputation, limb sparing, and rotationplasty) available. Each option has its own indication and after the surgery different advantages and disadvantages. The debate is whether limb-salvage or ablative surgery is advantageous for the individual patient. Purpose of the studies presented in this thesis are evaluate and compare QoL, functional ability and physical activity levels among children and young adults in the first years after bone cancer surgery of the leg. A cross sectional and a prospective study were conducted in the Dutch university bone cancer centres. The results of the cross-sectional study show that outcomes are equivalent for those undergoing limb salvage or ablative surgery. The results of the prospective study showed that; survivors improve in the two years following resection of the bone tumour and the resulting limb-sparing or ablative surgery at all domains evaluated, with the exception of the mental QoL domains. These improvements were most pronounced over the first year after surgery. Show less
Cross-cultural research shows that cultural frameworks provide guidance on what to feel and when, and how to express emotions from a young age. These cultural variations can cause misinterpretation... Show moreCross-cultural research shows that cultural frameworks provide guidance on what to feel and when, and how to express emotions from a young age. These cultural variations can cause misinterpretation and misunderstanding and are especially relevant for ethnic minority groups, who may be described as living ‘in between’ cultures. This thesis examines the extent to which Moroccan-Dutch adolescents’ emotional functioning can be considered in between cultures. Their emotion awareness, acknowledgment of social emotions, anger regulation, and anger communication was compared with those of their Dutch peers and with those of their peers living in Morocco. The thesis also addresses the adaptiveness of these aspects of emotional functioning in terms of psychological functioning. The results reveal that, overall, Moroccan-Dutch adolescents’ emotional functioning shows more similarities with that of their Dutch than their Moroccan peers. Although these ‘Dutch’ emotion patterns do not always seem adaptive for Moroccan-Dutch adolescents’ psychological wellbeing, the findings suggest that their emotional functioning in peer situations is a product of the Dutch culture. Show less
This thesis attempted to contribute to the quest of practitioners and researchers to find guidelines on how to establish a healthy motivational orientation in the classroom. This is not an easy... Show moreThis thesis attempted to contribute to the quest of practitioners and researchers to find guidelines on how to establish a healthy motivational orientation in the classroom. This is not an easy objective. There are many theories and concepts regarding motivation. We provided an overview in Chapter 2 of 36 motivation theories to gain more insight into what motivation is and how it works in the classroom. In Chapter 3 we highlighted motivation constructs derived from different motivation perspectives that can predict classroom performance together. Further, we presented the effects of a motivational intervention on intrinsic motivation, persistence, self-regulatory skills and performance (Chapter 4); we distinguished between the effects for boys and girls (Chapter 5); and investigated the applicability of self-determination theory across situations (Chapter 6). This chapter will start by presenting and elaborating on our results. We use the metaphor of the motivation cake that was introduced in the first chapter of this thesis to illustrate our conclusions. Subsequently, we discuss study limitations and present our suggestions for future research as well as the theoretical and practical implications of the present thesis. Show less
Celiac disease is an intolerance to dietary gluten in genetically predisposed individuals, leading to alterations of the small bowel mucosa. The treatment consists of a life-long, gluten-free diet.... Show moreCeliac disease is an intolerance to dietary gluten in genetically predisposed individuals, leading to alterations of the small bowel mucosa. The treatment consists of a life-long, gluten-free diet. The aims of this thesis were to measure some of the environmental factors considered to play a role in the prevention of celiac disease. For that purpose breast milk was studied on the presence of glutenpeptides and a food frequency questionnaire was developed and validated to quantify gluten intake in young infants. Furthermore, the current treatment at different ages and the ability to develop gluten tolerance were studied. It became clear that the nutrient intake of adolescents on a gluten-free diet can be ameliorated, and that the rather new naturally gluten-free cereal tef is frequently used by Dutch celiac patients and a wide majority of them can consume tef without clinical symptoms. Therefore tef can be a valuable addition to their diet. Although celiac disease is considered to be a permanent condition, we made an attempt to find patients who have become tolerant to gluten. We found 2 of these exceptional patients and found that one of them had HLA-typing different from HLA-DQ2/DQ8, suggesting that genetic factors may play a role in the development of tolerance. The underlying mechanisms leading to prevention, disease development or tolerance to gluten are complex and need to be further studied. Show less
The aim of this thesis was twofold: Firstly to create a reliable and valid new instrument to measure maladaptive social behaviour (MSB) of students in secondary vocational education, and secondly... Show moreThe aim of this thesis was twofold: Firstly to create a reliable and valid new instrument to measure maladaptive social behaviour (MSB) of students in secondary vocational education, and secondly to assess which school context variables could predict MSB at school. Three data-waves were conducted between December 2001 and July 2003. At the first data-wave 1800, at the second 931, and at the third 642 students participated from several schools, several departments, and several courses, spread over the Netherlands. Using several pilot-studies a new instrument was developed: The Questionnaire for Maladaptive Social Behaviour (QMSB). It consists of 49 items referring to five categories of behaviour: MSB toward Schoolwork and Rules, Delinquent Behaviour, Unfriendly Behaviour, Withdrawn Behaviour and Impolite Behaviour. Three studies were conducted to explore external validity of the instrument. Boys reported more MSB for all categories than girls. When controlled for gender, no differences in MSB were found between students with different ethnic origin, course level, or educational level of parents. School context variables predicted a small amount of variance of MSB. For Boys, feeling alienated from school appeared the most important predictor for their MSB at school; it predicted each type of MSB. For girls, the perception of a competitive school environment predicted their MSB best. Show less
Th e DISABKIDS project is a European collaboration of clinicians and investigators that received funding from the European Commission in 2001. Over the last four years the DISABKIDS project's aim... Show moreTh e DISABKIDS project is a European collaboration of clinicians and investigators that received funding from the European Commission in 2001. Over the last four years the DISABKIDS project's aim was to cross-nationally develop a new European health related quality of life (HRQoL) instrument for children and adolescents with a chronic medical condition 1(Box 1). Some of the steps taken during the developmental process of the European DISABKIDS HRQoL instrument for children and adolescents with a chronic medical condition are described in this thesis. Data from the asthma population is a recurring theme in most chapters as the Dutch DISABKIDS centre operated as asthma consultant Show less
The first study of this thesis (Chapter 2) showed that the majority of the internationally adopted children are well adjusted, although a relatively large minority of adopted children had behavior... Show moreThe first study of this thesis (Chapter 2) showed that the majority of the internationally adopted children are well adjusted, although a relatively large minority of adopted children had behavior problems of clinical significance or were referred to mental health services compared with non-adopted children. Nevertheless, adoption may often be the best solution for a child who would otherwise be raised in an institution or in other adverse environments (see also Juffer, 2002; Van IJzendoorn et al., 2005). The second and third study (Chapters 3 and 4) showed several longitudinal and concurrent influences on the behavioral and social development of adopted adolescents. The second study (Chapter 3) showed that early-onset delinquency was associated with stress hyporeactivity. The differentiation between delinquency and aggression, and between childhood-onset and adolescence-onset delinquency (Moffitt, 1993) appeared to be important for our understanding of the development of externalizing problem behaviors. The third study (Chapter 4) showed that individual development from infancy through middle childhood to adolescence was rather stable and that concurrent environmental experiences and child characteristics were essential influences on middle childhood and adolescent social development. Early parent-child relationships did not determine in final form social development in adolescence, but they provided the basis for healthy social development through the influence on earlier social development, even in the absence of genetic similarities between children and parents. Bowlby__s (1973, 1980) thesis that adaptation is always a product of both developmental history and current circumstances was supported. Show less
