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
Sande, M.C.E. van de; Fekkes, M.; Diekstra, R.F.W.; Gravesteijn, C.; Kocken, P.L.; Reis, R. 2023
Social and Emotional Learning programs, designed to enhance adolescents' social and emotional skills, are implemented in schools worldwide. One of these programs is Skills4Life (S4L), for students... Show moreSocial and Emotional Learning programs, designed to enhance adolescents' social and emotional skills, are implemented in schools worldwide. One of these programs is Skills4Life (S4L), for students in Dutch secondary education. To strengthen this program and adapt it to students' needs, we conducted an exploratory study on their perspectives on their own social-emotional development, focusing on low-achieving students in prevoca-tional education.We interviewed eleven boys and eleven girls in five focus groups on (1) their general school life experiences, (2) their perceptions and experiences regarding interactions with peers, the problems they encountered in these interactions, and (3) the strategies and skills they used to solve these problems. Driven by findings in related studies initial thematic analyzes were extended using a three-step approach: an inductive, data-driven process of open coding; axial coding; and selective coding, using the social-emotional skills comprised in an often-used SEL framework as sensitizing concepts. Overall, students were satisfied with their relationships with classmates and teachers and their ability to manage their daily interaction struggles. Their reflections on their interactions indicate that the skills they preferred to use mirror the social-emotional skills taught in many school programs. However, they also indicated that they did not apply these skills in situations they experienced as unsafe and uncontrollable, e.g., bullying and harassment. The insights into adolescents' social-emotional skills perceptions and the problems they encountered with peers at school presented here can contribute to customizing school-based skills enhancement programs to their needs. Teacher training is required to help teachers gain insight into students' perspectives and to use this insight to implement SEL programs tailored to their needs. Show less
There has been little attention to personality in research on school refusal (SR). This study examined personality traits among 41 adolescents receiving cognitive–behavioral therapy (CBT) during... Show moreThere has been little attention to personality in research on school refusal (SR). This study examined personality traits among 41 adolescents receiving cognitive–behavioral therapy (CBT) during participation in a School Refusal Program. Traits were examined via clinical scales and 2-point code types derived from the Minnesota Multiphasic Personality Inventory—Adolescent. The influence of personality traits on treatment outcome was examined at post-treatment and 1-year follow-up. At pretreatment, eight of the 10 clinical scales were disproportionately skewed toward the “high to very high” range relative to a norm group. Social introversion and depressive symptomatology were significantly increased relative to the norm group, and nearly one-half of the adolescents were characterized by code type 2-3/3-2 (depression/hysteria) or 2-0/0-2 (depression/social introversion). Adolescents characterized by a 2-0/0-2 code type were almost twice as likely (odds ratio = 1.78) to be treatment responders at post-treatment. There was no relation between personality traits and treatment outcome at follow-up. The small sample size limits generalization of the study’s findings. If the results are replicated, personality traits may provide useful indications for personalizing treatment when employing interventions recommended in CBT manuals for SR. 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
Vries, I. de; Abeyta, S.; Lockwood, S.; Cuevas, C.A.; Rothman, E. 2022
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
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
Background: Substance use and delinquency are considered to be mutual risk factors. Previous studies have shown that multidimensional family therapy (MDFT) is effective in tackling both conditions... Show moreBackground: Substance use and delinquency are considered to be mutual risk factors. Previous studies have shown that multidimensional family therapy (MDFT) is effective in tackling both conditions on the short term. The current study examines the long-term effects of MDFT on criminal offending.Methods: 109 adolescents with cannabis use disorder and comorbid problem behavior were randomly assigned to either MDFT or cognitive behavioral therapy (CBT). Police arrest data were collected for 6 years: 3 years prior to and 3 years after treatment entry. Using survival analysis and repeated measure General Linear Models (rmGLM), the two treatment groups were compared on number of arrests, type of offence, and severity of offence. Moderator analyses looking at age, disruptive behavior disorders, history of crimes, family functioning, and (severe) cannabis use were conducted (rmGLM).Results: While police arrest rates increased in the 3 years before treatment, the rates decreased substantially after the start of both treatments. No differences were found between the treatment groups with respect to either time to first offence from the start of the treatment or changes in frequency or severity of offending over time. A treatment effect trend favoring MDFT was found for property offending in the subgroup of adolescents with high baseline-severity of cannabis use.Conclusions: Across a follow-up period of 3 years, MDFT and CBT were similarly effective in reducing delinquency in adolescents with a cannabis use disorder. Show less
Media’s prevailing thin-body ideal plays a vital role in adolescent girls’ body image development, but the co-occurring impact of peer feedback is understudied. The present study used functional... Show moreMedia’s prevailing thin-body ideal plays a vital role in adolescent girls’ body image development, but the co-occurring impact of peer feedback is understudied. The present study used functional magnetic resonance imaging (fMRI) to test media imagery and peer feedback combinations on neural activity related to thin-body ideals. Twenty-four healthy female late adolescents rated precategorized body sizes of bikini models (too thin or normal), directly followed by ostensible peer feedback (too thin or normal). Consistent with prior studies on social feedback processing, results showed increased brain activity in the dorsal medial prefrontal cortex (dmPFC)/anterior cingulate cortex (ACC) and bilateral insula in incongruent situations: when participants rated media models’ body size as normal while peer feedback indicated the models as too thin (or vice versa). This effect was stronger for girls with lower self-esteem. A subsequent behavioral study (N = 34 female late adolescents, separate sample) demonstrated that participants changed behavior in the direction of the peer feedback: precategorized normal sized models were rated as too thin more often after receiving too thin peer feedback. This suggests that the neural responses upon peer feedback may influence subsequent choice. Our results show that media-by-peer interactions have pronounced effects on girls’ body ideals. 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
Adolescents with internalizing disorders and adolescents with childhood sexual abuse related post-traumatic stress disorder (CSA-related PTSD) show a large overlap in symptomatology. In addition,... Show moreAdolescents with internalizing disorders and adolescents with childhood sexual abuse related post-traumatic stress disorder (CSA-related PTSD) show a large overlap in symptomatology. In addition, brain research indicated hyper-responsiveness and sustained activation instead of habituation of amygdala activation to emotional faces in both groups. Little is known, however, about whether the same patterns of amygdala habituation are present in these two groups. The current study examined habituation patterns of amygdala activity to emotional faces (fearful, happy and neutral) in adolescents with a DSM-IV depressive and/or anxiety disorder (N = 25), adolescents with CSA-related PTSD (N = 19) and healthy controls (N = 26). Behaviourally, the adolescents from the internalizing and CSA-related PTSD group reported more anxiety to fearful and neutral faces than adolescents from the control group and adolescents from the CSA-related PTSD group reacted slower compared to the internalizing group. At the whole brain level, there was a significant interaction between time and group within the left amygdala. Follow-up ROI analysis showed elevated initial activity in the amygdala and rapid habituation in the CSA-related PTSD group compared to the internalizing group. These findings suggest that habituation patterns of amygdala activation provide additional information on problems with emotional face processing. Furthermore, the results suggest there are differences in the underlying neurobiological mechanisms related to emotional face processing for adolescents with internalizing disorders and adolescents with CSA-related PTSD. Possibly CSA-related PTSD is characterized by a stronger primary emotional response driven by the amygdala. (C) 2016 The Authors. Published by Elsevier Ltd. Show less
This study was designed to examine whether proactive and reactive aggression are meaningful distinctions at the variable- and person-based level, and to determine their associated behavioral... Show moreThis study was designed to examine whether proactive and reactive aggression are meaningful distinctions at the variable- and person-based level, and to determine their associated behavioral profiles. Data from 587 adolescents (mean age 15.6; 71.6 % male) from clinical samples of four different sites with differing levels of aggression problems were analyzed. A multi-level Latent Class Analysis (LCA) was conducted to identify classes of individuals (person-based) with similar aggression profiles based on factor scores (variable-based) of the Reactive Proactive Questionnaire (RPQ) scored by self-report. Associations were examined between aggression factors and classes, and externalizing and internalizing problem behavior scales by parent report (CBCL) and self-report (YSR). Factor-analyses yielded a three factor solution: 1) proactive aggression, 2) reactive aggression due to internal frustration, and 3) reactive aggression due to external provocation. All three factors showed moderate to high correlations. Four classes were detected that mainly differed quantitatively (no ‘proactive-only’ class present), yet also qualitatively when age was taken into account, with reactive aggression becoming more severe with age in the highest affected class yet diminishing with age in the other classes. Findings were robust across the four samples. Multiple regression analyses showed that ‘reactive aggression due to internal frustration’ was the strongest predictor of YSR and CBCL internalizing problems. However, results showed moderate to high overlap between all three factors. Aggressive behavior can be distinguished psychometrically into three factors in a clinical sample, with some differential associations. However, the clinical relevance of these findings is challenged by the person-based analysis showing proactive and reactive aggression are mainly driven by aggression severity. Show less
Brauers, M.; Kroneman, L.; Otten, R.; Lindauer, R.; Popma, A. 2016
Youths in compulsory residential care show a high prevalence of various mental health problems but often lack motivation to engage in therapeutic treatment. Although the self-determination-theory ... Show moreYouths in compulsory residential care show a high prevalence of various mental health problems but often lack motivation to engage in therapeutic treatment. Although the self-determination-theory (SDT) and the transtheoretical model of change (TTM) offer a useful framework for treatment motivation, they do not describe which interventions therapists can use to improve treatment motivation in juveniles, nor do they focus specifically on treatment motivation in a compulsory residential care setting. This article provides an overview of opportunities to enhance adolescents' motivation for treatment in compulsory residential care. Results show that in the reviewed literature, increasing autonomy and competence has received relatively little attention compared to relatedness. In addition, results show that treatment motivation can be enhanced in several different ways, ranging from interventions on an individual to an organizational level. This may indicate that enhancing motivation for treatment in a residential setting needs intervention on multiple levels, involving youths, therapists, group workers and parents. Scientific evidence, however, is limited. Regarding the lack of studies that examine the need for autonomy and competence, future studies should focus on these basic needs for motivation. Show less
Kersten, L.; Präzlich, M.; Mannstadt, S.; Ackermann, K.; Kohls, G.; Oldenhof, H.; ... ; Stadler, C. 2016
Background: In Europe, the number of females exhibiting oppositional defiant disorder (ODD) and conduct disorder (CD) is growing. Many of these females live in youth welfare institutions.... Show moreBackground: In Europe, the number of females exhibiting oppositional defiant disorder (ODD) and conduct disorder (CD) is growing. Many of these females live in youth welfare institutions. Consequently, there is a great need for evidence-based interventions within youth welfare settings. A recently developed approach targeting the specific needs of girls with ODD and CD in residential care is START NOW. The aim of this group-based behavioural skills training programme is to specifically enhance emotional regulation capacities to enable females with CD or ODD to appropriately deal with daily-life demands. It is intended to enhance psychosocial adjustment and well-being as well as reduce oppositional and aggressive behaviour. We present the study protocol (version 4.1; 10 February 2016) of the FemNAT-CD intervention trial titled 'Group-Based Treatment of Adolescent Female Conduct Disorders: The Central Role of Emotion Regulation'. Methods/design: The study is a prospective, confirmatory, cluster-randomised, parallel-group, multi-centre, randomised controlled trial with 128 institutionalised female adolescents who fulfil the diagnostic criteria of ODD and/or CD. Institutions/wards will be randomised either to provide the 12-week skills training as an add-on intervention or to provide treatment as usual. Once the first cycle is completed, each institution will run a second cycle with the opposite condition. Primary endpoints are the pre-post change in number of CD/ODD symptoms as assessed by a standardised, semi-structured psychiatric interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime, CD/ODD section) between baseline and the end of intervention, as well as between baseline and a 3-month follow-up point. Secondary objectives include pre-post change in CD/ODD-related outcome measures, most notably emotional regulation on a behavioural and neurobiological level after completion of START NOW compared with treatment as usual. Discussion: To our knowledge, this study is the first to date to systematically investigate the effectiveness of an adapted integrative psychosocial intervention designed for female adolescents with ODD and CD in youth welfare settings. Trial registration: German Clinical Trials Register (DRKS) identifier: DRKS00007524. Registered on 18 December 2015 and with the World Health Organisation International Clinical Trials Registry Platform. 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
