The association between delinquent peer affiliation and disruptive behavior interacts with functional brain correlates of reward sensitivity: a biosocial interaction study in adolescent delinquents.

BACKGROUND: Affiliating with delinquent peers may stimulate the development of antisocial behavior, especially for adolescents who are sensitive to social rewards. The current study examines whether the association between delinquent peer affiliation (DPA) and disruptive behavior interacts with functional brain correlates of reward sensitivity in early onset male adolescents delinquents. METHODS: Childhood arrestees (n = 126, mean age = 17.7 [s.d. 1.6]) completed a DPA questionnaire, and participated in an fMRI study in which reward sensitivity was operationalized through responsiveness of the ventral striatum (VS), amygdala, and medial prefrontal cortex (mPFC) during the monetary incentive delay paradigm (reward anticipation and outcome). Symptoms of disruptive behavior disorders (DBD) were assessed through structured psychiatric interviews (Diagnostic Interview Schedule for Children) with adolescents. RESULTS: DPA had a main effect on DBD symptoms. Adolescents with high VS reward responses showed a stronger significant positive association between DPA and DBD symptoms compared to low VS responders. No evidence for an interaction effect was found for the amygdala and mPFC. Post-hoc analyses revealed the positive association between DPA and DBD was only present in males, with a diminishing effect as age increased. CONCLUSIONS: We found evidence for a biosocial interaction between DPA and reward sensitivity of the VS in relation to DBD symptom severity. This study provides the first evidence of an interaction effect between a brain mechanism and an environmental factor in relation to DBD symptoms, implying that susceptibility to influences of delinquent peers may intertwine with individual biological differences.

Improving Collaboration Between Youth Peer Support Workers and Non-peer Colleagues in Child and Adolescent Mental Health Services.

The involvement of youth peer workers (YPSWs) in child and adolescent mental health services (CAMHS) stimulates hope, destigmatization, and more culturally and developmentally appropriate support. Nevertheless, the collaboration between YPSWs and non-peer colleagues remains challenging, as it requires services to embed a new type of expert into practice. To stimulate the involvement of YPSWs in practice, this study reports on 27 semi-structured interviews with YPSWs and non-peer colleagues to provide insight into the barriers and facilitators in the collaboration process. The study took place in the Netherlands. A total of 10 interviews with YPSWs, and 17 interviews with non-peer colleagues in different healthcare occupations in CAMHS were conducted. Overall, the participants perceived relatively more barriers compared to facilitators in the collaboration process. Barriers to operate efficiently with YPSWs in multidisciplinary teams included: condescending attitudes and professional stigma towards YPSWs; concerns for YPSW boundaries; bureaucratic and clinical language usage by non-peer colleagues; conflicts due to different sets of expertise; and, lack of role clarity and guidelines for YPSWs. To improve the partnership between YPSWs and non-peer colleagues, participants described the importance of supervision and monitoring of YPSW activities. Moreover, participants also stressed the need for clear guidelines, and introduction and evaluation sessions to facilitate the collaboration process. While YPSWs seem to be an asset to CAMHS, there are a number of barriers to overcome. To overcome these barriers, organizational commitment, supervision (especially from peer colleagues), flexibility by non-peer colleagues, training non-peer staff to support YPSWs, and consistent evaluation of the implementation of YPSWs in services is recommended.

Additional Value of Peer Informants in Psychological Autopsy Studies of Youth Suicides.

In this study, we examined the feasibility and added value of including peer informants in a psychological autopsy study of youth suicides. Peer semi-structured interview data from 16 cases were analyzed qualitatively and compared to parent data. Results show that peers added information to parents' narratives in general and particularly on social relationships, bullying, school experiences, social media, and family relations. Peers also provided additional information on the presence of certain issues (such as social media contagion) as well as on the emotional impact from certain adverse events that seemed to have functioned as precipitating factors. We conclude that including peers in psychological autopsy studies of youth suicides is feasible and of added value but that more research is desirable. The results initially can be used in the design of psychological autopsies so that the maximum amount of information about each suicide will be learned.

Perspectives on clinical guidelines for severe behavioural problems in children across Europe: a qualitative study with mental health clinicians.

Clinical guidelines for severe behavioural problems (SBPs) in children have recently been developed in several European countries. However, questions emerged regarding their applicability to practice. Our study aimed to provide a first European insight into guidelines' fitness-for-purpose by exploring mental health clinicians' familiarity with, use and perceived value of guidelines for SBPs in children. Participants included 161 clinicians, primarily psychiatrists, from 24 countries. Clinicians completed a semi-structured qualitative questionnaire on existing SBPs guidelines and development of new guidelines where not available. Clinicians' responses were mapped against academic experts' perceptions on SBPs guidelines highlighted in a previous study (Gatej et al. in Eur Psychiatry 57:1-9, 2019). Under half of the clinicians reported being unaware of guidelines. Of these, 37.6% represented countries where guidelines were available according to experts. The remaining half of clinicians who were aware of guidelines on average reported being moderately familiar with their content, perceiving them as moderately useful and using them some of the time. Additionally, 60.8% clinicians agreed that SBPs guidelines need to be developed, as these would create a shared scientific knowledge base and common practice. Guideline improvements included taking a multifactorial approach, creating specific case recommendations, and dissemination efforts. The modest familiarity with and use of guidelines amongst practitioners may highlight guidelines poor fitness-for-purpose, or, alternatively, an underlying confusion around the meaning and purpose of guidelines. Moving forward, efforts should be directed at disseminating clearer definitions of guidelines, addressing existing challenges, and unifying efforts to further develop and audit application of international guidelines for SBPs.

Correction to: Spontaneous discontinuation of distressing auditory verbal hallucinations in a school­based sample of adolescents: a longitudinal study.

In the Original Publication Table 2 was incorrectly published. The correct table is given below.

Spontaneous discontinuation of distressing auditory verbal hallucinations in a school-based sample of adolescents: a longitudinal study.

Auditory verbal hallucinations (AVH) can be transiently present in both clinical and healthy adolescent populations. It is not yet fully understood why AVH discontinue in some adolescents and persist in others. The aim of this explorative study is to investigate predictors of spontaneous discontinuation of distressing AVH in a school-based sample of adolescents. 1841 adolescents (mean age 12.4 years, 58% female) completed self-report questionnaires at baseline. The current study included 123 adolescents (7%; 63% female) who reported at least mild distressing AVH at baseline and completed follow-up measurements. LASSO analyses were used to uncover predictors of spontaneous discontinuation of distressing AVH. During follow-up, 43 adolescents (35%) reported having experienced distressing AVH during the last 12 months, while 80 adolescents did not. Spontaneous discontinuation of distressing AVH was predicted by never having used cannabis, parents not being divorced in the past year, never having been scared by seeing a deceased body, less prosocial behaviour, school grade repetition, having the feeling that others have it in for you, having anxiety when meeting new people, having lived through events exactly as if they happened before and having the feeling as if parts of the body have changed. No associations between spontaneous discontinuation of distressing AVH and age or ethnicity were found. Distressing AVH in non-clinical adolescents are mostly transient. Discontinuation was predicted up to a certain extent. However, several predictors were difficult to interpret and do not provide leads for preventive measures, except for discouraging cannabis use.

Psychotic experiences among ethnic majority and minority adolescents and the role of discrimination and ethnic identity.

PURPOSE: Research shows that the prevalence of psychiatric problems is higher in ethnic minority youth compared to native youth. This school-based screening study of early adolescents' mental health in the Netherlands examined differences in prevalence of psychotic experiences in ethnic minority youth compared to their Dutch peers. Moreover, we investigated the association between psychotic experiences, ethnic identity, and perceived discrimination. METHODS: A cohort of 1194 ethnic majority and minority adolescents (mean age 13.72, SD 0.63) filled-out questionnaires on psychotic experiences (including delusional and hallucinatory experiences), perceived group and personal discrimination, and ethnic identity. RESULTS: Apart from lower levels of hallucinatory experiences in Turkish-Dutch adolescents, prevalence of psychotic experiences did not differ between ethnic minority and majority adolescents. Perceived personal discrimination was associated with the presence of psychotic experiences (including delusional and hallucinatory experiences) (OR 2.30, 95% CI 1.22-4.34). This association was stronger for delusional experiences (OR 2.94, 95% CI 1.43-6.06) than for hallucinatory experiences (OR 1.65, 95% CI 0.73-3.72). No significant associations were found between perceived group discrimination and psychotic experiences. A weak ethnic identity was associated with higher risk for reporting psychotic experiences (OR 2.04, 95% CI 1.14-3.66), particularly hallucinatory experiences (OR 3.15, 95% CI 1.54-6.44). When looking at specific ethnic identity categories, marginalization, compared to separation, was associated with a threefold risk for reporting psychotic experiences (OR 3.26, 95% CI 1.33-8.03). Both marginalisation (OR 3.17, 95% CI 1.04-9.63) and assimilation (OR 3.25, 95% CI 1.30-8.13) were associated with a higher risk for hallucinatory experiences. CONCLUSIONS: These results underline the protective effect of ethnic identity against mental health problems. Future research should focus on interventions that focus on strengthen social identity.

Psychotic experiences and trauma predict persistence of psychosocial problems in adolescence.

Psychosocial problems during adolescence are heterogenic, rather common, and unstable. At the same time, they are associated with an elevated risk of developing psychiatric disorders later in life. We aimed to describe the trajectories of psychosocial problems during adolescence and examine potential markers of persistence as compared to remission of these problems. At baseline, 1841 adolescents (51.4% female) were included. Of these adolescents, 1512 (mean age = 12.6 [range 11-14 years]; 52.8% female) completed the first and second self-report questionnaires on psychosocial problems (measured with the Strengths and Difficulties Questionnaire), psychotic experiences, trauma, self-esteem and somatic symptoms at two time points over a 1-year period. Regression analyses were used to examine the association between potential predictors and the trajectory of psychosocial problems (remitting versus persistent). Four trajectories were distinguished: 75.6% of the sample showed no problems (the 'none' trajectory), 11.9% were in a 'remitting' trajectory, 9.7% were in an 'incident' trajectory and 2.8% were in the 'persistent' trajectory. Hallucinatory experiences and trauma at baseline were significantly associated with persistence of psychosocial problems compared to those with remitting psychosocial problems. Low rather than high self-esteem was associated with lower risk for persistent problems. Risk of persistence of psychosocial problems increased with accumulation of predictors. Psychotic, especially hallucinatory, experiences and trauma predict persistence of psychosocial problems in adolescents. This underlines the need to assess psychotic experiences and trauma in mental health screening programs.

Peer status in relation to psychotic experiences and psychosocial problems in adolescents: a longitudinal school-based study.

Social exclusion is related to many adverse mental health outcomes and may be particularly harmful for mental health in adolescence when peer relations become very important. This study examined associations between low peer status and psychotic experiences, psychosocial problems and short-term courses of these symptoms. A school-based sample of adolescents (N = 1171) was investigated in 2 consecutive years using the 16-item Prodromal Questionnaire and the self-report and teacher-report version of the Strengths and Difficulties Questionnaire (SDQ). Peer status was measured in the second year with positive and negative peer nominations of classmates. Low peer status was, after adjusting for gender, ethnic minority status and level of education, associated with more psychosocial difficulties with a persistent course and a higher level of psychotic experiences. Of all peer status groups, being neglected had the strongest associations with mental health problems. The results of this study show that social exclusion in adolescence is related to psychotic experiences and psychosocial problems, emphasizing the importance of belonging to a social group. Customized prevention programs at individual, family and school level should target causes and consequences of social exclusion.

Implementing Non-violent Resistance, a Method to Cope with Aggression in Child and Adolescent Residential Care: Exploration of Staff Members Experiences.

Staff members in residential care for youth are frequently confronted with aggressive behaviour, which has adverse effects on their stress levels and work satisfaction. This paper describes a qualitative evaluation to find out how staff members benefit from Non-violent Resistance (NVR), a method to create an aggression mitigating residential climate. Staff members were positive about NVR and reported feeling more relaxed. Most valued aspects of this method were the focus on being a team, delayed response and giving up the illusion of control. However, training and the intention to use NVR isn't enough, high quality implementation and maintenance are crucial.

Research Review: The effectiveness of multidimensional family therapy in treating adolescents with multiple behavior problems - a meta-analysis.

BACKGROUND: Multidimensional family therapy (MDFT) is a well-established treatment for adolescents showing both substance abuse and/or antisocial behavior. METHOD: The effectiveness of MDFT in reducing adolescents' substance abuse, delinquency, externalizing and internalizing psychopathology, and family malfunctioning was examined by means of a (three-level) meta-analysis, summarizing 61 effect sizes from 19 manuscripts (N = 1,488 participants). RESULTS: Compared with other therapies, the overall effect size of MDFT was significant, albeit small in magnitude (d = 0.24, p < .001), and similar across intervention outcome categories. Moderator analysis revealed that adolescents with high severity problems, including severe substance abuse and disruptive behavior disorder, benefited more from MDFT than adolescents with less severe conditions. CONCLUSIONS: It can be concluded that MDFT is effective for adolescents with substance abuse, delinquency, and comorbid behavior problems. Subsequently, it is important to match specific characteristics of the adolescents, such as extent of impairment, with MDFT.

Factors associated with psychiatric symptoms and psychiatric disorders in ethnic minority youth.

While ethnic diversity is increasing in many countries, ethnic minority youth is less likely to be reached, effectively treated and retained by youth mental health care compared to majority youth. Improving understanding of factors associated with mental health problems within socially disadvantaged ethnic minority youth is important to tailor current preventive and treatment interventions to the needs of these youth. The aim of this study was to explore factors at child, family, school, peer, neighbourhood and ethnic minority group level associated with mental health problems in Moroccan-Dutch youth (n = 152, mean age 13.6 ± 1.9 years). Self-reported and teacher-reported questionnaire data on psychiatric symptoms and self-report interview data on psychiatric disorders were used to divide children into three levels of mental health problems: no symptoms, only psychiatric symptoms and psychiatric disorders. Psychiatric symptoms and/or disorders were associated with more psychopathic traits, a higher number of experienced trauma and children in the family, and more conflicts with parents, affiliation with delinquent peers, perceived discrimination and cultural mistrust. Psychiatric symptoms and/or disorders were also associated with less self-esteem, parental monitoring, affiliation with religion and orientation to Dutch or Moroccan culture, and a weaker ethnic identity. For youth growing up in a disadvantaged ethnic minority position, the most important factors were found at family (parent-child relationship and parenting practices) and ethnic minority group level (marginalization, discrimination and cultural mistrust). Preventive and treatment interventions for socially disadvantaged ethnic minority youth should be aimed at dealing with social disadvantage and discrimination, improving the parent-child relationship and parenting practices, and developing a positive (cultural) identity.

The link between ethnicity, social disadvantage and mental health problems in a school-based multiethnic sample of children in The Netherlands.

To investigate to what extent differences in prevalence and types of mental health problems between ethnic minority and majority youth can be explained by social disadvantage. Mental health problems were assessed in a sample of 1,278 schoolchildren (55% Dutch, 32% Moroccan and 13% Turkish; mean age: 12.9 ± 1.8) using the Strengths and Difficulties Questionnaire self-report and teacher report. Measures of family socioeconomic status, neighbourhood deprivation, perceived discrimination, family structure, repeating a school year, housing stability and neighbourhood urbanization were used as indicators of social disadvantage, based on which a cumulative index was created. Ethnic minority youth had more externalizing and fewer internalizing problems than majority youth. Perceived discrimination and living in an unstable social environment were associated with mental health problems, independent of ethnicity. A dose-response relationship was found between social disadvantage and mental health problems. The adjusted odds ratio for mental health problems was 4.16 (95% CI 2.49-6.94) for more than four compared with zero indicators of social disadvantage. Social disadvantage was more common in ethnic minority than in majority youth, explaining part of the differences in prevalence of mental health problems. Ethnic minority youth in the Netherlands have a different profile of mental health problems than majority youth. In all ethnic groups, the risk of mental health problems increases with the degree of social disadvantage. The higher prevalence of externalizing problems among ethnic minority youth is explained partly by their disadvantaged social position. The findings suggest that social factors associated with ethnicity are likely to explain mental health problems in ethnic groups.

Mental health problems and recidivism among detained male adolescents from various ethnic origins.

This study examines differences in self-reported mental health problems between detained youths from Dutch, Moroccan, and Surinamese origin and the usefulness of mental health problems to predict violent and property recidivism in these juveniles. A sample of 296 detained boys aged between 12 and 18 years were assessed by means of the Strengths and Difficulties Questionnaire (SDQ). Official information regarding criminal history and recidivism was collected 3-6 years later. In general, Dutch youths and Surinamese youths reported more conduct problems than Moroccan youths, while Dutch youths also reported more hyperactivity than Surinamese youths. Mental health problems were not predictive of violent recidivism in any of the ethnic groups, while being related with property recidivism in Dutch and Surinamese youths. The current study showed that Moroccan youths present themselves on the SDQ as a less seriously disturbed group of youths than their Dutch and Surinamese counterparts. Our results also clearly showed that SDQ self-report scores are not predictive of future violent crimes in any of the three ethnic groups. Implications of the findings and limitations of the current study are discussed.

Relational security: conceptualization and operationalization in small-scale, strengths-based, community-embedded youth justice facilities.

BACKGROUND: Given the developmental vulnerability of justice-involved youth, providing a safe environment in secure facilities is a paramount, yet challenging task. Within this complexity, a sound security framework is key. The security framework exists on three dimensions: physical, procedural and relational security. Existing knowledge points at the importance of a shift in focus on physical and procedural security towards relational security as the core of the security framework. At the same time there is a dearth of knowledge on relational security, particularly in the context of youth justice. This paper explores relational security and its working mechanisms in practice. METHODS: This paper draws on findings of a comprehensive three-year evaluation of three small-scale, community-embedded facilities that are grounded in relational security. The approach of the evaluation was derived from action research, involving a cyclic process alternating between action, research and critical reflection, while engaging all stakeholders in the research process. The action research cycle involved qualitative research (a total of 63 semi-structured interviews) incorporating the perspective of staff, youth and parents. RESULTS: Relational security is grounded in three distinct, but interrelated, elements - staff's basic attitude, a constructive alliance between staff and youth, staff presence - and promotes a safe and therapeutic environment through several mechanisms. CONCLUSIONS: Relational security can be defined in a practical conceptualization; outlining a way of working that guides staff in how to establish a safe and therapeutic environment in secure facilities. This conceptualization finds support in the well-established literature covering the therapeutic alliance and can be substantiated by two aligning theories concerning youth justice strategies: social-ecological theory and self-determination theory. Relational security is not only a way of working, but also a way of being. It encompasses a vision about security and mentality towards justice-involved youth that sees them not merely as 'risks to be managed', but primarly as 'resources to be developed'.

Living Situation of Juveniles After Secure Residential Treatment: Exploring the Role of Family Centeredness, Child, and Family Factors.

To promote the return of juveniles to a home-like environment (e.g. living with (foster)parents) after secure residential treatment (SRT), it is important to know which factors are related to this outcome. The current study examined which characteristics of the juvenile, family, and SRT, including family centeredness and use of systemic interventions, are related to the living situation after discharge. For 259 juveniles (mean age 15.82 years, 127 girls) in SRT and their parents, questionnaires were administered at admission, discharge, and 6-months follow-up. Furthermore, information about the living situation before and after SRT was gathered. Higher likelihood of living in a home-like setting after SRT correlated with more furlough moments with parents, receiving a systemic intervention, and a shorter duration of the SRT. Systemic interventions during SRT and spending furlough moments with parents may have a positive impact on returning to a home-like situation after SRT for juveniles.

A Tailored Approach for Justice Involved Youth With an Intellectual Disability: The Suitability of a Small-Scale Community-Integrated Approach.

Youngsters with intellectual disabilities are overinvolved within the youth justice system. The aim of this study was to explore the suitability of a small-scale community-integrated approach for justice involved youngsters with intellectual disabilities. This study compared the numbers of transfers, the number, type, and rate of change in incidents, and the possible mediating effect of resilience thereon, between 40 youngsters with and 19 youngsters without intellectual disabilities, placed in a small-scale facility. There were no differences in the number of transfers, the number, type, and rate of change in incidents, and no mediating effect of resilience was found. A small-scale community integrated approach for youth justice facilities can be suited to provide tailored placement for youngsters with intellectual disabilities, given the presence of protective factors and motivation. Both youngsters with and without intellectual disabilities showed a low number of incidents and were able to continue or initiate structural daytime activities.

Autistic symptoms in childhood arrestees: longitudinal association with delinquent behavior.

BACKGROUND: To compare childhood arrestees with matched comparison groups on levels of autistic symptoms and to assess the unique predictive value of autistic symptoms for future delinquent behavior in childhood arrestees. METHODS: Childhood first-time arrestees (n = 308, baseline age 10.7 ± 1.5 years) were followed up for 2 years. Autistic symptoms, externalizing disorders and delinquent behavior were assessed yearly. Childhood arrestees were compared on autistic symptoms with matched (age, gender) general population and clinical autism spectrum disorder samples. The predictive value of autistic symptoms for delinquent behavior was analyzed using generalized estimating equations. RESULTS: At each assessment, levels of autistic symptoms in childhood arrestees were in between levels found in the general population and autism spectrum disorder samples. Autistic symptoms were positively associated with delinquent behavior in childhood arrestees, even after adjustment for externalizing disorders: IRR (incidence rate ratio) 1.23; 95% CI 1.11-1.36 and IRR 1.29; 95% CI 1.15-1.45 for core autistic symptoms and total symptom score, respectively. CONCLUSIONS: Autistic symptoms are more prevalent in childhood arrestees compared to the general population and are uniquely associated with future delinquent behavior. Attention should, therefore, be given to the possible presence of autism related symptomatology in these children. Implications for diagnostic assessment and intervention need further investigation.

Externalizing psychopathology and persistence of offending in childhood first-time arrestees.

This study aims to investigate the predictive validity of externalizing psychopathology for persistence in delinquent behavior when controlling for socio-demographic and first arrest characteristics in childhood first-time arrestees. A sample of first-time arrestees aged under 12 (n = 192) was assessed using the Diagnostic Interview Schedule for Children (DISC-IV) parent-version on attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD). Based on child and parent reports of offending as obtained at arrest and at 2-year follow-up, three groups of offenders were differentiated: (1) persistent high (n = 48), (2) occasional (n = 62), and (3) persistent low offenders (n = 82). Over one-third of the sample (33.9%) was diagnosed with an externalizing disorder, and 13.5% with both ADHD and ODD or CD. Higher levels of externalizing psychopathology distinguished persistent high offenders from occasional (comorbid ADHD and ODD/CD: OR 8.2, CI 2.6-25.5) and persistent low offenders (comorbid ADHD and ODD/CD: OR 18.2, CI 4.6-72.3; ADHD: OR 4.1, CI 1.3-13.0), over and above socio-demographic and first offense characteristics. Living with both biological parents distinguished the persistent low offenders from the occasional offenders (OR 2.5, CI 1.2-5.0). Since the prevalence of externalizing disorders was high and predicted re-offending, mental health screening and intervention initiatives, aiming at these conditions, should be investigated for this high-risk sample.

Resisting aggression in social contexts: The influence of life-course persistent antisocial behavior on behavioral and neural responses to social feedback.

Early adulthood has long been recognized as a potential turning point for the development of antisocial behavior, due to changes in social contexts and ongoing psychological and neurobiological maturation. However, it remains unclear how different developmental trajectories of antisocial behavior, their neural underpinnings, and individual differences in psychopathic traits may help explain the distinct developmental outcomes of individuals who persist in or desist from antisocial behavior in early adulthood - such as how they respond to others in social contexts. Therefore, in the current study, young adults (aged 18-30, 68% male) with a persistent or desistant antisocial trajectory (N = 54), as well as healthy controls (N = 39), completed the Social Network Aggression Task, during which they received positive, neutral, or negative feedback on a personal profile and got the opportunity to retaliate by blasting a loud noise. On a behavioral level, results indicated that in all groups, negative peer feedback evoked higher retaliatory aggression, compared to positive and neutral feedback. On a neural level, when receiving social feedback, individuals with persistent or desistent trajectories showed both similar and dissociable patterns of neural activity; desisting and persisting trajectory groups showed higher activity in the Insula, and the desisting trajectory group showed higher activity in dlPFC. Finally, when participants retaliated, they showed increased dlPFC and ACC activity following positive relative to neutral and negative feedback, where ACC activity correlated most strongly with inhibition of retaliatory responses in the desisting trajectory group. Together, these findings provide novel insights in dissociable patterns of brain activity that may increase our understanding of the mechanisms underlying different developmental trajectories of antisocial behavior.