How to support peer resistance in adolescents with mild-to-borderline intellectual disability? Intervention development and feasibility.

BACKGROUND: Adolescents with mild-to-borderline intellectual disability face peer resistance challenges, risking harmful or dangerous situations. METHOD: We designed a peer resistance group intervention at school for adolescents with mild-to-borderline intellectual disability, tested its feasibility (N = 4, Mage = 14.1, MIQ = 78.8), adapted it, and tested it again (N = 6, Mage = 15.0, MIQ = 72.8). RESULTS: Study 1 demonstrated feasibility in recruitment, resources, and potential benefits on the distal outcome risk taking. However, attendance, obtained knowledge, and potential benefits on peer resistance, peer problems, and prosocial behaviour were suboptimal. Consequently, study 2 contained more learning by doing and individual lessons, resulting in higher attendance and greater personalization. While potential benefits on improved peer resistance measures were not observed, risk taking improved. CONCLUSIONS: Despite finding no potential benefits on peer resistance, running a peer resistance intervention for adolescents with mild-to-borderline intellectual disability at school is considered feasible.

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.

Eye Movement Desensitization and Reprocessing in Young Children (Ages 4-8) with Posttraumatic Stress Disorder: A Multiple-Baseline Evaluation.

To reduce the acute and long-term effects of trauma, early and effective treatment is necessary. Eye movement desensitization and reprocessing (EMDR) therapy is a brief treatment for posttraumatic stress disorder (PTSD), with a substantial evidence base for children and adolescents aged 8 to 18 years. In the present study we aimed to provide preliminary evidence of EMDR as a trauma treatment for young children. We studied 9 children, aged 4 to 8 years old with a DSM-5 diagnosis of PTSD. A non-concurrent multiple baseline experimental design was used combined with standardized measures. Participants received six 1-h sessions of EMDR. Results post-treatment showed that EMDR was effective in reaching diagnostic remission of PTSD (85.7%), and decreasing severity of PTSD symptoms and emotional and behavioral problems. All gains were maintained at follow-up 3 months after treatment. EMDR appears an effective treatment for PTSD in young children aged 4 to 8 years. Further research is warranted.

Susceptibility to peer influence on prosocial behavior in adolescents with Mild Intellectual Disability or Borderline Intellectual Functioning.

BACKGROUND: Adolescents with Mild Intellectual Disability (MID) or Borderline Intellectual Functioning (BIF) are highly susceptible to negative peer influence. However, research in typically developing adolescents shows that peers can also promote prosocial behavior, which is an opportunity for positive development. AIMS: The current study aimed to investigate the effect of peer influence on prosocial behavior in adolescents with MID or BIF. METHODS AND PROCEDURES: In an experimental donation task, 40 adolescents with MID or BIF (Mage = 14.0, 40 % boys) were repeatedly asked how many of five coins they would like to donate to the group. The task had four consecutive within-subject conditions: alone, with virtual peers present, with virtual peer feedback, and alone again. OUTCOMES AND RESULTS: Results showed that adolescents made larger donations with virtual peers present, and even larger with peer feedback. This increase in donations sustained for subsequent decisions made alone. Finally, adolescents with BIF made larger donations with peer feedback compared to adolescents with MID. CONCLUSIONS AND IMPLICATIONS: Adolescents with MID or BIF are susceptible to peer influence on prosocial behavior, demonstrating the potential effect social context can have on promoting positive development.

Factors of Specialized Mental Health Care Use in the Netherlands: A Scoping Review Applying Andersen-Newman's Care Utilization Model.

As mental disorders impact quality of life and result in high costs for society, it is important patients receive timely and adequate care. This scoping review first aims to summarize which factors contribute to specialized mental health care (SMHC) use. Within the Dutch health care system, the general practitioner (GP) is the filter for SMHC and care use costs are relatively low. Second, to organize factors by Andersen and Newman's care utilization model in illness level, predisposing, and enabling factors. Third, to assess equity of access to SMHC in the Netherlands. A health care system is equitable when illness level and the demographic predisposing factors age and gender account for most variation in care use and inequitable when enabling factors and social predisposing factors such as education predominate. We identified 13 cross-sectional and cohort studies in the Netherlands published between 1970 and September 2020 with 20 assessed factors. Illness level factors, disease severity, diagnosis, personality, and comorbidity contributed the most to SMHC use. Predisposing factors related to a more solitary lifestyle contributed to a lesser degree. Enabling factors income and urbanicity contributed the least to SMHC use. These results imply inequity. Factors that did not fit the care utilization model were GP related, for example the ability to recognize mental disorders. This emphasizes their importance in a system where patients are dependent on GPs for access to SMHC. Focus should be on improving recognition of mental disorders by GPs as well as collaboration with mental health care professionals.

Mood Variability Among Early Adolescents in Times of Social Constraints: A Daily Diary Study During the COVID-19 Pandemic.

The COVID-19 pandemic and associated governmental regulations have drastically changed the daily social lives of children, adolescents, and adults. Changes in the social context may particularly affect children who are in the transition to adolescents (henceforth referred to as early adolescents) as adolescence is a crucial period for peer interactions and development of independence and autonomy. Yet, the impact of the pandemic and associated governmental regulations on early adolescents' emotional well-being has yet to be clarified. In the current study, we explored daily fluctuations in mood in 54 early adolescents (M age = 11.07) during the first few months (April 2020-June 2020) of the COVID-19 pandemic. Moreover, the role of parents and peers on adolescents' mood variability was investigated. Adolescents rated their mood (i.e., happiness, anger, sadness, anxiety) and peer interactions once a day during four separate weeks across different weeks of containment measures in the Netherlands. Moreover, adolescents reported on their experienced attachment to parents and peers and internalizing problems during baseline and the final measurement, respectively. Results showed relatively stable levels of mood during the first few months of the COVID-19 pandemic. However, individual differences in mood variability during the first assessment week were negatively associated with the experienced level of attachment to both parents and peers. Moreover, heightened levels of mood variability did not mediate the link between attachment and internalizing problems. Lastly, the quality of offline contact, but not online contact, was negatively related to adolescents' mood variability. Overall, this study suggests that mood of early adolescents did not heavily fluctuated across the first few months of the COVID-19 pandemic. Our findings add to the growing body of literature aiming to understand how adolescent's life are affected by the COVID-19 crisis and illustrates that social connectedness to parents or peers may facilitate resilience to distress and daily mood fluctuation in early adolescents.

Risk Taking by Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): a Behavioral and Psychophysiological Investigation of Peer Influence.

Adolescents with ADHD demonstrate increased risk-taking behavior (RTB) like substance abuse and dangerous traffic conduct. RTB in adolescence is more likely under peer influence. The current investigation (1) tests the hypothesis that adolescents with ADHD are particularly susceptible to such influence and (2) tests whether groups differed in autonomic reactivity to peer influence. Adolescent boys between 12 and 19 years with (n = 81) and without (n = 99) ADHD performed the Balloon Analogue Risk Task twice. In the peer condition, a highly credible virtual peer manipulation that encouraged risk taking was added, in the solo condition this was absent. Autonomic reactivity was indexed by heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA). All adolescents engaged in more risk taking in the peer condition relative to solo condition. Autonomic differences between groups were only found on PEP: a stronger sympathetic response to peer influence was observed in typically developing adolescents relative to adolescents with ADHD. Increased physiological stress (as indexed by PEP) in the peer relative to the solo condition predicted peer-induced risk taking in all adolescents. We conclude that susceptibility to peer influence is not exaggerated in ADHD but rather reflects a general tendency of adolescents. As adolescents experiencing peer influence as stressful are most susceptible to peer influence, we suggest that increasing resistance to peer influence may be an important treatment aim for these adolescents specifically.

When Do those "Risk-Taking Adolescents" Take Risks? The Combined Effects of Risk Encouragement by Peers, Mild-to-Borderline Intellectual Disability and Sex.

Adolescents with mild to borderline intellectual disability (MBID) show more daily life risk taking than typically developing adolescents. To obtain insight in when these "risk-taking adolescents" especially take risks, we investigated main and interaction effects of (a) MBID, (b) sex, and (c) type of peer influence on risk taking. The Balloon Analogue Risk Task (BART) was used as a proxy of real-life risk taking. 356 adolescents (12-19 years, 51.7% MBID, 63.4% boys) were randomly assigned to one of three BART peer-influence conditions: solo (no peers), positive risk encouragement (e.g., 'You are cool if you continue') or negative risk encouragement (e.g., 'You are a softy if you do not continue'). The main finding was that boys with MBID took more risks than typically developing boys in the negative risk encouragement condition. Boys with MBID also took more risks in the negative risk encouragement condition compared to the solo condition, whereas typically developing boys did not. There were no such effects for girls. Surprisingly, boys with MBID took less risks in the solo condition than typically developing boys. We conclude that boys with MBID especially show high risk taking when peers belittle or threat with exclusion from the peer group. Prevention and intervention programs should specifically target boys with MBID to teach them to resist negative risk encouragement by peers.

Decision-Making Deficits in Adolescent Boys with and without Attention-Deficit/Hyperactivity Disorder (ADHD): an Experimental Assessment of Associated Mechanisms.

Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) demonstrate increased levels of real-life risk-taking behavior like substance abuse and reckless behavior in traffic, which potentially originates in decision-making deficits. Using experimental gambling tasks, the current study investigated three potential underlying mechanisms: (1) risky vs. suboptimal decision making, (2) the complexity of decision-making strategies and (3) the influence of feedback. Participants were 181 male adolescents (81 ADHD, 100 Typically Developing (TD); Mage = 15.1 years). First, we addressed a common confound in many gambling tasks by disentangling risk seeking from suboptimal decision making, and found that ADHD-related decision-making deficits do not originate in increased risk seeking but in suboptimal decision making. Second, we assessed decision-making strategies with a Bayesian latent mixture analysis and found that ADHD-related decision-making deficits are characterized by the use of less complex strategies. That is, adolescent boys with ADHD, relative to TD adolescent boys, less often adopted strategies in which all characteristics relevant to make an optimal decision were integrated. Third, we administered two gambling task conditions with feedback in which adolescents experience the outcomes of their decisions and found that adolescents with ADHD performed worse relative to TD adolescents on both conditions. Altogether, this set of studies demonstrated consistent decision-making deficits in adolescent boys with ADHD: The use of less complex decision-making strategies may cause suboptimal decision making, both in situations with and without direct feedback on performance.

Formal Modeling of the Resistance to Peer Influence Questionnaire: A Comparison of Adolescent Boys and Girls With and Without Mild-to-Borderline Intellectual Disability.

Items of the Resistance to Peer Influence Questionnaire (RPIQ) have a tree-based structure. On each item, individuals first choose whether a less versus more peer-resistant group best describes them; they then indicate whether it is "Really true" versus "Sort of true" that they belong to the chosen group. Using tree-based item response theory, we show that RPIQ items tap three dimensions: A Resistance to Peer Influence (RPI) dimension and two Response Polarization dimensions. We then reveal subgroup differences on these dimensions. That is, adolescents with mild-to-borderline intellectual disability, compared with typically developing adolescents, are less RPI and more polarized in their responses. Also, girls, compared with boys, are more RPI, and, when high RPI, more polarized in their responses. Together, these results indicate that a tree-based modeling approach yields a more sensitive measure of individuals' RPI as well as their tendency to respond more or less extremely.

Peer-Influence on Risk-Taking in Male Adolescents with Mild to Borderline Intellectual Disabilities and/or Behavior Disorders.

This study aimed to disentangle the effects of Mild-to-Borderline Intellectual Disability (MBID) and Behavior Disorders (BD)on risk taking in circumstances where peer influence was absent or present. We studied 319 adolescents in four groups: MBID-only, MBID+BD, BD-only, and typically developing controls. The Balloon Analogue Risk-Task (BART), in a solo or peer condition, was used as a proxy of real-life risk-taking. Results show a significant main effect of BART condition. Post-hoc tests indicated higher risk-taking in the peer compared to the solo condition in all groups except BD-only. Moreover, risk taking was increased in adolescents with MBID compared to adolescents without MBID, but only under peer-influence. No main or interaction effects with BD were observed. Model based decomposition of BART performance in underlying processes showed that the MBID related increase in risk-taking under peer-influence was mainly related to increased risk-taking propensity, and in the MBID-only group also to increased safety estimates and increased confidence in these safety estimates. The present study shows that risk-taking in MBID may be better explained by low intellectual functioning than by comorbid BD, and may not originate in increased risk taking per se, but may rather be related to risk-taking under peer-influence, which is a complex, multifaceted risk-taking context. Therefore, interventions to decrease risk-taking by adolescents with MBID that specifically target peer-influence may be successful.

Is Clinical Anxiety a Risk or a Protective Factor for Executive Functioning in Youth with ADHD? A Meta-regression Analysis.

Comorbidity rates between ADHD and anxiety disorders (AD) are high, but little is known about the nature of this co-occurrence. A dominant idea is that AD may intensify some (i.e., attention and working memory) and attenuate other (i.e., inhibition) ADHD symptoms. Results are mixed, potentially because of between-study differences. To investigate this further we performed a meta-regression analysis on 11 studies (n 'ADHD-only' = 695; n 'ADHD + AD' = 608), containing 35 effect sizes on attention, inhibition and working memory. Main results were: (1) no evidence of a negative effect of AD on attention and working memory; (2) better response inhibition in children with ADHD with AD than those with only ADHD (medium ES g = - .40); (3) medication moderated this association: the effect seemed limited to studies that included medication-naïve participants; (4) the difference between the two groups increased with age for attention and with proportion of boys for working memory ability. There was no effect of comorbid disruptive behavior disorder. In conclusion, AD seems to be a protective factor for inhibition problems as assessed with laboratory tasks in ADHD, especially in children who are medication naïve. Further, AD may have a protective function for attention in older children, and for working memory in boys with ADHD. It is therefore important to screen for AD when diagnosing ADHD, and to educate those with comorbid AD about the possible positive function of feeling anxious. Potential negative effects of ADHD medication on inhibition in children with comorbid AD should be considered.

Time-on-task effects in children with and without ADHD: depletion of executive resources or depletion of motivation?

Children with attention-deficit/hyperactivity disorder (ADHD) are characterized by deficits in their executive functioning and motivation. In addition, these children are characterized by a decline in performance as time-on-task increases (i.e., time-on-task effects). However, it is unknown whether these time-on-task effects should be attributed to deficits in executive functioning or to deficits in motivation. Some studies in typically developing (TD) adults indicated that time-on-task effects should be interpreted as depletion of executive resources, but other studies suggested that they represent depletion of motivation. We, therefore, investigated, in children with and without ADHD, whether there were time-on-task effects on executive functions, such as inhibition and (in)attention, and whether these were best explained by depletion of executive resources or depletion of motivation. The stop-signal task (SST), which generates both indices of inhibition (stop-signal reaction time) and attention (reaction time variability and errors), was administered in 96 children (42 ADHD, 54 TD controls; aged 9-13). To differentiate between depletion of resources and depletion of motivation, the SST was administered twice. Half of the participants was reinforced during second task performance, potentially counteracting depletion of motivation. Multilevel analyses indicated that children with ADHD were more affected by time-on-task than controls on two measures of inattention, but not on inhibition. In the ADHD group, reinforcement only improved performance on one index of attention (i.e., reaction time variability). The current findings suggest that time-on-task effects in children with ADHD occur specifically in the attentional domain, and seem to originate in both depletion of executive resources and depletion of motivation. Clinical implications for diagnostics, psycho-education, and intervention are discussed.

Risky decision making in Attention-Deficit/Hyperactivity Disorder: A meta-regression analysis.

ADHD has been associated with various forms of risky real life decision making, for example risky driving, unsafe sex and substance abuse. However, results from laboratory studies on decision making deficits in ADHD have been inconsistent, probably because of between study differences. We therefore performed a meta-regression analysis in which 37 studies (n ADHD=1175; n Control=1222) were included, containing 52 effect sizes. The overall analysis yielded a small to medium effect size (standardized mean difference=.36, p<.001, 95% CI [.22, .51]), indicating that groups with ADHD showed more risky decision making than control groups. There was a trend for a moderating influence of co-morbid Disruptive Behavior Disorders (DBD): studies including more participants with co-morbid DBD had larger effect sizes. No moderating influence of co-morbid internalizing disorders, age or task explicitness was found. These results indicate that ADHD is related to increased risky decision making in laboratory settings, which tended to be more pronounced if ADHD is accompanied by DBD. We therefore argue that risky decision making should have a more prominent role in research on the neuropsychological and -biological mechanisms of ADHD, which can be useful in ADHD assessment and intervention.

Cool Decision-Making in Adolescents with Behavior Disorder and/or Mild-to-Borderline Intellectual Disability.

Adolescents with Behavior Disorders (BD), Mild-to-Borderline Intellectual Disability (MBID), and with both BD and MBID (BD + MBID) are known to take more risks than normal controls. To examine the processes underlying this increased risk-taking, the present study investigated cool decision-making strategies in 479 adolescents (12-18 years, 55.9 % male) from these four groups. Cool decision-making was assessed with the paper-and-pencil Gambling Machine Task. This task, in combination with advanced latent group analysis, allows for an assessment of decision strategies. Results indicated that adolescents with BD and controls were almost equivalent in their decision-making strategies, whereas adolescents with MBID and adolescents with BD + MBID were characterized by suboptimal decision-making strategies, with only minor differences between these two clinical groups. These findings may have important clinical implications, as they suggest that risk taking in adolescents with MBID and in adolescents with BD + MBID can be (partly) attributed to the strategies that these adolescents use to make their decisions. Interventions may therefore focus on an improvement of these strategies.

Rapid Automatized Naming in Children with Dyslexia: Is Inhibitory Control Involved?

Rapid automatized naming (RAN) is widely seen as an important indicator of dyslexia. The nature of the cognitive processes involved in rapid naming is however still a topic of controversy. We hypothesized that in addition to the involvement of phonological processes and processing speed, RAN is a function of inhibition processes, in particular of interference control. A total 86 children with dyslexia and 31 normal readers were recruited. Our results revealed that in addition to phonological processing and processing speed, interference control predicts rapid naming in dyslexia, but in contrast to these other two cognitive processes, inhibition is not significantly associated with their reading and spelling skills. After variance in reading and spelling associated with processing speed, interference control and phonological processing was partialled out, naming speed was no longer consistently associated with the reading and spelling skills of children with dyslexia. Finally, dyslexic children differed from normal readers on naming speed, literacy skills, phonological processing and processing speed, but not on inhibition processes. Both theoretical and clinical interpretations of these results are discussed.

Interference control in adolescents with mild-to-borderline intellectual disabilities and/or behavior disorders.

The aim of this study was to investigate interference control in adolescents with Mild to Borderline Intellectual Disability (MBID) by addressing two key questions. First, as MBID is often associated with comorbid behavior disorders (BD), we investigated whether MBID and BD both affect interference control. Second, we studied whether interference control deficits are associated to problems in everyday executive functioning. Four groups of adolescents with and without MBID and/or BD performed the Eriksen flanker task, requiring participants to respond to a central target while ignoring interfering flanking stimuli. Their teachers rated behavior on the Behavior Rating Inventory Executive Function (BRIEF). We found pronounced effects of MBID but not BD on flanker interference control. In contrast, we observed pronounced effects of BD, but not MBID, on the BRIEF. In addition, flanker interference scores and BRIEF scores did not correlate. These results are taken to suggest that adolescents with MBID are characterized by deficits in interference control that do not become manifest in ratings of everyday executive functioning. In contrast, adolescents with BD are not characterized by deficits in interference control but do show elevated ratings of deficits in everyday executive function.

Formal models of "resource depletion".

The opportunity cost model (OCM) aims to explain various phenomena, among which the finding that performance degrades if executive functions are used repeatedly ("resource depletion"). We argue that an OCM account of resource depletion requires two unlikely assumptions, and we discuss an alternative that does not require these assumptions. This alternative model describes the interplay between executive function and motivation.

Muscle or motivation? A stop-signal study on the effects of sequential cognitive control.

Performance on cognitive control tasks deteriorates when control tasks are performed together with other control tasks, that is, if simultaneous cognitive control is required. Surprisingly, this is also observed if control tasks are preceded by other control tasks, that is, if sequential cognitive control is required. The typical explanation for the latter finding is that previous acts of cognitive control deplete a common resource, just like a muscle becomes fatigued after repeated usage. An alternative explanation, however, is that previous acts of cognitive control reduce motivation to match allocated resources to required resources. In this paper we formalize these muscle and motivation accounts, and show that they yield differential predictions regarding the interaction between simultaneous and sequential cognitive control. These predictions were tested using a paradigm where participants had to perform multiple stop-signal tasks, which varied in their demands on simultaneous and sequential control. Results of two studies supported predictions derived from the motivation account. Therefore, we conclude that the effects of sequential cognitive control are best explained in terms of a reduction of motivation to match allocated to required resources.