Towards a more comprehensive understanding of PTSD and parenting.

BACKGROUND: The impact of post-traumatic stress disorder (PTSD) on parenting and the parent-child relationship has been well-documented in the scientific literature. However, some conceptual and methodological challenges within this research field remain. PROCEDURE: We reflect on a number of challenges that we identified while examining the literature in preparation of an individual participant data meta-analysis on the relationships between PTSD and parenting. FINDINGS: We address 1) the presence of 'trauma-islands'; 2) the need for transdiagnostic theoretical frameworks for mechanisms between PTSD and parenting; 3) the lack of developmental perspectives; 4) the overuse of self-reported retrospective measures; 5) the need to study more diverse samples and cultural contexts; and 6) the lack of research on resilience and post-traumatic growth in parenting. Based on these reflections, we offer suggestions on strategies for responding to these challenges through: 1) welcoming open science; 2) working towards shared theoretical frameworks; 3) doing more longitudinal research 4) expanding the methodological palette; 5) centering lived experience; and 6) taking systemic inequality into account. CONCLUSION: With this commentary, we aim to open a discussion on next steps towards a more comprehensive understanding of the association between PTSD and parenting, and inspire collaborative research.

Stability and change in maternal parenting profiles across infancy and toddlerhood.

During infancy and toddlerhood, parents show large individual differences in the extent to which they are able to tailor their parenting behaviors to their children's swiftly changing developmental needs. The first aim of our study was, therefore, to distinguish parenting profiles at three time points during infancy and toddlerhood (i.e., 5, 10, and 36 months) based on mothers' supportive presence, structure and limit-setting, and quality of instruction, as well as to examine the stability of profile structure and profile membership across time. The second aim was to examine how profile membership and profile transitions at each time point are associated with relevant parental, contextual, and child-specific factors. Data from 244 Dutch mother-child dyads were collected at three waves: when children were approximately 5 months (n = 203), 10 months (n = 181), and 3 years of age (n = 178). We found three types of parenting profiles at each wave: a competent profile, a sufficient profile, and a maladaptive profile. Only the competent parenting profile was found to have a stable structure across all three waves. In general, profile membership was least stable for the maladaptive profile. Results also showed that maternal agreeableness and a higher educational level increased the likelihood to exhibit a more competent parenting profile. Our findings advance our understanding of how parenting profiles might change due to children's swiftly changing needs and inform efforts to tailor parenting interventions to individual parents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The effectiveness of blended versus regular Forensic Outpatient Systemic Therapy in the treatment of juvenile antisocial behavior: a study protocol of a randomized controlled trial.

BACKGROUND: Antisocial behavior during adolescence can have long-lasting negative effects and leads to high societal costs. Forensic Outpatient Systemic Therapy (Forensische Ambulante Systeem Therapie; FAST) is a promising treatment for juveniles aged 12-21 showing severe antisocial behavior. The intensity, content and duration of FAST can be adjusted to the needs of the juvenile and their caregiver(s), which is considered crucial for effective treatment. Next to the regular version of FAST (FASTr), a blended version (FASTb) in which face-to-face contacts are replaced by minimally 50% online contacts over the duration of intervention was developed during the Covid-19 pandemic. The current study will investigate whether FASTb is equally effective as FASTr, and through which mechanisms of change, for whom, and under which conditions FASTr and FASTb work. METHODS: A randomized controlled trial (RCT) will be carried out. Participants (N = 200) will be randomly assigned to FASTb (n = 100) or FASTr (n = 100). Data collection will consist of self-report questionnaires and case file analysis, and include a pre-test at the start of the intervention, a post-test immediately after the intervention, and a six month follow-up. Mechanisms of change will be investigated using monthly questionnaires of key variables during treatment. Official recidivism data will be collected at two-year follow-up. DISCUSSION: This study aims to improve the effectiveness and quality of forensic mental health care for juveniles with antisocial behavior by studying the effectiveness of blended care, which has not been studied before in treatment of externalizing behavior. If found to be at least as effective as face-to-face treatment, blended treatment can help meet the urgent need for more flexible and efficient interventions in this field. In addition, the proposed study aims to unravel what works for whom, knowledge urgently needed in mental health care for juveniles with severe antisocial behavior. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov on 07/11/2022, registration number NCT05606978.

Adding Structured Components to Home Visitation to Reduce Mothers' Risk for Child Maltreatment: a Randomized Controlled Trial.

Purpose: Home visitation program effects are generally small, which may be caused by flexible intervention content leading to inconsistent outcomes. In this study we therefore examined whether the effectiveness of a Dutch home visitation program (i.e., Supportive Parenting) can be improved by adding structured intervention components targeting key risk factors for child maltreatment: parental sense of competence, perceived stress, parental anger, and PTSD symptoms. Method: Participants were randomly assigned to an experimental group (n = 74) that received four additional intervention components in two home visits, or a control group (n = 60) that received regular Supportive Parenting. Outcomes were assessed before (T1) and after (T2) the first, and before (T3) and after (T4) the second home visit. Effects were examined using ANCOVA for primary outcomes: parental sense of competence, perceived stress, parental anger, and PTSD symptoms, and secondary outcomes: risk of child maltreatment, parental warmth, and negative parenting. Moderation effects were examined for T1 scores, child temperament and life events. Results: Mothers who received the intervention components showed less stress compared to the control group at T3 and T4. There were no differences between groups on other outcomes and no moderation effects, although parental sense of competence reduced and anger increased within the experimental group specifically. Conclusion: The structured components may enhance the effectiveness of Supportive Parenting to reduce parenting stress. Future research into how other outcomes can be improved is needed. Supplementary Information: The online version contains supplementary material available at 10.1007/s10896-023-00509-7.

The effectiveness and cost-effectiveness of Acceptance and Commitment Therapy as a transdiagnostic intervention for transitional-age youth: study protocol of a randomized controlled trial.

BACKGROUND: Although the prevalence of psychological problems in transitional-age youth (i.e., youth aged 15 to 25; TAY) is high, TAY are much less likely to receive age-appropriate treatments for their psychological problems compared to younger adolescents or older adults. Hence, effective interventions for TAY seem warranted. ACT your way is a transdiagnostic treatment, specifically developed for TAY, based on the principles of Acceptance and Commitment Therapy (ACT). ACT your way is not directed primarily at symptom reduction, but mainly aims to change the underlying mechanism of psychopathology, namely increasing TAY's psychological flexibility. Meta-analyses show that ACT is an effective treatment for adults with diverse types of psychopathology. Less is known about the effectiveness of ACT for TAY. Therefore, the goal of this study is to examine the effectiveness and cost-effectiveness of ACT your way. In addition, we will investigate for whom and under what circumstances (i.e., moderators) and how (i.e., mediators) the intervention is (most) effective. METHOD: The study is designed as a multi-centre, randomized controlled trial. In total, 140 TAY diagnosed with any psychological disorder will be randomly assigned to either the ACT your way or treatment as usual (TAU) condition. In total, six assessments will be conducted: at baseline, after 3, 6 and 9 sessions, at post-intervention and at 6-month follow-up, using multiple informants (TAY, parents/caregivers, therapists). Assessments will include diagnostic interviews and questionnaires. The primary outcomes are psychological flexibility and number of DSM-5 diagnoses; the secondary outcomes are the presence of the primary DSM-5 diagnosis, psychopathology, personality problems, global, individual and societal functioning, quality of life, stress, treatment satisfaction, treatment drop-out and therapeutic alliance. We will also assess costs and various moderators (i.e., demographic characteristics, type and severity of problems, psychopathology of parents/caregivers, treatment expectancy and previous treatments) and mediators (i.e., psychological flexibility, emotion regulation, self-compassion, autonomy, perfectionism, self-esteem and group cohesion). DISCUSSION: To our knowledge, this is the first study investigating the (cost-)effectiveness of ACT compared to TAU in clinically referred TAY with various types of psychopathology, using a rigorous design. TRIAL REGISTRATION: The research project is registered in the Dutch Trial Register (Trial NL9642).

The direct and indirect effects of parenting behaviors and functional brain network efficiency on self-regulation from infancy to early childhood: A longitudinal mediation model.

There is growing interest in the hypothesis that early parenting behaviors impact children's self-regulation by affecting children's developing brain networks. Yet, most prior research on the development of self-regulation has focused on either environmental or neurobiological factors. The aim of the current study was to expand the literature by examining direct and indirect effects of variations in parenting behaviors (support and stimulation) and efficiency of functional brain networks (small-worldness) on individual differences in child self-regulation, using a three-wave longitudinal model in a sample of 109 infants and their mothers. Results revealed that parental support predicted child self-regulation at 5 months, 10 months, and 3 years of age. This effect was not mediated by infants' small-worldness within the alpha and theta rhythm. Parental stimulation predicted higher levels of infants' alpha small-worldness, whereas parental support predicted lower levels of infants' theta small-worldness. Thus, parents may need to stimulate their infants to explore the environment autonomously in order to come to more efficient functional brain networks. The findings of the current study highlight potential influences of both extrinsic environmental factors and intrinsic neurobiological factors in relation to child self-regulation, emphasizing the role of parental support as a form of external regulation during infancy, when the brain is not yet sufficiently developed to perform self-regulation itself.

Goodness of fit in the Chinese context of socialization in the first three years.

Based on the goodness-of-fit theory, the current research examined how parental socialization expectations and socialization practices in infancy predicted child social adjustment in the preschool year dependent on child characteristics in toddlerhood with a longitudinal sample of Chinese families. Participants were 272 Chinese mother-child dyads. Maternal socialization goals of child autonomy and obedience were assessed when the child was 6 months old. Maternal respect for autonomy and negative control were observed in free-plays at 15 months. Mothers reported child compliance and inhibitory control at 25 months and rated child externalizing behaviors at 37 months. Results showed that for children with low levels of compliance or high levels of inhibitory control, obedience socialization goals predicted more externalizing behaviors, whereas for children with high levels of compliance or low levels of inhibitory control, obedience socialization goals predicted fewer externalizing behaviors. Moreover, for children with high levels of inhibitory control, higher levels of respect for autonomy or lower levels of negative control foretold fewer externalizing behaviors. Conversely, for children with low levels of inhibitory control, lower levels of respect for autonomy or higher levels of negative control forecasted fewer externalizing behaviors. Together, our findings demonstrate that socialization expectations, socialization practices, and child characteristics are jointly predictive of social adjustment across early childhood and all the significant interactions are characterized by the pattern of a contrastive effect, therefore congruently supporting the goodness-of-fit hypotheses. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Triangulation and child adjustment after parental divorce: Underlying mechanisms and risk factors.

Parental triangulation is a particular risk to healthy child adjustment after divorce. However, detailed knowledge is lacking on how triangulation predicts child adjustment, and whether some children are more vulnerable to triangulation's effects. Therefore, the present study used a sample of 135 children (Mage = 11.76) and 130 parents from 77 recently divorced families to identify whether intrapersonal processes (loyalty conflicts, self-blame, and self-esteem) underlie the link between postdivorce triangulation and child adjustment over a period of 2 years. We also explored whether these direct and indirect effects were dependent on children's environmental sensitivity and empathy. By means of path analysis in MPlus, the mediation analyses indicated that more triangulation was only indirectly associated with a relative increase in children's internalizing problems, via experiencing more loyalty conflicts and lower self-esteem. Loyalty conflicts also explained the link between triangulation and children's externalizing problems. Yet, there were no indirect effects via children's self-blame attributions. Second, moderation analyses revealed that the effect of triangulation was dependent on children's level of empathy, but not sensitivity. Children scoring high on empathy showed a stronger association between triangulation and child-reported adjustment problems, both directly and indirectly via loyalty conflicts and self-esteem. There were hardly any significant effects for parent-reported child adjustment. Overall, the present study calls for more awareness on the adversity of postdivorce triangulation for children, its working mechanisms, and the factors that make children more vulnerable to its detrimental effects. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Self-regulation and frontal EEG alpha activity during infancy and early childhood: A multilevel meta-analysis.

Integrating behavioral and neurophysiological measures has created new and advanced ways to understand the development of self-regulation. Electroencephalography (EEG) has been used to examine how self-regulatory processes are related to frontal alpha power during infancy and early childhood. However, findings across previous studies have been inconsistent. To address this issue, the current meta-analysis synthesized all prior literature examining associations between individual differences in self-regulation and frontal EEG alpha power (baseline and/or task). In total, 23 studies consisting of 1275 participants between 1 month and 6 years of age were included, which yielded 149 effect sizes. Findings of the three-level meta-analytic model demonstrated a non-significant overall association between self-regulation and frontal alpha power. Yet, significant moderating effects were found for self-regulation construct (emotion regulation, effortful control, executive function), self-regulation measurement (behavioral task, computer assessment, lab observation, questionnaire), and children's mean age. Self-regulation was only significantly correlated with frontal alpha power when studies focused on the executive functioning construct. Moreover, the use of behavioral tasks or questionnaires and a higher mean age of the children resulted in small but significant effect size estimates. Higher frontal alpha power values were related to higher order top-down mechanisms of self-regulation, indicating that these mechanisms might become stronger when the frontal cortex is sufficiently developed. The findings of the current meta-analysis highlight the importance of longitudinal analyses and multimethod approaches in future work to reach a more comprehensive understanding of the role of frontal EEG alpha activity in the etiology of individual differences in early self-regulation. RESEARCH HIGHLIGHTS: The first meta-analysis of individual differences in self-regulation and frontal EEG alpha power during infancy and early childhood demonstrated a non-significant overall association. Moderation analyses revealed that variations in frontal alpha power were significantly associated with executive function, but not with effortful control and emotion regulation. Frontal alpha power was related to variations in self-regulation when measured by behavioral tasks and questionnaires, but not via computer assessments and lab observations. The association between individual differences in self-regulation and frontal alpha power becomes significantly stronger with age.

Heterogeneity of posttraumatic stress symptoms in bereaved children and adolescents: Exploring subgroups and possible risk factors.

Bereaved youths are at risk of developing posttraumatic stress (PTS), but there are large individual differences in presentation and severity of PTS symptoms among bereaved youths. The study sought to identify subgroups based on the distribution of self-rated loss-related PTS symptoms in a sample of 264 bereaved youths (aged 7-18). Based on latent class analysis, we identified three subgroups: no disturbance (37.9%), intermediate disturbance (39.0%) and pervasive disturbance (23.1%). Subgroups differed in PTS severity and symptom configuration. Specifically, avoidance was relatively more pronounced in bereaved youth with no and intermediate PTS disturbance, whereas emotional numbing was relatively more pronounced in bereaved youth with intermediate and pervasive PTS disturbance. Associations between subgroup membership, emotional stability and demographic and loss-related variables were also examined. Multinomial logistic regression indicated that youths in the pervasive disturbance subgroup reported lower emotional stability than youths in the no disturbance subgroup. Other variables were unrelated to subgroup membership. The study highlights the importance of considering the heterogeneity in PTS symptomatology in the diagnoses and treatment of loss-related traumatic stress in bereaved youth. Moreover, it underscores the need for further research on possible risk and protective factors involved in the maintenance and development of this traumatic stress.

A Friend in Prison: Human-Animal Bond, Stress and Self-Esteem of Detained Juveniles in Dutch Cell Dogs.

This study examined to what extent the human-animal bond (HAB) had a positive impact on stress and self-esteem among detained juveniles participating in the prison-based dog training program Dutch Cell Dogs (DCD). Participants were 75 detained juveniles (mean age = 19.5, 86.7% male). Self-reported stress and self-esteem were assessed before the start of DCD (T1), after four weeks (halfway training/T2) and after eight weeks (end training/T3). Structured interviews and questionnaire items were used to measure the HAB quality and perceived reciprocity in the HAB at T2 and T3. Data were analyzed using Structural Equation Modeling. In the variable-centered approach analyses, only the cross-sectional positive association between HAB quality and self-esteem at T2 was significant in the cross-lagged panel models. None of the cross-lagged paths between the HAB and stress or self-esteem were significant. In the person-centered approach analyses, growth mixture modeling identified two patterns of self-esteem ("high stable" and "high decreasing"); however, these patterns were not predicted by HAB. Thus, in contrast to our hypotheses, the HAB did not predict improvements in detained juveniles' stress and self-esteem. These findings underline the need for more research into the often-presumed role of HAB within prison-based dog training programs.

Parallel Changes in Positive Youth Development and Self-awareness: the Role of Emotional Self-regulation, Self-esteem, and Self-reflection.

The aim of the present study was to examine whether early adolescents' positive development (i.e., resilience and psychological wellbeing) could be enhanced by stimulating three dimensions of self-awareness: emotional self-regulation, self-esteem, and self-reflection. An experimental field study (randomized controlled trial) was conducted. Seventh grade students (N = 1299; Mage = 12.38; 54% boys) completed multiple assessments at the beginning, during, and immediately after the intervention or at parallel time points for students in the control condition. Changes in the assessed constructs were examined with parallel process latent growth curve models. The results showed that increases in emotional self-regulation and self-esteem were related to concurrent increases in both resilience and psychological wellbeing. Changes in self-reflection were, however, not related to changes in these outcomes. The trajectories of change and parallel processes were similar in the intervention and control condition. These findings suggest that interventions aiming to stimulate positive youth development might be optimized by also focusing on youth's self-awareness, though more knowledge about how self-awareness can be stimulated best is needed. This trial was registered in the Dutch Trial Register, number NL6371 (old number: NTR6554), on July 3, 2017.

Explaining Heterogeneity of Daily Conflict Spillover in the Family: The Role of Dyadic Marital Conflict Patterns.

In this multi-informant, longitudinal, daily diary study, we investigated whether long-term dyadic patterns of marital conflict resolution explain the heterogeneity in short-term day-to-day cross-lagged associations between marital conflict intensity and mother-adolescent conflict intensity. The sample consisted of 419 adolescents (44.6% girls, Mage = 13.02, SD = 0.44, at T1; Mage = 17.02, SD = 0.44, at T5), their mothers (N = 419, Mage = 44.48, SD = 4.17, at T1), and their fathers (N = 419, Mage = 46.76, SD = 4.99, at T1). Mothers and fathers reported on their marital conflict resolution strategies annually across 5 years. Mother-father daily conflict intensity (mother-reported) and mother-adolescent daily conflict intensity (mother- and adolescent-reported) were assessed for 75 days across 5 years. We hypothesized that long-term marital conflict resolution patterns would moderate the short-term daily dynamics of conflict between the marital and the mother-adolescent dyads. Latent Class Growth Analysis revealed four types of families based on long-term dyadic marital conflict resolution, including families where mostly constructive or mostly destructive conflict resolution was used. Dynamic Structural Equation Modeling was used to investigate the daily levels and short-term daily dynamics of conflict, revealing that for most families there were no day-to-day lagged associations between marital conflict and mother-adolescent conflict. Results showed that long-term conflict resolution patterns did not moderate the short-term dynamics of daily conflict. However, differences among long-term marital conflict resolution patterns were found in the levels of daily conflict, such that in families with long-term destructive conflict resolution patterns, daily conflict intensity was higher.

En este estudio de informantes múltiples, longitudinal y de registro diario, investigamos si los patrones diádicos de resolución de conflictos conyugales a largo plazo explican la heterogeneidad en las asociaciones diarias de retardo cruzado a corto plazo entre la intensidad del conflicto conyugal y la intensidad del conflicto entre las madres y los adolescentes. La muestra estuvo integrada por 419 adolescentes (el 44.6 % niñas, edad promedio = 13.02, desviación típica = 0.44, en la T1; edad promedio = 17.02, desviación típica= 0.44, en la T5), sus madres (número = 419, edad promedio = 44.48, desviación típica = 4.17, en la T1), y sus padres (número = 419, edad promedio= 46.76, desviación típica = 4.99, en la T1). Las madres y los padres informaron sus estrategias de resolución de conflictos conyugales anualmente durante cinco años. Se evaluaron la intensidad del conflicto diario entre la madre y el padre (informado por la madre) y la intensidad del conflicto diario entre la madre y el adolescente (informado por la madre y el adolescente) durante 75 días a lo largo de cinco años. Planteamos la hipótesis de que los patrones de resolución de conflicto conyugal a largo plazo moderarían la dinámica diaria de conflicto a corto plazo entre la díada conyugal y la díada madre-adolescente. El análisis de crecimiento de clases latentes reveló cuatro tipos de familias sobre la base de la resolución de conflictos conyugales diádicos a largo plazo, incluidas las familias donde se usó la resolución de conflictos principalmente constructiva o principalmente destructiva. Se utilizó el modelo de ecuaciones estructurales dinámicas para investigar los niveles diarios y la dinámica diaria de conflicto a corto plazo, el cual reveló que para la mayoría de las familias no hubo asociaciones diarias retardadas entre el conflicto conyugal y el conflicto entre madres y adolescentes. Los resultados indicaron que los patrones de resolución de conflictos a largo plazo no moderaron la dinámica a corto plazo del conflicto diario. Sin embargo, se encontraron diferencias entre los patrones de resolución de conflictos conyugales a largo plazo en los niveles de conflicto diario, de modo que, en las familias con patrones de resolución de conflictos destructivos a largo plazo, la intensidad del conflicto diario fue mayor.

Sexual Double Standards: Contributions of Sexual Socialization by Parents, Peers, and the Media.

(Hetero)sexual double standards (SDS) entail that different sexual behaviors are appropriate for men and women. There is large variation in whether people endorse SDS in their expectations about the sexual behavior of women and men (i.e., SDS-norms). To explain these individual differences, we examined associations between SDS-norms of Dutch adolescents (aged 16-20 years, N = 566) and what parents, peers, and the media teach adolescents about appropriate sexual behavior of boys and girls (i.e., SDS-socialization). Adolescents completed an online survey at school. Regarding SDS-socialization, more traditional SDS-norms conveyed by the media and peers, but not of parents, and less perceived sexual activity of female peers, were associated with more traditional SDS-norms. Only for boys, exposure to sexy girls/women on social media and sexual music videos of female artists were associated with more traditional SDS-norms. Thus, SDS-socialization by peers and the media and opposite gender models (for boys) are important in light of adolescents' SDS-norms.

Trajectories of Executive Functions and ADHD Symptoms in Preschoolers and the Role of Negative Parental Discipline.

In the present study, we investigated whether the longitudinal growth trajectories of executive functions (EF) and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms are related. In addition, we investigated whether negative discipline moderated these longitudinal relations. The sample consisted of predominantly clinically referred preschoolers (N = 248, age 42-66 months at Time 1; 79.0% boys). Assessment occurred three times: at baseline, at 9 months, and at 18 months. EF was assessed with five EF tasks. ADHD symptoms (Child Behavior Checklist 1.5-5) were reported by parents. Groups of medium to high and low negative discipline were based on mother- and father-reports (Parenting Practices Inventory). Growth curve models showed that EF generally increased and ADHD symptoms generally decreased over time. Parallel process models showed that there was no relation between the change in EF and the change in ADHD symptoms over time, suggesting no co-development. However, higher EF at baseline was related to lower ADHD symptoms at baseline. This was irrespective of whether children were exposed to high or low negative discipline. Overall, the results suggest that, while EF and ADHD symptoms are related, they develop independently across the preschool years.

A Therapeutic Game for Sexually Abused Children and Adolescents (Vil Du?!): Exploratory Mixed Methods Evaluation.

BACKGROUND: Talking about experiences of sexual abuse in therapy is difficult for children and adolescents. Possible reasons for this difficulty are a lack of vocabulary to describe the situation or feelings of shame, fear, and self-blame associated with sexual abuse. The serious game Vil Du?! was developed to help children open up about their sexual abuse experiences. Vil Du?! is a nonverbal communication game that resembles a dress-up game in which children can show the therapist what happened to them. OBJECTIVE: This exploratory evaluation study examines which working elements of the game could be identified in therapy with victims of sexual abuse (aim 1). In addition, this study examines how therapists evaluate the acceptability of the game (aim 2). METHODS: The therapists completed 23 web-based surveys on the use of Vil Du?! In addition, semistructured interviews were conducted with 10 therapists. The data were analyzed in NVivo following previously reported stepwise guidelines. RESULTS: Regarding aim 1, therapists mentioned various working elements of Vil Du?!; for instance, Vil Du?! puts the child in control of the situation. In addition, Vil Du?! reduces barriers to disclosure because there is no need to talk or have eye contact with the therapist. Regarding aim 2, Vil Du?! was generally evaluated more positively than negatively by the therapists. For instance, therapists indicated that using Vil Du?! is time efficient and might make the treatment process less confronting and difficult for the client. According to therapists, most clients indeed experienced less tension and more positive (or neutral) emotions than negative emotions when using Vil Du?! CONCLUSIONS: The most important working elements of Vil Du?!, according to therapists, are that it enables children to regain control over their sexual abuse experiences and reduces barriers to disclosing sexual abuse experiences. The more positive evaluation of Vil Du?! indicates the acceptability of the game for therapists as well as their clients.

Exploring emotional face processing in 5-month-olds: The relation with quality of parent-child interaction and spatial frequencies.

It is unclear whether infants differentially process emotional faces in the brain at 5 months of age. Contradictory findings of previous research indicate that additional factors play a role in this process. The current study investigated whether five-month-old infants show differential brain activity between emotional faces. Furthermore, we explored the relation between emotional face processing and (I) stimulus characteristics, specifically the spatial frequency content, and (II) parent, child, and dyadic qualities of interaction characteristics. Face-sensitive components (i.e., N290, P400, Nc) in response to neutral and fearful faces that contained only lower or higher spatial frequencies were assessed. Quality of parent-child interaction was assessed with the Manchester Assessment of Caregiver Infant Interaction (MACI). The results show that, as a full group, none of the components differed between emotional expressions. However, when splitting the group based on median MACI scores, infants who showed high quality of interaction (i.e., more attentiveness to caregiver, positive and negative affect, and liveliness) processed emotions differently, whereas infants who showed low quality did not. These results indicate that a sub-group of infants show differential emotional face processing at 5 months of age, which seem to relate to quality of their behavior during the parent-child interaction.

Emotion regulation training as a treatment element for externalizing problems in adolescence: A randomized controlled micro-trial.

Improving interventions for externalizing problems in adolescence may require determining which treatment elements actually produce change. In this micro-trial, we tested a treatment element addressing one widely-hypothesized mechanism underlying externalizing problems: emotion regulation. We tested whether emotion regulation could be improved via training, whether adolescents who received such training would subsequently show reduced externalizing problems, and which training approach and sequence was most effective. We randomized 108 adolescents with elevated externalizing problems (71.3% boys, Mage = 13.66, SD = 1.10) to a control condition or an experimental condition teaching emotion regulation through either a cognitive or behavioral approach, in alternated sequences. Effects of the modules were assessed before and after the modules, and with weekly assessments. The results showed a positive effect of the experimental training on self-reported use of adaptive emotion regulation strategies. However, self-reported externalizing problems decreased more in the control condition than in the experimental condition. No mediation, approach (cognitive versus behavioral) or sequence (cognitive-behavioral versus behavioral-cognitive sequence) effects were found. These findings illustrate that change in a proposed mechanism may not be accompanied by change in targeted problems; this highlights the importance of testing the hypothesized impact of specific treatment elements on targeted mental health problems. TRIAL REGISTRATION: This trial was registered in the Dutch Trial Register (NTR7334, July 10th, 2018) and the study protocol was published (te Brinke, Schuiringa, Menting, Dekovic, & de Castro, 2018).

Vil Du?! incorporation of a serious game in therapy for sexually abused children and adolescents.

BACKGROUND: Talking about experiences of sexual abuse in therapy is difficult for children and adolescents, amongst others due to a lack of vocabulary to describe the situation, avoidance, or feelings of shame, fear, and self-blame. The serious game Vil Du?! was developed to help children open up about sexual experiences. Vil Du?! is a non-verbal communication game, which resembles a dress-up game, in which children can show the therapist what happened to them. The current study examined how and for which therapy components Vil Du?! was used by therapists. METHODS: We used a mixed-methods triangulation design. Therapists filled out online surveys about the use of Vil Du?! with 23 clients (Mage = 11.38 years, SD = 3.96; 61 % female). We also conducted semi-structured interviews with 10 therapists. The data were analyzed in SPSS (quantitative) and Nvivo (qualitative) following the stepwise guidelines of Zhang and Wildemuth. RESULTS: Merged qualitative and quantitative data revealed that therapists acknowledged the usefulness of Vil Du?! mostly for the therapy components trauma narration and processing, and psycho-education about sexuality. In addition, Vil Du?! might be most useful for clients who have difficulty with disclosing sexual abuse experiences, due to limited verbal abilities or feelings of guilt, shame, avoidance, and tension. CONCLUSIONS: Recommendations from this study were incorporated in a user manual as a first step toward more systematic and broad implementation of Vil Du?! in the treatment of young sexual abuse victims. A next step is to test whether implementing Vil Du?! in therapy is effective in reducing the negative mental health consequences of sexual abuse for children and adolescents.