Mental health screening and assessment tools for forcibly displaced children: a systematic review.

Background: An unprecedentedly large number of people worldwide are forcibly displaced, of which more than 40 percent are under 18 years of age. Forcibly displaced children and youth have often been exposed to stressful life events and are therefore at increased risk of developing mental health issues. Hence, early screening and assessment for mental health problems is of great importance, as is research addressing this topic. However, there is a lack of evidence regarding the reliability and validity of mental health assessment tools for this population. Objective: The aim of the present study was to synthesise the existing evidence on psychometric properties of patient reported outcome measures [PROMs] for assessing the mental health of asylum-seeking, refugee and internally displaced children and youth. Method: Systematic searches of the literature were conducted in four electronic databases: MEDLINE, PsycINFO, Embase and Web of Science. The methodological quality of the studies was examined using the COSMIN Risk of Bias checklist. Furthermore, the COSMIN criteria for good measurement properties were used to evaluate the quality of the outcome measures. Results: The search yielded 4842 articles, of which 27 met eligibility criteria. The reliability, internal consistency, structural validity, hypotheses testing and criterion validity of 28 PROMs were evaluated. Conclusion: Based on the results with regard to validity and reliability, as well as feasibility, we recommend the use of several instruments to measure emotional and behavioural problems, PTSD symptoms, anxiety and depression in forcibly displaced children and youth. However, despite a call for more research on the psychometric properties of mental health assessment tools for forcibly displaced children and youth, there is still a lack of studies conducted on this topic. More research is needed in order to establish cross-cultural validity of mental health assessment tools and to provide optimal cut-off scores for this population. HIGHLIGHTS Research on the psychometric properties of mental health screening and assessment tools for forcibly displaced children and youth is slowly increasing.However, based on the current evidence on the validity and reliability of screening and assessment tools for forcibly displaced children, we are not able to recommend a core set of instruments. Instead, we provide suggestions for best practice.More research of sufficient quality is important in order to establish crsoss-cultural validity and to provide optimal cut-off scores in mental health screening and assessment tools for different populations of forcibly displaced children and youth.

Antecedentes: Un número sin precedentes de personas en todo el mundo son desplazadas por la fuerza, de las cuales más del 40 por ciento son menores de 18 años. Los niños y jóvenes desplazados por la fuerza a menudo han estado expuestos a eventos vitales estresantes y, por lo tanto, corren un mayor riesgo de desarrollar problemas de salud mental. Por lo tanto, la detección temprana y la evaluación de los problemas de salud mental son de gran importancia, al igual que la investigación que aborda este tema. Sin embargo, hay una falta de evidencia con respecto a la confiabilidad y validez de las herramientas de evaluación de la salud mental para esta población.Objetivo: El objetivo del presente estudio fue sintetizar la evidencia existente sobre las propiedades psicométricas de los instrumentos de medición de resultado reportadas por el paciente [PROM, por sus siglas en inglés] para evaluar la salud mental de los niños y jóvenes solicitantes de asilo, refugiados y desplazados internos.Método: Se realizaron búsquedas sistemáticas de la literatura en cuatro bases de datos electrónicas: MEDLINE, PsycINFO, Embase y Web of Science. La calidad metodológica de los estudios se examinó mediante la lista de verificación de riesgo de sesgo de COSMIN. Además, se utilizaron los criterios COSMIN de buenas propiedades de medición para evaluar la calidad de los instrumentos de medición de resultados.Resultados: La búsqueda arrojó 4842 artículos, de los cuales 27 cumplieron con los criterios de elegibilidad. Se evaluaron la confiabilidad, consistencia interna, validez estructural, prueba de hipótesis y validez de criterio de 28 PROM.Conclusión: En base a los resultados con respecto a la validez y confiabilidad, así como la factibilidad, recomendamos el uso de varios instrumentos para medir problemas emocionales y de conducta, síntomas de TEPT, ansiedad y depresión en niños y jóvenes desplazados por la fuerza. Sin embargo, a pesar de la petición de más investigación sobre las propiedades psicométricas de las herramientas de evaluación de la salud mental para niños y jóvenes desplazados por la fuerza, todavía faltan estudios sobre este tema. Se necesita más investigación para establecer la validez transcultural de las herramientas de evaluación de la salud mental y proporcionar puntajes de corte óptimos para esta población.

Development of the Dog Attachment Insecurity Screening Inventory (D-AISI): A Pilot Study on a Sample of Female Owners.

To date, the Strange Situation Procedure is the only tool available to investigate the quality of the dog's attachment bond towards the owner. This study aimed to adapt a parent-report scale, named the Attachment Insecurity Screening Inventory (AISI) 6-12, originally designed to assess 6- to 12-year-old children's attachment insecurity, to dog-owner dyads and assess measures of consistency and validity. The online questionnaire was completed by 524 female dog owners. Principal component analysis (PCA) revealed five components named, respectively, "physical contact", "control", "separation anxiety", "owner as emotional support", and "owner as a source of positive emotion". Because of the three-factor structure of the original AISI, a PCA with a pre-fixed set of three factors was also performed. The resulting subscales mirrored the ones found for the original scale (i.e., ambivalent, avoidant, and disorganized), although four items did not fit the model. Internal reliability appeared to be satisfying for the ambivalent and the disorganized subscales, and good for the avoidant subscale. The theoretical background and the results of this study suggest that the three-dimensional model represents a better solution for the interpretation of the Dog Attachment Insecurity Screening Inventory (D-AISI). Although promising, this scale requires refinement and assessment of additional validity measures.

Development and validation of the Attachment Relationship Inventory-Caregiver Perception 2-5 years (ARI-CP 2-5): Psychometric structure, external validity, and norms.

There is a lack of instruments assessing child-caregiver attachment relationships in early childhood to be used in attachment-based practice, in particular from a caregiver's perception, which is an important factor of clinical importance to take into account in parenting interventions targeting young children. Therefore, the 48-item Attachment Relationship Inventory-Caregiver Perception 2-5 years (ARI-CP 2-5) was developed. Survey data of 446 caregivers of 2- to 5-year-old children were collected, and a subsample of 83 caregivers participated in an observation study. Confirmatory factor analysis confirmed a four-factor structure of secure, avoidant, ambivalent, and disorganized attachment relationship. Indications of configural, metric, and scalar invariance were found for caregivers' and children's sex, children's age, and population (clinical vs. general population). The four scales showed sufficient internal consistency and significant associations with children's psychopathology, caregivers' general attachment representations, caregivers' mind-mindedness, and population type. Moreover, preliminary evidence for convergent validity with observational attachment measures was found. It is concluded that the ARI-CP 2-5 is a valid instrument that can be used as part of the screening and assessment of insecure attachment relationships.

Hacen falta instrumentos que evalúen las relaciones de afectividad niño-cuidador en la temprana niñez para ser usados en la práctica que se basa en la afectividad, en particular desde la perspectiva del cuidador, lo cual es un factor clave de importancia clínica para tomar en cuenta en las intervenciones de crianza que se enfocan en niños pequeños. Por tanto, se desarrolló el Inventario de la Relación Afectiva - Percepción del Cuidador 2-5 años, que consta de 48 aspectos (ARI-CP 2-5). Se recogió información de encuesta de 446 cuidadores de niños de 2 a 5 años de edad, y un subgrupo muestra de 83 cuidadores participó en un estudio de observación. Los análisis de factores confirmatorios corroboraron una estructura de cuatro factores de la relación de afectividad que es segura, la que evita, la ambivalente y la desorganizada. Se encontraron indicaciones de invariabilidad en el aspecto configuracional, métrico y de escala en cuanto al género sexual de los cuidadores y del niño, la edad del niño, y la población (clínica y general). Las cuatro escalas mostraron una suficiente consistencia interna y asociaciones significativas con la sicopatología de los niños, las representaciones generales de afectividad del cuidador, la conciencia mental de los cuidadores, así como el tipo de población. Es más, se encontró una evidencia preliminar para la validez convergente con las medidas de afectividad de observación. Se concluye con que el ARI-CP 2-5 es un instrumento válido que puede usarse como parte de la detección y evaluación de las relaciones de afectividad inseguras.

Il y a un manque d'instruments évaluant les relations d'attachement enfant-aidant naturel dans la petite enfance pouvant être utilisés dans une pratique basée sur l'attachement, en particulier sur la perception de l'aidant naturel, qui est un facteur important de l'importance clinique à prendre en compte dans les interventions de parentages ciblant les jeunes enfants. Par conséquent l'Inventaire de 48 articles de la Relation d'Attachement - Perception de l'Aidant Naturel 2-5 ans (abrégé en anglais ARI-CP 2-5) a été développé. Les données de sondage de 446 aidants naturels d'enfants de 2 à 5 ans ont été recueillies et un sous-échantillon de 83 aidants naturels ont participé à une étude d'observation. Une analyse factorielle confirmatoire a confirmé une structure à quatre facteurs de la relation d'attachement sécure, évitant, ambivalent et désorganisé. Des indications d'invariance configurale, métrique et scalaire ont été trouvées pour le sexe des aidants naturels et des enfants, l'âge des enfants, et la population (clinique par rapport à population générale). Les quatre échelles ont démontré une cohérence interne suffisante et des associations importantes avec la psychopathologie des enfants, les représentations de l'attachement générale des aidants naturels, l'esprit-qualité mentale et le type de population. De plus une preuve préliminaire de validité convergente ave les mesures observationnelles d'attachement a été trouvée. Nous concluons que l'ARI-CP 205 est un instrument valide qui peut être utilisé pour le dépistage et l'évaluation de relations d'attachement insécures.

Internal structure and reliability of the Attachment Insecurity Screening Inventory (AISI) for children age 6 to 12.

BACKGROUND: The aim of the present study was to examine the internal structure and reliability of the Attachment Insecurity Screening Inventory (AISI) 6-12. The AISI 6-12 years is a parent-report questionnaire for assessing the parents' perspective on the quality of the attachment relationship with their child aged between 6 and 12 years. METHODS: The sample consisted of 681 mothers and fathers reporting on 372 children (72.3% adoption parents, 14.9% non-biological primary care takers including foster parents, and 12.8% biological parents). The internal structure was assessed with multilevel confirmatory factor analyses (CFA) and the reliability of the scores with Cronbach's and ordinal alphas. RESULTS: Multilevel CFA confirmed a three-factor model of avoidant, ambivalent/resistant and disorganized attachment. Multi-group CFA indicated full configural and metric measurement invariance, and partial scalar and strict measurement invariance across mothers and fathers. Reliability coefficients were found to be sufficient. CONCLUSIONS: This study showed the potential of using parental reports in the initial screening of attachment related problems, especially considering the practical approach of parental reports. However, further development of the AISI 6-12 years seems important to increase the validity of the AISI 6-12 years. In addition, future studies are necessary to replicate the current findings, and to strengthen the evidence that the AISI 6-12 years is appropriate for the use in middle childhood and validly assesses the parents' perspective on attachment insecurities in their child.

Concordance between self-reported and observer-rated anxiety severity in outpatients with anxiety disorders: The Leiden routine outcome monitoring study.

OBJECTIVES: Anxiety severity measures can be self-report or observer-rated. Although mostly these measures concur, they can diverge markedly. We examined concordance between two anxiety scales: the observer-rated Brief Anxiety Scale (BAS) and the self-report Brief Symptom Inventory 12-item version (BSI-12), and described associations between patient characteristics and discordance. DESIGN: The study used an observational design, using prospective data from 2,007 outpatients with DSM-IV-TR panic disorder with or without agoraphobia, agoraphobia without panic, social phobia, and/or generalized anxiety disorder. METHODS: Overall agreement was described using Pearson's product-moment correlation coefficient. Associations between patient characteristics and discordance (defined as |Z-BAS-Z-BSI-12| ≥ 1) were evaluated with univariable and multivariable multinomial logistic regression analyses. RESULTS: Overall correlation between BAS and BSI-12 was positive and strong (r = .59). Discordance occurred in 24.8% of patients ([Z-BAS ≥ Z-BSI-12 + 1] = 12.2%; [Z-BAS ≤ Z-BSI-12 - 1]  = 12.6%). Patients with higher observed than self-reported anxiety severity did not differ from concordant patients. Patients with lower observed than self-reported anxiety severity more often had panic disorder, less often had social phobia, and had higher scores on cluster B and C personality characteristics than concordant patients. Lower observed than self-reported anxiety severity was best predicted by panic disorder, social phobia, and affective lability. CONCLUSIONS: Results demonstrate that the use of a single source of information gives a one-sided view of pathology. A multimethod approach is highly preferable, as this allows for assessment across different domains and through multiple sources of information, and as such, provides clinicians with vital information. PRACTITIONER POINTS: When assessing anxiety severity, the use of self-report measures provides additional information to observer-rated measures. In patients who have strong cluster B and C personality traits, anxiety severity might be overlooked, even by trained observers. The use of a multimethod assessment strategy is preferable in anxiety severity assessment.

Age-related characteristics of outpatients with anxiety disorders: the Leiden routine outcome monitoring study.

OBJECTIVE: It has been hypothesised that clinically important age-related differences between adults with anxiety disorders exist; this study aims to elucidate these differences. METHODS: We analysed data from 1950 outpatients diagnosed with DSM-IV-TR anxiety disorders treated at a Dutch hospital or affiliated mental healthcare centres. Three age-groups (young- (18-25; n = 435), mid- (26-40; n = 788) and older adult (41-65; n = 727)) were compared with regard to social demographic characteristics, diagnostic characteristics, anxiety symptom profile, general psychiatric symptom profile and generic health status, in addition, linear analyses were carried out with age as a continuous variable. RESULTS: Average age was 36.48 years (SD 11.71), 62.8% were female. Significant associations with age emerged for gender, employment, education level, living situation, observed depression, agoraphobia (AP), social phobia, aches and pains, inner tension, sleep, interpersonal sensitivity, observed hostility, physical functioning, role limitations due to physical problems, vitality and bodily pain in categorical and continuous analyses. Self reported hostility was only significant in group-wise comparisons; role limitations due to emotional problems were only significant in linear analyses (all at p < .001). CONCLUSIONS: This study identified clinically relevant differences between younger and older adult outpatients with anxiety disorders. Clinicians should take these findings into account, as they may support treatment.

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.

Day hospital Mentalization-based treatment versus intensive outpatient Mentalization-based treatment for patients with severe borderline personality disorder: protocol of a multicentre randomized clinical trial.

BACKGROUND: Borderline personality disorder (BPD) is associated with a high socioeconomic burden. Although a number of evidence-based treatments for BPD are currently available, they are not widely disseminated; furthermore, there is a need for more research concerning their efficacy and cost-effectiveness. Such knowledge promises to lead to more efficient use of resources, which will facilitate the effective dissemination of these costly treatments. This study focuses on the efficacy and cost-effectiveness of Mentalization-Based Treatment (MBT), a manualized treatment for patients with BPD. Studies to date have either investigated MBT in a day hospitalization setting (MBT-DH) or MBT offered in an intensive outpatient setting (MBT-IOP). No trial has compared the efficacy and cost-effectiveness of these MBT programmes. As both interventions differ considerably in terms of intensity of treatment, and thus potentially in terms of efficacy and cost-effectiveness, there is a need for comparative trials. This study therefore sets out to investigate the efficacy and cost-effectiveness of MBT-DH versus MBT-IOP in patients with BPD. A secondary aim is to investigate the association between baseline measures and outcome, which might improve treatment selection and thus optimize efficacy and cost-effectiveness. METHODS/DESIGN: A multicentre randomized controlled trial comparing MBT-DH versus MBT-IOP in severe BPD patients. Patients are screened for BPD using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and are assessed before randomization, at the start of treatment and 6, 12, 18, 24, 30 and 36 months after the start of treatment. Patients who refuse to participate will be offered care as usual in the same treatment centre. The primary outcome measure is symptom severity as measured by the Brief Symptom Inventory. Secondary outcome measures include parasuicidal behaviour, depression, substance use, social, interpersonal, and personality functioning, attachment, mentalizing capacities, and quality of life. All analyses will be conducted based on the intention-to-treat principle. Cost-effectiveness will be calculated based on costs per quality-adjusted life-year. DISCUSSION: This multisite randomized trial will provide data to refine criteria for treatment selection for severe BPD patients and promises to optimize (cost-)effectiveness of the treatment of BPD patients. TRIAL REGISTRATION: NTR2292 . Registered 16 April 2010.

Day Hospital Mentalization-Based Treatment (MBT-DH) versus treatment as usual in the treatment of severe borderline personality disorder: protocol of a randomized controlled trial.

BACKGROUND: Severe borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment (MBT-DH), are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible influence of researcher allegiance in one of the trials, and potential problems with the generalization of findings to mental health systems in other countries, this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands. METHODS/DESIGN: The trial is being conducted at two sites in The Netherlands. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of ≥ 20 on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual. The MBT-DH program consists of a maximum of 18 months' intensive treatment, followed by a maximum of 18 months of maintenance therapy. Specialist treatment as usual is provided by the City Crisis Service in Amsterdam, a service that specializes in treating patients with personality disorders, offering manualized, non-MBT interventions including family interventions, Linehan training, social skills training, and pharmacotherapy, without a maximum time limit. Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment. The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index. Secondary outcome measures include parasuicidal behaviour, symptomatic distress, social and interpersonal functioning, personality functioning, attachment, capacity for mentalizing and quality of life. Cost-effectiveness is assessed in terms of the cost per quality-adjusted life year. Outcomes will be analyzed using multilevel analyses based on intention-to-treat principles. DISCUSSION: Severe borderline personality disorder is a serious psychological disorder that is associated with high burden. This multi-site randomized trial will provide further data concerning the efficacy and cost-effectiveness of MBT-DH for these patients. TRIAL REGISTRATION: NTR2175.

Feasibility of mentalization-based treatment for adolescents with borderline symptoms: a pilot study.

Mentalization-based treatment (MBT) is an evidence-based treatment for adults suffering from borderline personality disorder. Different adaptations of MBT for adolescents have been described, but almost none of these have been systematically evaluated so far. This article presents pilot data from a feasibility study of an adaptation of inpatient MBT for adolescents with borderline symptoms (MBT-A). Preliminary outcome results were examined in a pilot study including 11 female adolescents (aged 14-18 years) in a mental health care center in the Netherlands. Maximum treatment duration was 12 months and patients were assessed at start and at 12 months after start of treatment. Outcome measures included symptom severity (Brief Symptom Inventory), personality functioning (Severity Indices of Personality Problems), and quality of life (EuroQol). Results showed significant decreases in symptoms, and improvements in personality functioning and quality of life at 12 months after start of treatment. Effect sizes (d) ranged from .58 to 1.46, indicating medium to large effects. In total, 91% of the adolescents showed reliable change on the BSI, and 18% also moved to the functional range on the BSI. The results of this feasibility study are promising and encourage further research concerning the efficacy of MBT in adolescents with borderline symptoms, although some problems with implementation suggest that an outpatient variant of MBT for adolescents might be as effective while at the same time reducing potential iatrogenic effects of inpatient treatment for this age group.

Psychotic-like symptoms as a risk factor of violent recidivism in detained male adolescents.

The aim of this study was to prospectively examine whether psychotic-like symptoms (PLSs) are positively associated with violent recidivism and whether this relation is stronger when PLSs co-occur with substance use disorders (SUDs). Participants were 224 detained male adolescents from all youth detention centers in Flanders. The Diagnostic Interview Schedule for Children was used to assess PLSs and the number of SUDs. Two to 4 years later, information on official recidivism was obtained. Although hallucinations were unrelated to violent recidivism, paranoid delusions (PDs) and threat/control override delusions (TCODs) were negatively related to violent recidivism. The relation between PLSs and violent recidivism did not become stronger in the presence of SUDs. Detained youths with PLSs do not have a higher risk for violent recidivism than detained youths without PLSs. In contrast, by identifying detained youths with PDs or TCODs, clinicians are likely to identify youths with a low risk for future violent crimes.

Youth Psychopathic Traits Inventory-Short Version: A Further Test of the Internal Consistency and Criterion Validity.

The Youth Psychopathic Traits Inventory-Short Version (YPI-S; van Baardewijk et al., 2010) is a self-report measure to assess psychopathic-like traits in adolescents. The aim of the present study is to investigate the factor structure, the internal consistency, and the criterion validity of the YPI-S in 768 Belgian community adolescents (45.4 % males). In general, our study supported the YPI three factor structure while relevant indices showed that the instrument is internally consistent. In addition, relations between the YPI-S total score and dimension scores on the one hand and external criterion measures (e.g. conduct problems and self-reported offending) on the other hand were generally in line with predictions. The present study replicated and substantially extended previous findings of the YPI-S in a sample of community youth. Future studies are needed to test whether findings from community samples can be replicated in clinical-referred and justice-involved boys and adolescents.

Framework for modelling the cost-effectiveness of systemic interventions aimed to reduce youth delinquency.

BACKGROUND: Many interventions initiated within and financed from the health care sector are not necessarily primarily aimed at improving health. This poses important questions regarding the operationalisation of economic evaluations in such contexts. AIMS OF THE STUDY: We investigated whether assessing cost-effectiveness using state-of-the-art methods commonly applied in health care evaluations is feasible and meaningful when evaluating interventions aimed at reducing youth delinquency. METHODS: A probabilistic Markov model was constructed to create a framework for the assessment of the cost-effectiveness of systemic interventions in delinquent youth. For illustrative purposes, Functional Family Therapy (FFT), a systemic intervention aimed at improving family functioning and, primarily, reducing delinquent activity in youths, was compared to Treatment as Usual (TAU). "Criminal activity free years" (CAFYs) were introduced as central outcome measure. Criminal activity may e.g. be based on police contacts or committed crimes. In absence of extensive data and for illustrative purposes the current study based criminal activity on available literature on recidivism. Furthermore, a literature search was performed to deduce the model's structure and parameters. RESULTS: Common cost-effectiveness methodology could be applied to interventions for youth delinquency. Model characteristics and parameters were derived from literature and ongoing trial data. The model resulted in an estimate of incremental costs/CAFY and included long-term effects. Illustrative model results point towards dominance of FFT compared to TAU. DISCUSSION: Using a probabilistic model and the CAFY outcome measure to assess cost-effectiveness of systemic interventions aimed to reduce delinquency is feasible. However, the model structure is limited to three states and the CAFY measure was defined rather crude. Moreover, as the model parameters are retrieved from literature the model results are illustrative in the absence of empirical data. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The current model provides a framework to assess the cost-effectiveness of systemic interventions, while taking into account parameter uncertainty and long-term effectiveness. IMPLICATIONS FOR HEALTH POLICIES: The framework of the model could be used to assess the cost-effectiveness of systemic interventions alongside (clinical) trial data. Consequently, it is suitable to inform reimbursement decisions, since the value for money of systemic interventions can be demonstrated using a decision analytic model. IMPLICATIONS FOR FURTHER RESEARCH: Future research could be focussed on testing the current model based on extensive empirical data, improving the outcome measure and finding appropriate values for that outcome.

The relation between insecure attachment and child anxiety: a meta-analytic review.

Attachment theory suggests that children's attachment insecurity plays a key role in the development of anxiety. In the present study we evaluated the empirical evidence for the link between insecure attachment and anxiety from early childhood to adolescence. A meta-analysis of 46 studies, from 1984 to 2010, including 8,907 children, was conducted. The results show an overall effect size of r = .30, indicating that attachment is moderately related to anxiety. Moderator analyses indicated that ambivalent attachment showed the strongest association with anxiety. Further, the relation was stronger during adolescence, when attachment and anxiety were measured through questionnaires, when the informant was the child, when attachment was measured as internal working model, in cross-sectional studies, and in studies conducted in Europe. No difference was found between studies that measured anxiety as symptoms or as a disorder, and when different kinds of anxiety were considered.

The care-system for homeless youth in The Netherlands: perceptions of youngsters through a peer research approach.

The aim of this study was to examine the perceptions of homeless youth of the care they receive. Since we wanted to involve homeless youth as participants in this project, we adopted the approach of peer-research. This form of collaborative research has a major role for homeless youth in making an inventory of the problems. A parallel is drawn between the parent-adolescent relationship and the relationship between social worker and homeless adolescent.

Aggressive adolescents in residential care: a selective review of treatment requirements and models.

This article presents a selective inventory of treatment methods of aggressive behavior. Special attention is paid to types of intervention that, according to research, are frequently used in Dutch residential youth care. These methods are based on (1) principles of (cognitive) behavior management and control, (2) the social competence model, and (3) influencing the peer culture. Suggestions are made as to how the treatment of aggressive adolescents may be realized in residential settings. The article concludes that more attention should be paid to the involvement of parents and to the part played by the peer group in the treatment of aggressive behavior.

Self-efficacy and emotional adjustment as precursors of smoking in early adolescence.

The aim of this study was to examine the associations between self-efficacy, emotional adjustment, and smoking in a large sample of early adolescents cross-sectionally and short-term longitudinally. A prospective sample was used consisting of 1861 12-13-year-olds at 11 secondary schools. Questionnaires were administered at baseline and at a follow-up 6 months after the baseline assessment. Findings showed that higher depressive mood, low self-esteem, and low self-efficacy appeared to be related to enhanced levels of smoking in cross-sectional analyses. Short-term longitudinal analyses indicated that depressive mood and self-esteem were only related to the onset of smoking in girls. In three out of four cross-sectional analyses, self-efficacy x emotional adjustment interactions revealed that in particular adolescents with low levels of self-efficacy and low levels of emotional adjustment are likely to smoke.