MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations.

3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.

The effects of COVID-19 on child mental health: Biannual assessments up to April 2022 in a clinical and two general population samples.

Background: The COVID-19 pandemic has had an acute impact on child mental and social health, but long-term effects are still unclear. We examined how child mental health has developed since the start of the COVID-19 pandemic up to 2 years into the pandemic (April 2022). Methods: We included children (age 8-18) from two general population samples (N = 222-1333 per measurement and N = 2401-13,362 for pre-covid data) and one clinical sample receiving psychiatric care (N = 334-748). Behavioral questionnaire data were assessed five times from April 2020 till April 2022 and pre-pandemic data were available for both general population samples. We collected parent-reported data on internalizing and externalizing problems with the Brief Problem Monitor and self-reported data on Anxiety, Depressive symptoms, Sleep-related impairments, Anger, Global health, and Peer relations with the Patient-Reported Outcomes Measurement Information System (PROMIS®). Results: In all samples, parents reported overall increased internalizing problems, but no increases in externalizing problems, in their children. Children from the general population self-reported increased mental health problems from before to during the pandemic on all six PROMIS domains, with generally worst scores in April 2021, and scores improving toward April 2022 but not to pre-pandemic norms. Children from the clinical sample reported increased mental health problems throughout the pandemic, with generally worst scores in April 2021 or April 2022 and no improvement. We found evidence of minor age effects and no sex effects. Conclusions: Child mental health in the general population has deteriorated during the first phase of the COVID-19 pandemic, has improved since April 2021, but has not yet returned to pre-pandemic levels. Children in psychiatric care show worsening of mental health problems during the pandemic, which has not improved since. Changes in child mental health should be monitored comprehensively to inform health care and policy.

The prevalence of anxiety and depression symptoms (ADS), persistent and chronic ADS among the adult general population and specific subgroups before and during the COVID-19 pandemic until December 2021.

BACKGROUND: It is unclear to what extent the prevalence of moderate and severe anxiety and depression symptoms (ADS) is higher during the first 20 months after the COVID-19 outbreak than before the outbreak. The same holds for persistent and chronic ADS among the adult general population and subgroups (such as employed, minorities, young adults, work disabled). METHODS: Data were extracted from six surveys conducted with the Dutch longitudinal LISS panel, based on a traditional probability sample (N = 3493). Biographic characteristics and ADS (MHI-5 scores) were assessed in March-April 2019, November-December 2019, March-April 2020, November-December 2020, March-April 2021, and November-December 2021. Generalized estimating equations were conducted to examine differences in the prevalence of post-outbreak ADS, persistent and chronic ADS compared to the pre-outbreak prevalence in similar periods. The Benjamini-Hochberg correction for multiple testing was applied. RESULTS: Among the general population chronic moderate ADS increased significantly but slightly in the period March-April 2020 to March-April 2021 compared to a similar period before the pandemic (11.9 % versus 10.9 %, Odds Ratio = 1.11). In the same period a somewhat larger significant increase in chronic moderate ADS was observed among 19-24 years old respondents (21.4 % versus 16.7 %, Odds Ratio = 1.35). After the Benjamini-Hochberg correction several other differences were no longer significant. LIMITATIONS: No other mental health problems were assessed. CONCLUSIONS: The Dutch general population and most of the assessed subgroups were relatively resilient given the limited increase or absence of increases in (persistent and chronic) ADS. However, young adults suffered from an increase of chronic ADS.

Neurobiological correlates of antisociality across adolescence and young adulthood: a multi-sample, multi-method study.

BACKGROUND: Antisociality across adolescence and young adulthood puts individuals at high risk of developing a variety of problems. Prior research has linked antisociality to autonomic nervous system and endocrinological functioning. However, there is large heterogeneity in antisocial behaviors, and these neurobiological measures are rarely studied conjointly, limited to small specific studies with narrow age ranges, and yield mixed findings due to the type of behavior examined. METHODS: We harmonized data from 1489 participants (9-27 years, 67% male), from six heterogeneous samples. In the resulting dataset, we tested relations between distinct dimensions of antisociality and heart rate, pre-ejection period (PEP), respiratory sinus arrhythmia, respiration rate, skin conductance levels, testosterone, basal cortisol, and the cortisol awakening response (CAR), and test the role of age throughout adolescence and young adulthood. RESULTS: Three dimensions of antisociality were uncovered: 'callous-unemotional (CU)/manipulative traits', 'intentional aggression/conduct', and 'reactivity/impulsivity/irritability'. Shorter PEPs and higher testosterone were related to CU/manipulative traits, and a higher CAR is related to both CU/manipulative traits and intentional aggression/conduct. These effects were stable across age. CONCLUSIONS: Across a heterogeneous sample and consistent across development, the CAR may be a valuable measure to link to CU/manipulative traits and intentional aggression, while sympathetic arousal and testosterone are additionally valuable to understand CU/manipulative traits. Together, these findings deepen our understanding of the fundamental mechanisms underlying different components of antisociality. Finally, we illustrate the potential of using current statistical techniques for combining multiple datasets to draw robust conclusions about biobehavioral associations.

Internalizing problems before and during the COVID-19 pandemic in independent samples of Dutch children and adolescents with and without pre-existing mental health problems.

The aim of the study was to assess internalizing problems before and during the pandemic with data from Dutch consortium Child and adolescent mental health and wellbeing in times of the COVID-19 pandemic, consisting of two Dutch general population samples (GS) and two clinical samples (CS) referred to youth/psychiatric care. Measures of internalizing problems were obtained from ongoing data collections pre-pandemic (NGS = 35,357; NCS = 4487) and twice during the pandemic, in Apr-May 2020 (NGS = 3938; clinical: NCS = 1008) and in Nov-Dec 2020 (NGS = 1489; NCS = 1536), in children and adolescents (8-18 years) with parent (Brief Problem Monitor) and/or child reports (Patient-Reported Outcomes Measurement Information System®). Results show that, in the general population, internalizing problems were higher during the first peak of the pandemic compared to pre-pandemic based on both child and parent reports. Yet, over the course of the pandemic, on both child and parent reports, similar or lower levels of internalizing problems were observed. Children in the clinical population reported more internalizing symptoms over the course of the pandemic while parents did not report differences in internalizing symptoms from pre-pandemic to the first peak of the pandemic nor over the course of the pandemic. Overall, the findings indicate that children and adolescents of both the general and clinical population were affected negatively by the pandemic in terms of their internalizing problems. Attention is therefore warranted to investigate long-term effects and to monitor if internalizing problems return to pre-pandemic levels or if they remain elevated post-pandemic.

White matter integrity in delinquent emerging adults and non-delinquent controls, and its relationship with aggression, psychopathic traits, and cannabis use.

Background: Atypical white matter integrity may be one of the biological factors related to delinquency. In adults, decreased white matter integrity has been related to antisocial behavior, but findings from research in adolescent and young adult populations are either mixed or lacking. Here we investigated this association within a naturalistic sample of delinquent young adults (age 18-27). Methods: In a sample of 95 young adult, delinquent men and 22 age and gender matched controls, we assessed white matter integrity through fractional anisotropy and mean diffusivity measures. We compared white matter integrity between the groups, and within the delinquent group assessed the association between white matter integrity and aggression, psychopathic traits, and cannabis use. Results: We found no differences in fractional anisotropy or mean diffusivity between delinquent young adults and non-delinquent controls. Additionally, within the group of delinquent young adults, we found no associations between white matter integrity and aggression, psychopathic traits, or cannabis use. Conclusion: Our null findings suggest that white matter integrity differences may be unrelated to antisocial behavior in emerging adults, and/or that white matter differences between delinquent populations and controls may only arise later in life.

Neurobiological Responses towards Stimuli Depicting Aggressive Interactions in Delinquent Young Adults and Controls: No Relation to Reactive and Proactive Aggression.

Neurobiological measures underlying aggressive behavior have gained attention due to their potential to inform risk assessment and treatment interventions. Aberrations in responsivity of the autonomic nervous system and electrophysiological responses to arousal-inducing stimuli have been related to emotional dysregulation and aggressive behavior. However, studies have often been performed in community samples, using tasks that induce arousal but not specifically depict aggression. In this study, we examined differences in psychophysiological (i.e., heart rate, respiratory sinus arrhythmia, skin conductance level) and electrophysiological responses (i.e., P3, late positive potential, mu suppression) to aggressive versus neutral scenes in a sample of 118 delinquent young adults and 25 controls (all male, aged 18-27). With respect to group differences, we only found significant higher SCL reactivity during the task in the delinquent group compared to controls, but this was irrespective of condition (aggressive and neutral interactions). Within the delinquent group, we also examined associations between the neurobiological measures and reactive and proactive aggression. No significant associations were found. Therefore, although we found some indication of emotional dysregulation in these delinquent young adults, future studies should further elucidate the neurobiological mechanisms underlying emotional dysregulation in relation to different types of aggression.

Mental and Social Health of Children and Adolescents With Pre-existing Mental or Somatic Problems During the COVID-19 Pandemic Lockdown.

Background: The COVID-19 lockdown increases psychological problems in children and adolescents from the general population. Here we investigate the mental and social health during the COVID-19 lockdown in children and adolescents with pre-existing mental or somatic problems. Methods: We included participants (8-18 years) from a psychiatric (N = 249) and pediatric (N = 90) sample, and compared them to a general population sample (N = 844). Measures were assessed during the first lockdown (April-May 2020) in the Netherlands. Main outcome measures were Patient-Reported Outcomes Measurement Information System (PROMIS®) domains: Global Health, Peer Relationships, Anxiety, Depressive Symptoms, Anger, and Sleep-Related Impairment, as reported by children and youth. Additionally, socio-demographic variables, COVID-19-related questions, changes in atmosphere at home from a parent and child perspective, and children's experiences of lockdown regulations were reported by parents. Results: On all measures except Global Health, the pediatric sample reported least problems. The psychiatric sample reported significantly more problems than the general population sample on all measures except for Anxiety and Peer Relationships. Having a COVID-19 affected friend/relative and a COVID-19 related change in parental work situation negatively moderated outcome, but not in the samples with pre-existing problems. All parents reported significant decreases in atmosphere at home, as did children from the general population. Conclusion: We observed significant differences in mental and social health between three child and adolescent samples during the COVID-19 pandemic lockdown and identified COVID-19-related factors influencing mental and social health.

Moving Past Mysticism in Psychedelic Science.

The mysticism framework is used to describe psychedelic experiences and explain the effects of psychedelic therapies. We discuss risks and difficulties stemming from the scientific use of a framework associated with supernatural or nonempirical belief systems and encourage researchers to mitigate these risks with a demystified model of the psychedelic state.

The impact of lockdown during the COVID-19 pandemic on mental and social health of children and adolescents.

PURPOSE: During the COVID-19 pandemic in the Netherlands, governmental regulations resulted in a lockdown for adults as well as children/adolescents. Schools were closed and contact with other people was limited. In this cross-sectional, population-based study, we aimed to investigate the mental/social health of children/adolescents during COVID-19 lockdown. METHODS: Two representative samples of Dutch children/adolescents (8-18 years) before COVID-19 (2018, N = 2401) and during lockdown (April 2020, N = 844) were compared on the Patient-Reported Outcomes Measurement Information System (PROMIS) domains: global health, peer relationships, anxiety, depressive symptoms, anger, sleep-related impairment by linear mixed models and calculating relative risks (RR (95% CI)) for the proportion of severe scores. Variables associated with worse mental/social health during COVID-19 were explored through multivariable regression models. The impact of COVID-19 regulations on the daily life of children was qualitatively analyzed. RESULTS: Participants reported worse PROMIS T-scores on all domains during COVID-19 lockdown compared to before (absolute mean difference range 2.1-7.1 (95% CI 1.3-7.9). During lockdown, more children reported severe Anxiety (RR = 1.95 (1.55-2.46) and Sleep-Related Impairment (RR = 1.89 (1.29-2.78) and fewer children reported poor Global Health (RR = 0.36 (0.20-0.65)). Associated factors with worse mental/social health were single-parent family, ≥ three children in the family, negative change in work situation of parents due to COVID-19 regulations, and a relative/friend infected with COVID-19. A large majority (> 90%) reported a negative impact of the COVID-19 regulations on daily life. CONCLUSION: This study showed that governmental regulations regarding lockdown pose a serious mental/social health threat on children/adolescents that should be brought to the forefront of political decision-making and mental healthcare policy, intervention, and prevention.

No Association Between Autonomic Functioning and Psychopathy and Aggression in Multi-Problem Young Adults.

BACKGROUND: Aberrant functioning of the autonomic nervous system (ANS) is an important factor in the occurrence of antisocial behavior. Baseline autonomic functioning and the responsivity of the ANS have been related to psychopathic traits and aggression. Here we investigated whether a naturalistic sample of male multi-problem young adults (age 18-27) present with similar autonomic deficits in relation to their psychopathy and aggression as previous studies observed in clinical samples. METHODS: In a sample of 112 multi-problem young adults, baseline autonomic functioning and autonomic responsivity to emotional stimuli were assessed through four physiological measures: heart rate, respiratory sinus arrhythmia, pre-ejection period, and skin conductance. 27 control participants were included primarily to assess whether the task worked appropriately. Participants watched a neutral 5 min video to assess baseline autonomic functioning and watched two sad clips to assess autonomic reactivity to sadness. We investigated the association between autonomic functioning and self-reported psychopathic traits and aggression within the multi-problem group. RESULTS: We found no significant associations between autonomic functioning and psychopathy and aggression. CONCLUSION: These null-findings highlight the importance of research in naturalistic samples in addition to research in clinical and general populations samples and underscore the complexity of translating research findings into practical and clinical implications.

The predictive value of neurobiological measures for recidivism in delinquent male young adults.

Background: Neurobiological measures have been associated with delinquent behaviour, but little is known about the predictive power of these measures for criminal recidivism and whether they have incremental value over and above demographic and behavioural measures. This study examined whether selected measures of autonomic functioning, functional neuroimaging and electroencephalography predict overall and serious recidivism in a sample of 127 delinquent young adults. Methods: We assessed demographics; education and intelligence; previous delinquency and drug use; behavioural traits, including aggression and psychopathy; and neurobiological measures, including heart rate, heart rate variability, functional brain activity during an inhibition task and 2 electroencephalographic measures of error-processing. We tested longitudinal associations with recidivism using Cox proportional hazard models and predictive power using C-indexes. Results: Past offences, long-term cannabis use and reactive aggression were strongly associated with recidivism, as were resting heart rate and error-processing. In the predictive model, demographics, past delinquency, drug use and behavioural traits had moderate predictive power for overall and for serious recidivism (C-index over 30 months [fraction of pairs in the data, where the higher observed survival time was correctly predicted]: C30 = 0.68 and 0.75, respectively). Neurobiological measures significantly improved predictive power (C30 = 0.72 for overall recidivism and C30 = 0.80 for serious recidivism). Limitations: Findings cannot be generalized to females, and follow-up was limited to 4 years. Conclusion: Demographic and behavioural characteristics longitudinally predicted recidivism in delinquent male young adults, and neurobiological measures improved the models. This led to good predictive function, particularly for serious recidivism. Importantly, the most feasible measures (autonomic functioning and electroencephalography) proved to be useful neurobiological predictors.

Disentangling multiproblem behavior in male young adults: A cluster analysis.

Multiproblem young adults present with major problems across key life domains, but empirical studies investigating the nature of multiproblem behavior in accordance to ecobiodevelopmental theory are scarce. To address this gap, we performed a cluster analysis on indicators spanning the key life domains addiction, mental health, social network, and justice. In a large sample (N = 680) of multiproblem young adults, we identified five subgroups labeled "severe with alcohol and cannabis problems" (4.3%), "severe with cannabis problems" (25.6%), "severe without alcohol or drug problems" (33.2%), "moderate with mental health problems" (22.9%), and "moderate without mental health problems" (14.0%). There were large differences between the severe and moderate groups in terms of childhood risk factors such as emotional and physical abuse, concerning baseline functioning such as comorbid disorders and aggressive behavior, and in the outcome measure of violent offending. Our findings indicate that multiproblem young adult behavior clusters within profiles that differ according to the severity and nature of problems. Investing in screening for clustered problems may be beneficial for early problem differentiation and selection of appropriate intervention before and during treatment programs.

The role of adverse childhood experiences and mental health care use in psychological dysfunction of male multi-problem young adults.

Adverse childhood experiences (ACEs) are associated with severe problems later in life. This study examines how eleven types of ACEs and mental health care use history are related to current psychological dysfunction among multi-problem young adults. A sample of 643 multi-problem young adult men (age 18-27) gave informed consent for us to collect retrospective regional psychiatric case register data and filled out questionnaires. ACEs were highly prevalent (mean 3.6, SD 2.0). Logistic regression analysis showed that compared with participants who experienced other ACEs, participants who experienced psychological problems in their family and grew up in a single-parent family were more likely to have used mental health care, and physically abused participants were less likely to have used mental health care. Linear regression analyses showed a dose-response relationship between ACEs and internalizing and externalizing problems. Linear regression analyses on the single ACE items showed that emotional abuse and emotional neglect were positively related to internalizing problems. Emotional and physical abuse and police contact of family members were positively related to externalizing problems. While multi-problem young adults experienced many ACEs, only a few ACEs were related to mental health care use in childhood and adolescence. Long-term negative effects of ACEs on psychological functioning were demonstrated; specifically, emotional abuse and emotional neglect showed detrimental consequences. Since emotional abuse and emotional neglect are not easily identified and often chronic, child health professionals should be sensitive to such problems.

Neural Correlates of Moral Evaluation and Psychopathic Traits in Male Multi-Problem Young Adults.

Multi-problem young adults (18-27 years) present with a plethora of problems, including varying degrees of psychopathic traits. The amygdala and ventromedial prefrontal cortex (vmPFC) have been implicated in moral dysfunction in psychopathy in adolescents and adults, but no studies have been performed in populations in the transitional period to adulthood. We tested in multi-problem young adults the hypothesis that psychopathic traits are related to amygdala and vmPFC activity during moral evaluation. Additionally, we explored the relation between psychopathic traits and other regions consistently implicated in moral evaluation. Our final sample consisted of 100 multi-problem young adults and 22 healthy controls. During fMRI scanning, participants judged whether pictures showed a moral violation on a 1-4 scale. Whole brain analysis revealed neural correlates of moral evaluation consistent with the literature. Region of interest analyses revealed positive associations between the affective callous-unemotional dimension of psychopathy and activation in the left vmPFC, left superior temporal gyrus, and left cingulate. Our results are consistent with altered vmPFC function during moral evaluation in psychopathy, but we did not find evidence for amygdala involvement. Our findings indicate the affective callous-unemotional trait of psychopathy may be related to widespread altered activation patterns during moral evaluation in multi-problem young adults.

The impact of chronic stress during adolescence on the development of aggressive behavior: A systematic review on the role of the dopaminergic system in rodents.

Pathological aggression, frequently observed in psychiatric patients and criminal subjects, poses a major burden on the health care and criminal justice system, necessitating better aetiological models to inform targets for prevention and intervention. Emerging evidence suggests that adverse experiences during development can cause long-lasting brain alterations associated with maladaptive behaviors, such as aggression. The present review discusses, mainly based on studies in rodents, whether disruption of the mesocorticolimbic dopamine system through chronic stress-exposure during adolescence predisposes to adult aggression. Our findings suggest that chronic stress in adolescence induces prefrontal cortex (PFC) hyperdopaminergia and ultimately leads to blunted prefrontal dopamine transmission in adulthood. This, in turn, disrupts the ability of the PFC to guide adaptive, long-term focused action selection by regulating mesolimbic dopamine signaling. We propose that, especially during the dynamic and transitional period of adolescence, exposure to chronic stress could lead to excessive adaptive change, which may result in an increased vulnerability to maladaptive aggression in adulthood. We discuss how these findings in rodents may translate to humans.

Children with Obsessive-Compulsive Symptomology in the General Population: Different Subtypes?

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a moderately prevalent neurodevelopmental disorder, and many children suffer from subclinical obsessive-compulsive (OC) symptoms. The disorder is heterogeneous and has high comorbidity rates. In early disease stages of psychiatric disorders, symptoms are typically hard to attribute exclusively to specific disorders. The authors investigated whether profiles of neuropsychiatric symptoms can be distinguished within a large population-based study of school-aged children (7-10 years) scoring high on OC symptoms. METHODS: OC symptoms and comorbid symptoms common in pediatric OCD were assessed: symptoms of attention-deficit hyperactivity disorder, oppositional defiant disorder, autism, and anxiety. Latent profile analysis was performed on the subgroup of children scoring high on OC symptoms (high-OC sample, n = 209, i.e., 4.5% of total sample, n = 4632) using the z scores of the measures of comorbid symptoms as indicators. RESULTS: Three distinguishable profiles were found within the high-OC sample. The first subgroup ("OC-specific"; 81.3%, 3.7% of total sample) had only OC-specific problems, the second subgroup ("Comorbid OC"; 11.0%, 0.5% of total sample) had high scores on all measures of comorbid symptomology, and the third subgroup ("Autistic OC"; 7.7%, 0.3%, of total sample) scored especially high on autism. CONCLUSION: The findings show that profiles based on neuropsychiatric symptoms can be distinguished within a population-based sample of school-aged children scoring high on obsessive-compulsive symptoms. These profiles may be useful in establishing patterns of symptom course during development. Longitudinal follow-up is necessary to ascertain whether at a later age these subgroups still differ in their symptom profile and neuropsychiatric trajectory.

A multimodal day treatment program for multi-problem young adults: study protocol for a randomized controlled trial.

BACKGROUND: Effective interventions for young adults with severe, multiple problems - such as psychosocial and psychiatric problems, delinquency, unemployment and substance use - are scarce but urgently needed in order to support an adequate transition to adulthood. A multimodal day treatment program called "New Opportunities" (in Dutch: "De Nieuwe Kans"; DNK) was specifically developed to target multi-problem young adults in The Netherlands. The aim of this study protocol is to describe the design of a randomized controlled trial (RCT) in clinical practice to examine the effectiveness of DNK in comparison with care as usual (CAU). METHODS/DESIGN: Multi-problem young adults in Rotterdam, The Netherlands, will be assigned randomly to DNK (expected N = 150) and CAU (expected N = 150). Primary outcome measures are recidivism and self-sufficiency. Secondary outcome measures include quality of life, attending school/work, psychological functioning, cognitive distortions and substance use. Participant and program characteristics will be examined as potential moderators of effectiveness. Additionally, cost-effectiveness will be measured. During 14 months, data from multiple resources will be collected at four time points. DISCUSSION: This study is one of the first RCTs on the effectiveness of interventions developed for multi-problem young adults. The results will contribute to the currently scant knowledge about what works for various multi-problem young adults in their transition to adulthood. In addition, the study protocol will provide insight into implementing an RCT in a dynamic setting of clinical practice. TRIAL REGISTRATION: Dutch Trial Register, identifier: NTR5163 . Registered on 17 April 2015; retrospectively registered during the recruitment phase.

Child Protection Service interference in childhood and the relation with mental health problems and delinquency in young adulthood: a latent class analysis study.

BACKGROUND: Most multi-problem young adults (18-27 years old) have been exposed to childhood maltreatment and/or have been involved in juvenile delinquency and, therefore, could have had Child Protection Service (CPS) interference during childhood. The extent to which their childhood problems persist and evolve into young adulthood may differ substantially among cases. This might indicate heterogeneous profiles of CPS risk factors. These profiles may identify combinations of closely interrelated childhood problems which may warrant specific approaches for problem recognition and intervention in clinical practice. The aim of this study was to retrospectively identify distinct statistical classes based on CPS data of multi-problem young adults in The Netherlands and to explore whether these classes were related to current psychological dysfunctioning and delinquent behaviour. METHODS: Age at first CPS interference, numbers and types of investigations, age at first offence, mention of child maltreatment, and family supervision order measures (Dutch: ondertoezichtstelling; OTS) were extracted from the CPS records of 390 multi-problem young adult males aged 18-27 (mean age 21.7). A latent class analysis (LCA) was conducted and one-way analyses of variance and post-hoc t-tests examined whether LCA class membership was related to current self-reported psychological dysfunctioning and delinquent behaviour. RESULTS: Four latent classes were identified: (1) late CPS/penal investigation group (44.9%), (2) early CPS/multiple investigation group (30.8%), (3) late CPS interference without investigation group (14.6%), and (4) early CPS/family investigation group (9.7%). The early CPS/family investigation group reported the highest mean anxiousness/depression and substance use scores in young adulthood. No differences were found between class membership and current delinquent behaviour. CONCLUSIONS: This study extends the concept that distinct pathways are present in multi-problem young adults who underwent CPS interference in their youth. Insight into the distinct combinations of CPS risk factors in the identified subgroups may guide interventions to tailor their treatment to the specific needs of these children. Specifically, treatment of internalizing problems in children with an early onset of severe family problems and for which CPS interference is carried out should receive priority from both policy makers and clinical practice.

Embodied cognition, abstract concepts, and the benefits of new technology for implicit body manipulation.

Current approaches on cognition hold that concrete concepts are grounded in concrete experiences. There is no consensus, however, as to whether this is equally true for abstract concepts. In this review we discuss how the body might be involved in understanding abstract concepts through metaphor activation. Substantial research has been conducted on the activation of common orientational metaphors with bodily manipulations, such as "power is up" and "more is up" representations. We will focus on the political metaphor that has a more complex association between the concept and the concrete domain. However, the outcomes of studies on this political metaphor have not always been consistent, possibly because the experimental manipulation was not implicit enough. The inclusion of new technological devices in this area of research, such as the Wii Balance Board, seems promising in order to assess the groundedness of abstract conceptual spatial metaphors in an implicit manner. This may aid further research to effectively demonstrate the interrelatedness between the body and more abstract representations.