Effectiveness of a Comprehensive School-Based Sex Education Program for Young Adolescents in the Netherlands.

Most sexual education programs traditionally focused on providing sexual information regarding the risks of sex. However, current studies on sexual behavior in youth show a need for truly comprehensive sex education approaches with a sex-positive focus on sexuality, that effectively improve sexual competence. Therefore, in the current study the effectiveness of "Love is…", a four lesson school-based program based on the Sexual Interactional Competence model and Attitude-Social-Influence-Self-Efficacy-model was studied. A cluster-randomized controlled trial on the effectiveness of "Love is…" was conducted in 2018-2020. The sample consisted of 1160 adolescents in grades 8 and 9 from nine schools in the Netherlands. The sample was 48% female, 34% Dutch/Caucasian, 41% none-religious and 50% higher educated. They were randomized at class level into a program group [n = 32 classes; 567 students (Mage = 13.74 (SD = 0.74))] and a control group [n = 31 classes; 593 students (Mage = 13.86 (SD = 0.73))]. Results showed that "Love is…" increased sexual knowledge, that adolescents in the program group showed less cyber victim blaming attitudes and increased in communications skills after the program. In conclusion, the current study shows that "Love is…" was effective not only on the knowledge level, but also regarding sexual attitudes and competences. However, due to the developmental process of sexuality, there is a necessity to continue lessons in following grades through booster sessions by reinforcing competences as communicating comfortably about sexuality.On 12 November 2019 the study design and hypotheses were registered in the Dutch Trial Registration, number NL8150. ( https://onderzoekmetmensen.nl/nl/trial/26676 ).

Using the biopsychosocial model for identifying subgroups of detained juveniles at different risk of re-offending in practice: a latent class regression analysis approach.

BACKGROUND: Juvenile delinquents constitute a heterogeneous group, which complicates decision-making based on risk assessment. Various psychosocial factors have been used to define clinically relevant subgroups of juvenile offenders, while neurobiological variables have not yet been integrated in this context. Moreover, translation of neurobiological group differences to individual risk assessment has proven difficult. We aimed to identify clinically relevant subgroups associated with differential youth offending outcomes, based on psychosocial and neurobiological characteristics, and to test whether the resulting model can be used for risk assessment of individual cases. METHODS: A group of 223 detained juveniles from juvenile justice institutions was studied. Latent class regression analysis was used to detect subgroups associated with differential offending outcome (recidivism at 12 month follow-up). As a proof of principle, it was tested in a separate group of 76 participants whether individual cases could be assigned to the identified subgroups, using a prototype 'tool' for calculating class membership. RESULTS: Three subgroups were identified: a 'high risk-externalizing' subgroup, a 'medium risk-adverse environment' subgroup, and a 'low risk-psychopathic traits' subgroup. Within these subgroups, both autonomic nervous system and neuroendocrinological measures added differentially to the prediction of subtypes of reoffending (no, non-violent, violent). The 'tool' for calculating class membership correctly assigned 92.1% of participants to a class and reoffending risk. CONCLUSIONS: The LCRA approach appears to be a useful approach to integrate neurobiological and psychosocial risk factors to identify subgroups with different re-offending risk within juvenile justice institutions. This approach may be useful in the development of a biopsychosocial assessment tool and may eventually help clinicians to assign individuals to those subgroups and subsequently tailor intervention based on their re-offending risk.

Predicting quality of life during and post detention in incarcerated juveniles.

PURPOSE: Besides reducing recidivism, juvenile justice institutions aim to rehabilitate juvenile delinquents, in order for them to reintegrate in society. As such, improving quality of life (QoL), especially post detention, is an important treatment goal. However, research is primarily focused on recidivism as an outcome measure for juvenile detention. The aim of the current study is therefore to describe and predict QoL of detained young offenders up to 1 year after an initial assessment, and to examine whether QoL differs between youth who are still detained versus released. METHODS: A sample of 186 juveniles admitted to juvenile justice institutions in the Netherlands was assessed within the institution (initial assessment/T0), using psychosocial and neurobiological factors as predictors (self-control, treatment motivation, trauma, mental health problems, respiratory sinus arrhythmia). QoL (MANSA), as well as substance use (alcohol, cannabis) and daily activities (education, work) were assessed at first, second, and third follow-up (respectively 2.5 months, 4.5 months, and 12 months after T0). RESULTS: QoL increased from first to third follow-up, and was higher for individuals who were no longer detained. The model that best predicted higher QoL upon follow-up consisted of lower trauma and stronger parasympathetic nervous system reactivity. The effects of the predictors did not differ between the various follow-ups, nor between individuals who were or were not detained. CONCLUSION: Methods incorporating trauma-sensitive focus and relaxation techniques in treatment protocols in juvenile justice institutions may be of added value in improving the general functioning of these individuals.

Are Proactive and Reactive Aggression Meaningful Distinctions in Adolescents? A Variable- and Person-Based Approach.

This study was designed to examine whether proactive and reactive aggression are meaningful distinctions at the variable- and person-based level, and to determine their associated behavioral profiles. Data from 587 adolescents (mean age 15.6; 71.6 % male) from clinical samples of four different sites with differing levels of aggression problems were analyzed. A multi-level Latent Class Analysis (LCA) was conducted to identify classes of individuals (person-based) with similar aggression profiles based on factor scores (variable-based) of the Reactive Proactive Questionnaire (RPQ) scored by self-report. Associations were examined between aggression factors and classes, and externalizing and internalizing problem behavior scales by parent report (CBCL) and self-report (YSR). Factor-analyses yielded a three factor solution: 1) proactive aggression, 2) reactive aggression due to internal frustration, and 3) reactive aggression due to external provocation. All three factors showed moderate to high correlations. Four classes were detected that mainly differed quantitatively (no 'proactive-only' class present), yet also qualitatively when age was taken into account, with reactive aggression becoming more severe with age in the highest affected class yet diminishing with age in the other classes. Findings were robust across the four samples. Multiple regression analyses showed that 'reactive aggression due to internal frustration' was the strongest predictor of YSR and CBCL internalizing problems. However, results showed moderate to high overlap between all three factors. Aggressive behavior can be distinguished psychometrically into three factors in a clinical sample, with some differential associations. However, the clinical relevance of these findings is challenged by the person-based analysis showing proactive and reactive aggression are mainly driven by aggression severity.

Trajectories of adolescent conduct problems in relation to cortical thickness development: a longitudinal MRI study.

Multiple cross-sectional imaging studies have identified structural abnormalities in prefrontal, temporal and limbic regions related to conduct problems (CPs). However, the relationship between development of such neurobiological deficits and developmental pathways of CPs has remained unclear. The current study investigated distinct trajectories of CP and related trajectories of cortical thickness within a community-based sample of adolescents (n=239), age range 12-19, to address this gap. Three trajectory classes were revealed using latent class growth analyses (LCGAs), comprising a 'desisting' CP group, an 'intermediate' CP group and a 'stable low' CP group. Structural magnetic resonance imaging (MRI) scans were collected with a subgroup of 171 adolescents at three waves throughout adolescence (ages 12, 16 and 19). Generalized estimating equation (GEE) analysis-comparing longitudinal changes in cortical thickness and subcortical volume between CP groups for several regions of interest (ROIs)-showed that these CP groups had differential trajectories of cortical thickness in the dorsolateral prefrontal cortex (dl-PFC), and the anterior cingulate cortex (ACC), and volume of the hippocampus. Adolescents in the desisting CP group showed an attenuation of the typical pattern of cortical thinning as present in the intermediate and stable low CP groups, in addition to an exaggeration of the typical pattern of hippocampal volume increase. These findings suggest that a deviant cortical thickness trajectory was related to a desisting CP pathway across adolescence. Such deviant neurodevelopmental growth trajectories may act as an underlying mechanism for developmental CP pathways, and possibly distinguish desisting antisocial adolescents.

Inhibited attachment behaviour and disinhibited social engagement behaviour as relevant concepts in referred home reared children.

BACKGROUND: Disorders of attachment and social engagement have mainly been studied in children, reared in institutions and foster care. There are few studies amongst home reared children living with biological parents. The aim of this study was to test the clinical significance of inhibited attachment behaviour and disinhibited social engagement behaviour in young home reared children, referred for treatment of emotional and behavioural problems, compared with young children in treatment foster care. METHODS: The Disturbances of Attachment Interview, Maltreatment Classification System, the Child Behaviour Checklist and Parenting Stress Index were used in 141 referred home reared children and 59 referred foster children, aged 2.0-7.9 years (M = 4.7, SE = 1.3), 71% boys. RESULTS: Inhibited attachment behaviour was less prevalent in the referred home reared group (9%) than in the foster care group (27%). Disinhibited social engagement behaviour was found in 42% of the home reared group, similar to the foster care group. Inhibited attachment behaviour and disinhibited social engagement behaviour were not associated with child maltreatment. More inhibited attachment behaviour was associated with clinical levels of child internalizing and externalizing behaviour in the home reared group, not in the foster care group. In both groups, more disinhibited social engagement behaviour was associated with clinical levels of externalizing behaviour and with more parenting stress. CONCLUSIONS: Even without evident links to maltreatment, results of this study suggest clinical significance of inhibited attachment behaviour and disinhibited social engagement behaviour in young home reared children referred for treatment of emotional and behavioural problems.

A longitudinal biosocial study of cortisol and peer influence on the development of adolescent antisocial behavior.

It is increasingly recognized that in order to understand the complex phenomenon of antisocial behavior, interrelations between biological and social risk factors should be taken into account. In the current study, this biosocial approach was applied to examine the mediating role of deviant peers in longitudinal associations linking the level of hypothalamic-pituitary-adrenal (HPA) axis activity to aggression and rule-breaking. Participants were 425 boys and girls from the general population, who were assessed yearly at ages 15, 16, and 17. As a measure of HPA axis activity, cortisol was assessed at awakening, 30, and 60 min later (the cortisol awakening response, CAR). Participants, as well as their best friend, reported on their own aggressive and rule-breaking behavior, thereby allowing to assess bidirectional influences within friendships. Aggression was only predicted by a decreased cortisol level at awakening, and not by aggressive behavior of their friend. Decreased levels of cortisol at awakening predicted adolescents' rule-breaking, which subsequently predicted increased rule-breaking of their best friend. The latter was only found for adolescents who changed friends, as compared to adolescents with the same friend in every year. Gender differences were not found. These findings suggest that interrelations between biological and social risk factors are different for the development of aggression versus rule-breaking. Furthermore, decreased levels of HPA axis activity may represent a susceptibility to selecting deviant peers.

Detained adolescent females' multiple mental health and adjustment problem outcomes in young adulthood.

BACKGROUND: Although prior studies have shown that detained females are marked by significant adverse circumstances, little is known about their adult outcomes. METHOD: Prospective follow-up study of 184 (80.4% of original sample of 229) detained adolescent females who were reassessed 4.5 (SD=0.6) years later in young adulthood (mean age=20.0, SD=1.4) on mental health and adjustment outcomes. Associations between these outcomes and detained females' behavior problems and offense history were examined. RESULTS: In the total sample, 59.0% had one or more mental health problems at follow-up, whereas 96.2% were facing at least one adjustment problem. Subjects with a personality disorder (PD) reported more adjustment problems compared to subjects without PD. Mental health and adjustment problems in young adulthood were predicted by detained adolescent females' behavior problems and offense history. CONCLUSION: Detained adolescent females suffered from multiple mental health and adjustment problems in young adulthood. Females who developed PD were most impaired. Results of this study underline the compelling need for continued and gender-specific interventions. The identification of predictors during detention for poor adult outcomes can serve as targets for intervention.