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 ).

[Twenty-five years of child and adolescent psychiatry in the Netherlands: patterns of practice]. / 25 jaar Nederlandse kinder- en jeugd­psychiatrie in de praktijk.

BACKGROUND: The department of child- and adolescent psychiatry of the Dutch Association of Psychiatry has regularly investigated the practice of child- and adolescent psychiatry since 1996. This article reports the results of the 2021 survey. AIM: Investigating the composition and practice of the group of child- and adolescent psychiatrists, with special attention to the effect of the decentralization of child mental healthcare to the municipalities in 2015. METHOD: A postal survey; descriptive analysis of collected data. RESULTS: The number of child- and adolescent psychiatrists remained constant since 2012: 445, with sixty-eight percent women. Eighty percent works in institutional practice. Ten percent holds an interim position. Eighty percent reports an increase in workload. Professional satisfaction is mainly derived from patient care. CONCLUSION: Despite the unrest caused by the decentralization, the number of child- and adolescent psychiatrists remained stable over the last ten years. Since 2021 there have been negative, as well as positive developments. Therefore repetition of this survey in a few years is recommended.

Burden of mental health problems: quality of life and cost-of-illness in youth consulting Dutch walk-in youth health centres.

BACKGROUND: Little is known about the burden of (sub-threshold) mental health problems in youth. AIM: To examine the burden of mental health problems in terms of health-related quality of life (HRQoL) and cost-of-illness, for first visitors of the Dutch youth walk-in centres (@ease). METHOD: A bottom-up, prevalence-based burden of disease study from a societal perspective. HRQoL was assessed through the EuroQoL (EQ-5D-5L), and cost-of-illness via items about truancy and health care utilization. RESULTS: Participants (N = 80) showed a decreased HRQoL compared to the general population of Dutch youth. In the three months prior to their 1st attendance, participants skipped on average 4.11 days of school and had 1.03 health care visits, leading to total costs of €512.64 per person. Females had significantly higher health care costs and lower HRQoL. Health care use was lower in those not speaking the Dutch language. Living alone was a significant predictor of truancy (costs), and therefore total costs. CONCLUSIONS: Mental health problems in youth consulting @ease have a considerable impact on the individual's HRQoL, and an economic impact on society, yet almost 75% is not receiving care. A lack of interventions in this critical period in life may have major lifelong consequences.

[Treatment plan for female adolescents in the grip of chronic suicidality]. / Behandelbeleid bij vrouwelijke adolescenten gegijzeld door chronische suïcidaliteit.

BACKGROUND: A psychological autopsy study (Mérelle e.a. 2020) demonstrates a subgroup of female adolescents with chronic suicidal behavior and severe internalizing problems. AIM: To describe characteristics of the suicidal process and the challenges experienced in providing mental health care for this subgroup. METHOD: A case description and review of literature. RESULTS: The persistent suicidal threat and the following despair of the patient and its parents are forcing care providers into an impasse: the primary focus of treatment is to guarantee the patient's safety, whereby the treatment of underlying problems is underexposed. Based on expert knowledge we make recommendations including autonomy-promoting treatment policy, treating suicidality as a transdiagnostic phenomenon, creating a multidisciplinary network of care providers and making chronic suicidality tolerable for care providers. CONCLUSION: We propose preliminary practical recommendations in our quest for optimal mental health care for chronic suicidal adolescents.

ENgage YOung people earlY (ENYOY): a mixed-method study design for a digital transdiagnostic clinical - and peer- moderated treatment platform for youth with beginning mental health complaints in the Netherlands.

BACKGROUND: The onset of mental disorders typically occurs between the ages of 12 and 25, and the burden of mental health problems is the most consequential for this group. Indicated prevention interventions to target individuals with subclinical symptoms to prevent the transition to clinical levels of disorders, even leading to suicide, have shown to be effective. However, the threshold to seek help appears to be high. Digital interventions could offer a solution, especially during the Covid-19 pandemic. This implementation study will investigate the digital indicated prevention intervention ENgage YOung people Early (ENYOY), the Dutch version of the original Moderated Online Social Therapy Platform (MOST+) from Australia. In addition, the relationship between stress biomarkers, symptoms and outcome measures of youth using the platform will be investigated in this study. METHODS: The MOST+ platform will be adapted, translated and developed for the situation in the Netherlands in collaboration with a Youth Panel. A prospective cohort of 125 young people (16-25 years) with beginning mental health complaints will be on the platform and followed for a year, of which 10 participants will have an additional smart watch and 10 participants will be asked to provide feedback about the platform. Data will be collected at baseline and after 3, 6 and 12 months. Outcome measures are Psychological Distress assessed with the Kessler Psychological Distress Scale (K10), Social and occupational functioning (measures by the SOFAS), positive mental health indicators measured by the Positive Health Instrument, stress biomarkers with a smart-watch, website journeys of visitors, and feedback of youth about the platform. It will be a mixed-method study design, containing qualitative and quantitative measures. DISCUSSION: This trial will specifically address young people with emerging mental health complaints, and offers a new approach for treatment in the Netherlands. Considering the waiting lists in (child and adolescent)-psychiatry and the increase in suicides among youth, early low-threshold and non-stigmatizing help to support young people with emerging psychiatric symptoms is of crucial importance. Moreover, this project aims to bridge the gap between child and adolescent and adult psychiatry. TRIAL REGISTRATION: Netherlands Trial Register ID NL8966 , retrospectively registered on the 19th of October 2020.

[Intensive home treatment (IHT): indication criteria for children and adolescents]. / Intensive home treatment: indicatie­criteria bij kinderen en jongeren.

BACKGROUND: Intensive home treatment (IHT) is an intervention that provides intensive psychiatric (crisis) care in the home environment. AIM: To formulate indication criteria for IHT in children and adolescents, to improve assessment and to reduce the time needed for triage. METHOD: The Delphi method was used to assess the opinion of experts on the indication for IHT in children and adolescents. In round 1, 18 employees of the IHT team of Levvel (Academic Centre for Child and Adolescent Psychiatry) list the indication criteria that they thought should be used to determine whether a patient belonged to the IHT target group. Open coding was used to analyze the responses and to derive statements that, in the following three rounds, were rated by the participants on their importance. RESULTS: 33 statements were deemed important enough (> 80% consensus) to include in the final list. These statements concerned the aim, target group, treatment services, the role and responsibilities of the referrer and logistical issues. CONCLUSION: The list with assessment indicators is a promising tool to help IHT teams working with children and adolescents improve and standardize their triage.

Neurocognitive predictors of treatment completion and daytime activities at follow-up in multiproblem young adults.

Previous research has shown an association between cognitive control deficits and problematic behavior such as antisocial behavior and substance use, but little is known about the predictive value of cognitive control for treatment outcome. The current study tests whether selected markers of baseline cognitive control predict (1) treatment completion of a day treatment program involving a combination of approaches for multiproblem young adults and (2) daytime activities a year after the start of treatment, over and above psychological, social, and criminal characteristics. We assessed individual, neurobiological, and neurobehavioral measures, including functional brain activity during an inhibition task and two electroencephalographic measures of error processing in 127 male multiproblem young adults (age 18-27 years). We performed two hierarchical regression models to test the predictive power of cognitive control for treatment completion and daytime activities at follow-up. The overall models did not significantly predict treatment completion or daytime activities at follow-up. However, activity in the anterior cingulate cortex (ACC) during response inhibition, years of regular alcohol use, internalizing problems, and ethnicity were all significant individual predictors of daytime activity at follow-up. In conclusion, cognitive control could not predict treatment completion or daytime activities a year after the start of treatment over and above individual characteristics. However, results indicate a direct association between brain activity during response inhibition and participation in daytime activities, such as work or school, after treatment. As adequate baseline inhibitory control is associated with a positive outcome at follow-up, this suggests interventions targeting cognitive control might result in better outcomes at follow-up.

Improving mental wellbeing of forensic psychiatric outpatients through the addition of an informal social network intervention to treatment as usual: a randomized controlled trial.

BACKGROUND: Forensic psychiatric patients often suffer from a multitude of severe psychiatric and social problems. Meanwhile multimodal evidence-based interventions are scarce and treatment effectiveness is in need of improvement. The main goal of forensic psychiatric treatment is to address psychiatric and social factors and thereby mitigate criminal behaviour. Notably, a supportive social network is an important protective factor for criminal behaviour. As such, improving a poor social network may decrease the risk of criminal recidivism. This study aims to examine the effectiveness of the addition of an informal social network intervention (FNC) to treatment as usual (TAU) among forensic psychiatric outpatients. METHODS: In a mono-center randomized controlled clinical trial with two parallel groups, forensic psychiatric outpatients with social network-related problems (N = 105) will be allocated to either TAU + FNC or TAU alone. The informal social network intervention consists of a 12-month coaching intervention, performed by the forensic network coach (a volunteer trained by an informal care institute). Assessments will be conducted at baseline and 3 months, 6 months, 9 months, 12 months, and 18 months after baseline. The primary outcome variable is mental wellbeing. Psychiatric functioning, criminal recidivism, substance abuse, quality of life, social network, social support, loneliness and self-sufficiency are included as secondary outcomes. A variety of potential mediators and moderators of effectiveness will be explored. Additionally, a qualitative evaluation of effectiveness will be performed. DISCUSSION: This study will contribute to the existing literature of forensic treatment effectiveness as it is the first RCT examining the effectiveness of adding a social network intervention in a forensic outpatient population. If effectiveness is shown, forensic mental health care could be optimized by collaborating with informal care or community initiatives aimed at improving a positive social network. In addition, results will provide insight regarding mediators and moderators of treatment effectiveness. TRIAL REGISTRATION: This study is registered at the Netherlands Trial Register ( NTR7163 ). Date of registration: 16 april 2018.

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.

Sleep, chronotype, and sleep hygiene in children with attention-deficit/hyperactivity disorder, autism spectrum disorder, and controls.

Sleep problems are highly prevalent in ADHD and autism spectrum disorder (ASD). Better insight in the etiology is of clinical importance since intervention and prevention strategies of sleep problems are directed at underlying mechanisms. We evaluated the association of sleep problems and sleep patterns with sleep hygiene (behavioral/environmental practices that influence sleep quality, e.g. caffeine use), access to electronic media, chronotype, and anxiety/depression in children aged 6-12 years with ADHD, ASD, or typical development (TD) using parental questionnaires. ANOVA and linear regression analyses were adjusted for age and sex. Children with ADHD and ASD showed more sleep problems (63.6 and 64.7%, vs 25.1% in TD) and shorter sleep duration than controls, while differences between ADHD and ASD were not significant. Sleep hygiene was worse in ADHD and ASD compared to TD, however, the association of worse sleep hygiene with more sleep problems was only significant in ASD and TD. There was a significant association of access to electronic media with sleep problems only in typically developing controls. Chronotype did not differ significantly between groups, but evening types were associated with sleep problems in ADHD and TD. Associations of greater anxiety/depression with more sleep problems were shown in ADHD and TD; however, anxiety/depression did not moderate the effects of chronotype and sleep hygiene. We conclude that sleep problems are highly prevalent in ADHD and ASD, but are differentially related to chronotype and sleep hygiene. In ASD, sleep problems are related to inadequate sleep hygiene and in ADHD to evening chronotype, while in TD both factors are important. Clinical implications are discussed.

EEG theta and beta power spectra in adolescents with ADHD versus adolescents with ASD + ADHD.

Attention problems are common in youngsters with attention deficit hyperactivity disorder (ADHD) as well as in adolescents with combined autism spectrum disorder (ASD) and ADHD. However, it is unknown whether there is psychophysiological overlap and/or a difference in electroencephalogram (EEG) power spectra between ADHD and comorbid ASD and ADHD (ASD + ADHD), on and off stimulant medication. To explore potential differences and overlap, measures of theta and beta power in adolescents diagnosed with ADHD (n = 33) versus adolescents with combined ASD + ADHD (n = 20), categorized by stimulant medication use (57 % of the total sample), were compared. EEG measures were acquired in three conditions: (1) resting state, eyes closed (2) resting state, eyes open and (3) during an oddball task. In addition, performance on the d2 attention test was analyzed. Adolescents with ADHD displayed more absolute theta activity than adolescents with ASD + ADHD during the eyes open and task conditions, independent of stimulant medication use. In addition, only the adolescents with ADHD showed an association between diminished attention test performance and increased theta in the eyes open condition. Results of the current study suggest that although there is behavioral overlap between ADHD characteristics in adolescents with ADHD and adolescents with combined ASD + ADHD, the underlying psychophysiological mechanisms may be different. Adolescents with ASD + ADHD exhibited fewer of the EEG physiological signs usually associated with ADHD, although there was an overlap in attentional problems between the groups. This may indicate that treatments developed for ADHD work differently in some adolescents with ASD + ADHD and adolescents with ADHD only.

[Examining the developing brain in Dutch child and adolescent psychiatry]. / Nederlandse kinder- en jeugdpsychiatrie: in internationale voorhoede met onder-zoek naar de hersenen in ontwikkeling.

BACKGROUND: Research on the developing brain in children and adolescents is delivering new insights into the underlying mechanisms of childhood psychiatric disorders. AIM: To provide important information about the role that departments of Dutch child and adolescent psychiatry are playing in this international field that is expanding rapidly. METHOD: This article provides an overview of recent, mainly Dutch neuro-imaging studies on the developing brain. RESULTS: A large number of studies from Dutch research centers have greatly increased our knowledge about normal and abnormal brain development in relation to the development of psychiatric disorders. CONCLUSION: Neuro-developmental research can help us to understand the underlying mechanisms of developing psychiatric disorders. This is likely to lead to new preventive measures and to more effective treatment in the future. Policy-makers should therefore commit a larger proportion of their neuroscience research budgets to neurodevelopmental studies in children.

[Forensic child, adolescent and transitional psychiatry]. / Forensische kinder-, jeugd- en transitiepsychiatrie.

BACKGROUND: Over the past 20 years there has been a marked increase in research relating to forensic child and adolescent psychiatry. AIM: To review briefly and reflect on this research. METHOD: First of all, we describe the characteristics of forensic psychiatry and consider the consequences of this type of psychiatry for research in forensic settings. Secondly, we highlight several lines of research; these range from neurobiology to the prevalence of psychiatric disorders in persons who have committed specific types of offences. RESULTS: A majority of young people who have been in contact with the law appeared to have a psychiatric disorder, especially behavioural disorders, ADHD and substance abuse. However, also anxiety and depressive disorders were found in 10-20% of all delinquent young people. Particularly the existence of more than one disorder showed a connection between the nature and the severity of the delinquent behaviour and the disfunctioning of the adolescent. Current research focuses on stress and HPA axis of young people in relation to proactive and reactive aggression. CONCLUSION: In the past decades research in forensic child and adolescent psychiatry has taken an enormous flight. One of the challenges for the future will be translating the results of the research into practice.

The effectiveness of social network interventions for psychiatric patients: A systematic review and meta-analysis.

Strengthening social networks is an important goal in mental health treatment. This study aimed to determine the effectiveness of social network interventions for psychiatric patients. A systematic review and meta-analysis was conducted comparing these interventions with control groups on social and mental health-related outcomes in psychiatric patients. PubMed, EMBASE.com, PsycInfo, Scopus, and IBSS were searched for studies until December 21, 2022. Three-level random effects models were used to obtain Cohen's d mean estimates on composite outcomes of social network and secondary mental health outcomes. Heterogeneity was examined with potential moderators. Thirty-three studies were included. Small-to-moderate effects of social network interventions were detected on positive social network (d = 0.115, p = 0.022) and support (d = 0.159; p = 0.007), general functioning (d = 0.127, p = 0.046), mental health treatment adherence (d = 0.332, p = 0.003), days substance use (d = 0.097, p = 0.004), and abstinence (d = 0.254, p = 0.004). Estimates of psychiatric functioning were higher in samples with more females. The quality of evidence was moderate-to-low. This evidence suggests that social network interventions can improve positive social networks, general functioning, mental health treatment adherence, and substance use in psychiatric patients receiving usual care. PROSPERO ID: CRD42019131959.

How do group workers respond to suicidal behavior? Experiences and perceptions of suicidal female adolescents residing in secure residential youth care in the Netherlands.

BACKGROUND: Adolescent suicidal behavior, including non-suicidal self-injury, is increasingly prevalent in Secure Residential Youth Care (SRYC) in the Netherlands. Group workers play a vital role in the well-being and functioning of adolescents in SRYC as they interact with adolescents on a daily basis. However, we have little understanding of how adolescents perceive group workers' responses to suicidal behavior and we lack knowledge about the impact of these responses on adolescents and the group climate. AIM: The aim of this study is to explore (a) how adolescents value group workers responses towards suicidal behavior and (b) the impact of these responses on adolescents, as well as (c) on the group climate. The results can be used to develop care-policy to improve care for suicidal adolescents in SYRC. METHOD: Eleven suicidal female adolescents residing in SRYC were interviewed. All adolescents had previously displayed suicidal behavior, including non-suicidal self-injury. Interviews were analyzed using grounded theory. CONCLUSION: This study presents the perceptions of suicidal female adolescents residing in SRYC about group workers' responses on suicidal behavior. Adolescents prefer group workers who react responsive to suicidal behavior. Responsive care, trust and connectedness help adolescents disclose their suicidal thoughts. Participants criticize group workers who are non-responsive as being distant, and their relationship with these group workers lacked trust, communication, a sense of connection, or personal depth. All adolescents underline the devastating impact of involuntary seclusion, and stress the importance of being able to disclose without fear of coercive consequences. Findings indicate that non-responsive reactions contribute to an increase in suicidal distress as well as a closed group climate.

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.

Biocueing and ambulatory biofeedback to enhance emotion regulation: A review of studies investigating non-psychiatric and psychiatric populations.

Over the last years, biofeedback applications are increasingly used to enhance interoceptive awareness and self-regulation, in psychiatry and beyond. These applications are used to strengthen emotion regulation skills by home training (ambulatory biofeedback) and real-time support in everyday life stressful situations (biocueing). Unfortunately, knowledge about the feasibility and effectivity of these applications is still scarce. Therefore, a systematic literature search was performed. In total, 30 studies (4 biocueing, 26 ambulatory biofeedback) were reviewed; 21 of these studies were conducted in non-psychiatric samples and 9 studies in psychiatric samples. Study characteristics, biofeedback characteristics, effectivity and feasibility outcomes were extracted. Despite the rapid advances in wearable technology, only a few biocueing studies were found. In the majority of the studies significant positive effects were found on self-reported (stress-related) psychological measures. Significant improvements on physiological measures were also reported, though these measures were used less frequently. Feasibility of the applications was often reported as sufficient, though not adequately assessed in most studies. Taken into account the small sample sizes and the limited quality of the majority of the studies in this recently emerging field, biocueing and ambulatory biofeedback interventions showed promising results. Future research is expected to be focusing on biocueing as a just-in-time adaptive intervention. To establish this research field, closer cooperation between research groups, use of more rigorous as well as individually tailored research designs and more valid feasibility and effectivity assessment are recommended.

Error-related brain activity in relation to psychopathic traits in multi-problem young adults: An ERP study.

One of the most prominent issues in psychopathy is the inability to adequately monitor one's performance and learn from one's mistakes. We investigated the relationship between psychopathic traits, as measured with the Youth Psychopathy Inventory - Short Version, and both early and late error-related brain activity in an at-risk sample of male young adults. These multi-problem young adults (age 18-27) are severely dysfunctional in society and suffer from multiple problems including financial problems, delinquency, psychological problems, and drug use. Our final sample consisted of 115 multi-problem young adults and 26 controls. Participants performed an Eriksen-Flanker task during EEG measurements. We used the difference wave of the error-related negativity (ΔERN) as a measure of early error processing and the error positivity (Pe) as a measure of late error processing. Multi-problem young adults showed reduced ERN amplitudes compared to controls, but did not differ in Pe amplitude. We found no statistically significant relation between psychopathic traits and ERN and Pe amplitudes within the multi-problem group. Thus, we found evidence for dysfunctional error-processing in multi-problem young adults compared to controls. However, within the multi-problem sample we did not find evidence for a relationship between psychopathic traits and dysfunctional error-processing. One explanation may be that this is due to the specific developmental stage of our young adult participants in which a transition between error-processing deficits, as present in adolescents high in psychopathic traits, and error-processing overcompensation, as present in adults high in psychopathic traits, may occur.

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.