The effectiveness of Grief-Help, a cognitive behavioural treatment for prolonged grief in children: study protocol for a randomised controlled trial

BACKGROUND: There is growing recognition of a syndrome of disturbed grief referred to as prolonged grief disorder (PGD). PGD is mostly studied in adults, but clinically significant PGD symptoms have also been observed in children and adolescents. Yet, to date no effective treatment for childhood PGD exists. The aims of this study are: (1) to investigate the effectiveness of Grief-Help, a nine-session cognitive-behavioural treatment for childhood PGD, combined with five sessions of parental counselling, immediately after the treatment and at three, six and twelve months follow-up; (2) to examine tentative mediators of the effects of Grief-Help, (i.e., maladaptive cognitions and behaviours and positive parenting), and (3) to determine whether demographic variables, child personality, as well as symptoms of PGD, anxiety, and depression in parents moderate the treatment effectiveness. METHODS/DESIGN: We will conduct a Randomised Controlled Trial (RCT) in which 160 children and adolescents aged 8–18 years are randomly allocated to cognitive behavioural Grief-Help or to a supportive counselling intervention; both treatments are combined with five sessions of parental counselling. We will recruit participants from clinics for mental health in the Netherlands. The primary outcome measure will be the severity of Prolonged Grief Disorder symptoms according to the Inventory of Prolonged Grief for Children (IPG-C). Secondary outcomes will include PTSD, depression and parent-rated internalizing and externalizing problems. Mediators like positive parenting and maladaptive cognitions and behaviours will be identified. We will also examine possible moderators including demographic variables (e.g. time since loss, cause of death), psychopathology symptoms in parents (PGD, anxiety and depression) and child personality. Assessments will take place in both groups at baseline, after the treatment-phase and three, six and twelve months after the post-treatment assessment. DISCUSSION: We aim to contribute to the improvement of mental health care for children and adolescents suffering from loss. By comparing Grief-Help with supportive counselling, and by investigating mediators and moderators of its effectiveness we hope to provide new insights in the effects of interventions for bereaved children, and their mechanisms of change. TRIAL REGISTRATION: Netherlands Trial Register NTR385

Parental Self-Control and the Development of Male Aggression in Early Childhood: A Longitudinal Test of Self-Control Theory

A number of studies have evaluated associations between parenting practices, adolescent self-control, and adolescent antisocial behavior. Yet, few studies have examined associations between these constructs in early childhood or examined the extent to which both maternal and paternal self-control shapes them. To address these gaps, the current study utilizes longitudinal data collected on a sample of 117 Dutch boys and their parents to investigate the across time interrelationships between parental self-control, ineffective parenting, child self-control, and child aggression. The results provide evidence of an indirect association between maternal self-control and early childhood self-control through maternal ineffective parenting, an indirect association between maternal ineffective parenting and early childhood aggression through early childhood self-control, and an indirect association between maternal self-control and early childhood aggression through both maternal ineffective parenting and early childhood self-control. In contrast, paternal self-control and paternal ineffective parenting were unrelated to child self-control and child aggression. The implications and limitations of the study are discussed

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

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

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

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

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

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

Pragmatic Quasi-Experimental Controlled Trial Evaluating the Outcomes of Blended CBT Compared to Face-to-Face CBT and Treatment as Usual for Adolescents with Depressive Disorders

Depression is a major problem in youth mental health. Current treatment is on average effective, but adolescents are hesitant to seek help. Blended treatment could lower the barriers to seeking treatment. Evidence on effectiveness is, however, scarce. The present pragmatic quasi-experimental controlled trial aimed to compare the outcomes of blended cognitive behavioral therapy (CBT) to face-to-face CBT and treatment as usual. A total of 129 adolescents with clinical depression (82.2% female), aged 13–22 (M = 16.60, SD = 2.03) received blended CBT, face-to-face CBT or treatment as usual. Clinical diagnosis, depressive symptoms, and secondary outcomes were assessed at baseline, post-intervention, and six-months follow-up. Participants receiving blended CBT were, compared to participants receiving face-to-face CBT and treatment as usual, evenly likely to be in remission from their depressive disorder at post-intervention and at six-month follow-up. Depressive symptoms decreased significantly over time in all three conditions, and changes were not significantly different between conditions. Other secondary outcomes (suicide risk, internalizing and externalizing symptoms, severity of depression, and global functioning) did not differ between treatment conditions at post-intervention and six-month follow-up. Since there was no evidence for favorable outcomes for face-to-face therapies above blended CBT, blended CBT may also be an effective treatment format in clinical practice

Титульные страницы и содержание

This study gives an overview of Project STARS (Studies on Trajectories of Adolescent Relationships and Sexuality), a four-wave longitudinal study of 1297 Dutch adolescents. First, the sample, measures and four sub-projects are described. Second, hierarchical regression analyses were conducted to examine how key variables from the individual domain (impulsivity), parent domain (parent-adolescent relationship quality), peer domain (involvement with peers) and media domain (time spent on social networking sites), and their interactions predict changes in the experience with sexual behaviour of adolescents across time. Results showed that higher levels of impulsivity, lower quality of relation with parents, more frequent involvement with peers and more time spent on social networking sites at baseline predicted increases in sexual experience of adolescents over a subsequent 1.5-year time period. No interaction effects among the domains were found. The findings highlight the significance of a multi-domain approach to the study of adolescent sexual development

How Competent are Adolescent Bullying Perpetrators and Victims in Mastering Normative Developmental Tasks in Early Adulthood?

A substantive body of literature suggests that those involved in bullying as perpetrators but particularly victims are at greater risk for psychological maladjustment. In comparison, relatively little is known about associations between bullying-victimization and perpetration and mastery of early adult tasks in domains including romantic relationships, education, work, financial competence, and conduct. These links were tested using data from two Dutch cohorts (RADAR-young, n = 497, 43% girls; TRAILS, n = 2230, 51% girls) who reported on victimization and perpetration at age 11 (TRAILS) and 13 (RADAR-young) and mastery of developmental tasks in early adulthood. Unadjusted regression analyses suggested for both cohorts that perpetrators were less likely to abide the law and more likely to smoke. Victims in TRAILS were less competent in the domains of education, work, and finances, and more likely to smoke in RADAR-young. Adjusting for childhood demographics and child intelligence and including psychopathology in the prediction models substantially reduced the strength of associations between bullying involvement and later outcomes in both cohorts; although association were retained between victimization and welfare dependence and perpetration and crime involvement in TRAILS. Parental support did not buffer associations in either sample and neither were gender differences detected. Overall, findings underline that negative outcomes of bullying are not only a concern for victims but also for their perpetrators although involvement in bullying is not a stable predictor of mastery of developmental tasks when childhood demographics, child intelligence, and psychopathology are taken into account

The Relationship Between Early Sexual Debut and Psychosocial Outcomes: A Longitudinal Study of Dutch Adolescents

In a longitudinal dataset of 470 Dutch adolescents, the current study examined the ways in which early sexual initiation was related to subsequent attachment, self-perception, internalizing problems, and externalizing problems. For male adolescents, analyses revealed general attachment to mother and externalizing problems at Wave 1 to predict to early transition at Wave 2. However, there was no differential change in these psychosocial factors over time for early initiators of sexual intercourse and their non-initiating peers. For female adolescents, the model including psychosocial factors at Wave 1 did not predict to sexual initiation at Wave 2. However, univariate repeated measures analyses revealed early initiators to have significantly larger increases in self-concept and externalizing problems than their non-initiating female peers. While the difference between female early initiators and non-initiators were statistically significant, the mean levels of problem behaviors were very low. The findings suggest that, contrary to previous research, early sexual initiation does not seem to be clustered with problem behaviors for this sample of Dutch adolescents