Bullying Among Adolescents With Autism Spectrum Disorders: Prevalence and Perception

This study examined: (a) the prevalence of bullying and victimization among adolescents with ASD, (b) whether they correctly perceived bullying and victimization, and (c) whether Theory of Mind (ToM) and bullying involvement were related to this perception. Data were collected among 230 adolescents with ASD attending special education schools. We found prevalence rates of bullying and victimization between 6 and 46%, with teachers reporting significantly higher rates than peers. Furthermore, adolescents who scored high on teacher- and self-reported victimization were more likely to misinterpret non-bullying situations as bullying. The more often adolescents bullied, according to teachers and peers, and the less developed their ToM, the more they misinterpreted bullying situations as non-bullying. Implications for clinical practice are discussed

The Teachers’ Role in Behavioral Problems of Pupils With EBD in Special Education:Teacher–Child Relationships Versus Structure

This longitudinal study examined bidirectional associations between special education pupils’ teacher–child relationship characteristics (quality, satisfaction, and conflict), classroom structure, and behavioral problems (externalizing and attention-hyperactivity). A secondary goal was to investigate the extent to which severity of behavioral problems moderated the prospective associations. Participants were 586 pupils (86% boys) in Grades 4 to 6 (Mage time 1 = 10.82 years, SD = 0.86) from 13 special education schools in the Netherlands and their teachers. Findings indicated that primarily teacher–child conflict was related to increased externalizing problems. More classroom structure was related to decreased attention-hyperactivity problems, but higher teacher–child relationship quality was linked to increases in attention-hyperactivity problems. Moreover, both types of problems were related to increases in conflict. Severity of behavior problems did not moderate these associations. Although findings were not consistent in both school years, they suggested that particularly reducing conflict and instilling more classroom structure were the most effective strategies in reducing behavioral problems. Furthermore, disrupting negative transactional associations between conflict and externalizing behavior is important to reduce externalizing behavior.</p

The Teachers’ Role in Behavioral Problems of Pupils With EBD in Special Education:Teacher–Child Relationships Versus Structure

This longitudinal study examined bidirectional associations between special education pupils’ teacher–child relationship characteristics (quality, satisfaction, and conflict), classroom structure, and behavioral problems (externalizing and attention-hyperactivity). A secondary goal was to investigate the extent to which severity of behavioral problems moderated the prospective associations. Participants were 586 pupils (86% boys) in Grades 4 to 6 (Mage time 1 = 10.82 years, SD = 0.86) from 13 special education schools in the Netherlands and their teachers. Findings indicated that primarily teacher–child conflict was related to increased externalizing problems. More classroom structure was related to decreased attention-hyperactivity problems, but higher teacher–child relationship quality was linked to increases in attention-hyperactivity problems. Moreover, both types of problems were related to increases in conflict. Severity of behavior problems did not moderate these associations. Although findings were not consistent in both school years, they suggested that particularly reducing conflict and instilling more classroom structure were the most effective strategies in reducing behavioral problems. Furthermore, disrupting negative transactional associations between conflict and externalizing behavior is important to reduce externalizing behavior.</p

The bidirectional relationships between online victimization and psychosocial problems in adolescents: a comparison with real-life victimization

Although peer victimization is of major concern and adolescents spend increasing amounts of time on the Internet, relatively little is known about the psychosocial antecedents and consequences of online victimization. The main aim of this study was to compare the psychosocial antecedents and consequences of online versus real-life victimization. More specifically, the bidirectional relationship between online and real-life victimization on the one hand and psychosocial problems (i.e., loneliness and social anxiety) on the other was examined. In addition, the moderating role of online aggression in the relationship between online victimization and subsequent psychosocial problems was studied. This prospective study, consisting of three annual measurements, was conducted among a sample of 831 adolescents (50.3 % girls) aged 11-15, of which most (80.2 %) had a Dutch ethnic background. The results indicate a unidirectional relationship whereby loneliness and social anxiety predict an increase in latter online victimization rather than the reverse. A bidirectional relationship was found for real-life victimization: loneliness (but not social anxiety) predicted an increase in latter real-life victimization, which in turn predicted an increase in subsequent social anxiety (but not loneliness). No moderating effects of online aggression were found. The findings of the present study suggest that negative online and in real life peer interactions have a differential meaning for, and impact on adolescents' well-being

Parental Conflicts and Posttraumatic Stress of Children in High-Conflict Divorce Families

Parental conflicts consistently predict negative outcomes for children. Research suggests that children from high-conflict divorces (HCD) may also experience post-traumatic stress symptoms (PTSS), yet little is known about the association between parental conflicts in HCD families and child PTSS. We investigated this association, hypothesizing that parental conflicts would predict child PTSS. We also tested the moderating role of interparental contact frequency, hypothesizing that frequent contact would intensify the association between parental conflicts and child PTSS. This study was part of an observational study on the outcomes of No Kids in the Middle (NKM), a multi-family group intervention for HCD families. A total of 107 children from 68 families participated in the study with at least one parent. We used pre- (T1) and post-intervention (T2) data. Research questions were addressed cross-sectionally, using regression analyses to predict PTSS at T1, and longitudinally, using a correlated change (T1 to T2) model. The cross-sectional findings suggested that mother- and child-reported conflicts, but not father-reported conflicts, were related to the severity of child PTSS. Longitudinally, we found that change in father-reported conflicts, but not change in child- or mother-reported conflicts, were related to change in child PTSS. The estimated associations for the different informants were not significantly different from one another. The frequency of contact between ex-partners did not moderate the relationship between parental conflicts and child PTSS. We conclude that there is a positive association between parental conflicts and child PTSS in HCD families independent of who reports on the conflicts

The influence of partners on successful lifestyle modification in patients with coronary artery disease

Background: Marital status is associated with prognosis in patients with cardiovascular disease (CVD). However, the influence of partners on successful modification of lifestyle-related risk factors (LRFs) in secondary CVD prevention is unclear. Therefore, we studied the association between the presence of a partner, partner participation in lifestyle interventions and LRF modification in patients with coronary artery disease (CAD). Methods: In a secondary analysis of the RESPONSE-2 trial (n = 711), which compared nurse-coordinated referral to community-based lifestyle programs (smoking cessation, weight reduction and/or physical activity) to usual care in patients with CAD, we investigated the association between the presence of a partner and the level of partner participation on improvement in >1 LRF (urinary cotinine <200 ng/l, ≥5% weight reduction, ≥10% increased 6-min walking distance) without deterioration in other LRFs at 12 months follow-up. Results: The proportion of patients with a partner was 80% (571/711); 19% women (108/571). In the intervention group, 48% (141/293) had a participating partner in ≥1 lifestyle program. Overall, the presence of a partner was associated with patients' successful LRF modification (adjusted risk ratio (aRR) 1.93, 95% confidence interval (CI) 1.40-2.51). A participating partner was associated with successful weight reduction (aRR 1.73, 95% CI 1.15-2.35). Conclusion: The presence of a partner is associated with LRF improvement in patients with CAD. Moreover, patients with partners participating in lifestyle programs are more successful in reducing weight. Involving partners of CAD patients in weight reduction interventions should be considered in routine practice. Keywords: (Mesh): Secondary prevention; Coronary artery disease; Risk reduction behaviour; Social support; Spouses

It’s not just the Therapist: Therapist and Country-Wide Experience Predict Therapist Adherence and Adolescent Outcome

Contains fulltext : 173905.pdf (publisher's version ) (Open Access)Objective: Therapist adherence is a quality indicator in routine clinical care when evaluating the success of the implementation of an intervention. The current study investigated whether therapist adherence mediates the association between therapist, team, and country-wide experience (i.e. number of years since implementation in the country) on the one hand, and treatment outcome on the other hand. We replicated and extended a study by Löfholm et al. (2014). Method: Data over a 10-year period were obtained from 4290 adolescents (12-17 years) with antisocial or delinquent problem behavior, who were treated with Multisystemic Therapy (MST) by 222 therapists, working in 27 different teams in the Netherlands. Multilevel structural equation modeling was used to assess the associations between experience, therapist adherence, and post-treatment outcomes. Results: Treatment outcomes were directly predicted by therapist experience, countrywide experience, and therapist adherence, but not by team experience. Moreover, therapist adherence mediated the association between therapist and country-wide experience, and treatment outcomes. The association between therapist experience and therapist adherence was not affected by the number of years of team experience or country-wide experience. Conclusion: The effect of country-wide experience on outcome may reflect increasing experience of training and supporting the therapists. It suggests that nation-wide quality control may relate to better therapist adherence and treatment outcome for adolescents treated with systemic therapy.17 p

The course of readmission in frail older cardiac patients

Aim: The aim of this study is to explore patients' and (in)formal caregivers' perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. Design: This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. Methods: Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi-structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients' medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six-step analysis of Strauss & Corbin have been used. Results: Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients' health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers' perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). Conclusion: Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients' care needs and expectations should be prioritized to stimulate participation. Impact: (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients' care needs and expectations

Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention - a qualitative study

Background: Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients' participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients. Methods: A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed. Results: Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants' recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention. Conclusion: Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients' needs, considering their frailty, self-management skills and existing formal and informal caregiver networks. Keywords: Cardiac rehabilitation; Cardiology; Case management; Disease management; Frailty; Nurses; Physical therapists; Qualitative research; Transitional care