Does affirming children's autonomy and prosocial intentions help? A microtrial into intervention component effects to improve psychosocial behavior

Item does not contain fulltextPrior research has related children's prosocial behavior to overall well-being, and stimulating prosocial behavior is the aim of many social-emotional skills interventions. This study assessed if affirming children's autonomy stimulates their psychosocial behavior. We conducted a three-arm microtrial with four repeated measures to assess if a social-emotional skills intervention with an autonomy affirmation component had an additive effect on children's behavior as compared to a "regular" intervention focused exclusively on teaching social-emotional skills and a no-treatment control condition. Our sample consisted of 779 children in Grades 4-6 (Mage = 10.61, SD = 0.93). Findings from latent change modeling demonstrated that the social-emotional skills intervention with an autonomy affirmation component yielded superior effects as compared to the "regular" intervention and the no-treatment control condition on the improvement of internalizing and externalizing problem behavior in the three-month period after the intervention. The intervention with autonomy affirmation did not yield superior effects on prosociality and social skills, self-efficacy, and self-esteem or self-perceived competence. The absence of these effects may be attributed to the dosage of the interventions implemented - the affirmation of children's autonomy may require more than four sessions to sort observable effects. Overall, however, the findings of this study provide an initial suggestion that it may be beneficial to affirm children's autonomy and prosocial intentions when enhancing children's behavior.22 p

High-dose alkylating chemotherapy in BRCA-altered triple-negative breast cancer:the randomized phase III NeoTN trial

Exploratory analyses of high-dose alkylating chemotherapy trials have suggested that BRCA1 or BRCA2-pathway altered (BRCA-altered) breast cancer might be particularly sensitive to this type of treatment. In this study, patients with BRCA-altered tumors who had received three initial courses of dose-dense doxorubicin and cyclophosphamide (ddAC), were randomized between a fourth ddAC course followed by high-dose carboplatin-thiotepa-cyclophosphamide or conventional chemotherapy (initially ddAC only or ddAC-capecitabine/decetaxel [CD] depending on MRI response, after amendment ddAC-carboplatin/paclitaxel [CP] for everyone). The primary endpoint was the neoadjuvant response index (NRI). Secondary endpoints included recurrence-free survival (RFS) and overall survival (OS). In total, 122 patients were randomized. No difference in NRI-score distribution (p = 0.41) was found. A statistically non-significant RFS difference was found (HR 0.54; 95% CI 0.23–1.25; p = 0.15). Exploratory RFS analyses showed benefit in stage III (n = 35; HR 0.16; 95% CI 0.03–0.75), but not stage II (n = 86; HR 1.00; 95% CI 0.30–3.30) patients. For stage III, 4-year RFS was 46% (95% CI 24–87%), 71% (95% CI 48–100%) and 88% (95% CI 74–100%), for ddAC/ddAC-CD, ddAC-CP and high-dose chemotherapy, respectively. No significant differences were found between high-dose and conventional chemotherapy in stage II-III, triple-negative, BRCA-altered breast cancer patients. Further research is needed to establish if there are patients with stage III, triple negative BRCA-altered breast cancer for whom outcomes can be improved with high-dose alkylating chemotherapy or whether the current standard neoadjuvant therapy including carboplatin and an immune checkpoint inhibitor is sufficient. Trial Registration: NCT01057069

Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials

Background Increasing the dose intensity of cytotoxic therapy by shortening the intervals between cycles, or by giving individual drugs sequentially at full dose rather than in lower-dose concurrent treatment schedules, might enhance efficacy. Methods To clarify the relative benefits and risks of dose-intense and standard-schedule chemotherapy in early breast cancer, we did an individual patient-level meta-analysis of trials comparing 2-weekly versus standard 3-weekly schedules, and of trials comparing sequential versus concurrent administration of anthracycline and taxane chemotherapy. The primary outcomes were recurrence and breast cancer mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, and trial, yielded dose-intense versus standard-schedule first-event rate ratios (RRs). Findings Individual patient data were provided for 26 of 33 relevant trials identified, comprising 37 298 (93%) of 40 070 women randomised. Most women were aged younger than 70 years and had node-positive disease. Total cytotoxic drug usage was broadly comparable in the two treatment arms; colony-stimulating factor was generally used in the more dose-intense arm. Combining data from all 26 trials, fewer breast cancer recurrences were seen with dose-intense than with standard-schedule chemotherapy (10-year recurrence risk 28·0% vs 31·4%; RR 0·86, 95% CI 0·82–0·89; p<0·0001). 10-year breast cancer mortality was similarly reduced (18·9% vs 21·3%; RR 0·87, 95% CI 0·83–0·92; p<0·0001), as was all-cause mortality (22·1% vs 24·8%; RR 0·87, 95% CI 0·83–0·91; p<0·0001). Death without recurrence was, if anything, lower with dose-intense than with standard-schedule chemotherapy (10-year risk 4·1% vs 4·6%; RR 0·88, 95% CI 0·78–0·99; p=0·034). Recurrence reductions were similar in the seven trials (n=10 004) that compared 2-weekly chemotherapy with the same chemotherapy given 3-weekly (10-year risk 24·0% vs 28·3%; RR 0·83, 95% CI 0·76–0·91; p<0·0001), in the six trials (n=11 028) of sequential versus concurrent anthracycline plus taxane chemotherapy (28·1% vs 31·3%; RR 0·87, 95% CI 0·80–0·94; p=0·0006), and in the six trials (n=6532) testing both shorter intervals and sequential administration (30·4% vs 35·0%; RR 0·82, 95% CI 0·74–0·90; p<0·0001). The proportional reductions in recurrence with dose-intense chemotherapy were similar and highly significant (p<0·0001) in oestrogen receptor (ER)-positive and ER-negative disease and did not differ significantly by other patient or tumour characteristics. Interpretation Increasing the dose intensity of adjuvant chemotherapy by shortening the interval between treatment cycles, or by giving individual drugs sequentially rather than giving the same drugs concurrently, moderately reduces the 10-year risk of recurrence and death from breast cancer without increasing mortality from other causes. Funding Cancer Research UK, Medical Research Council

Effects of Kanjertraining (Topper Training) on Emotional Problems, Behavioural Problems and Classroom Climate

Reducing difficulties in social interactions and negative classroom climate at an early age may prevent escalation into severe problems that are harder to treat and save society from the associated costs and risks. Topper Training (Kanjertraining in Dutch) has been widely implemented in Dutch schools and mental healthcare centres as a preventive and curative programme for 4- to 15-year-olds. The programme aims to reduce social problems and to improve classroom climate. Given the scarcity of intervention studies in the Netherlands, it is highly relevant to study the effectiveness of Topper Training. Therefore, the main aim of this dissertation is to study the effectiveness of Topper Training. In addition, the quality of the Topper questionnaire is examined, measuring social functioning of 8- to 13-year-olds. The dissertation starts with a literature review on risk and protective factors for positive social interaction. Topper Training is directed at many of the evidence-based effective elements (i.e., cognitive behavioural strategies, parent involvement, group training) and includes two additional characterizing elements: activating children’s latent intentions to behave prosocially and making children aware of their responsibility for their own behaviour (‘I can choose how to act’). Chapter 3 demonstrates that the Topper questionnaire is able to reliably and validly measure four distinctive aspects of social functioning: Negative intentions, Unhappy & Gloomy, Prosocial and Restless & Disruptive behaviour. Normative data are based on a representative sample of 10,552 primary school children aged 8 to 13 in the Netherlands. Chapters 4, 5, and 6 provide the first indications of the effectiveness of Topper Training in schools and in mental healthcare centres. Chapter 4 describes a quasi-experimental study on 696 children aged 8 to 13. Fourteen disruptive primary school classes in urgent need for help were trained and were compared to fourteen classes of the same schools. Psychologists delivered the program, including a parent evening and 15 hours of training in class with parents. After correction for pre-test differences, significant effects were found for relationship with the teacher, perceived social acceptance, self-esteem, depressed mood and prosocial behaviour.Chapter 5 and 6 examined the effectiveness of Topper Training in a mental healthcare setting directed at eight-to-eleven-year-olds with mild to severe problems in social interaction. Psychologists delivered the programme consisting of 10 lessons of 1,5 hour directed at children and their parents. In Chapter 5 we used a quasi-experimental design on 185 intervention and 39 waitlist control children. Significant effects were found for parent-reported overall problems, internalising, externalizing and social relationship problems, aggression and withdrawn depressed mood. We found no effects for rule breaking and thought problems. In Chapter 6 we used a randomised controlled trial on 77 intervention and 55 waitlist control children. We found significant effects on parent-reported (but not teacher-reported) emotional problems, peer problems, and impact of the problems. Teachers reported a significant effect on conduct problems. No effects were found on prosocial behaviour. Children reported a significant effect on self-worth and child-perceived victimization of bullying. All effects persisted over a 6-month period

Effects of Topper Training on psychosocial problems, self-esteem, and peer victimisation in Dutch children:A randomised trial

Most interventions aimed at improving social interactions either target internalising or externalising problem behaviour in children. However, a recent review shows that a transdiagnostic approach might fit better to the diversity of problems within a group and within an individual (comorbidity). We examined the effectiveness of a transdiagnostic intervention, called Topper Training: a cognitive behavioural intervention in the peer group with parents included, that targets both internalising and externalising behaviour problems. A randomised trial with a waiting list control group was conducted, using 132 children with mild to severe psychosocial problems. Children were randomised into 77 intervention and 55 waiting list children (50% boys; age = 8–11 years). GLM repeated measures analyses yielded significant intervention effects directly after the training on parent-reported (but not teacher-reported) emotional symptoms (Cohen’s d = .70), peer relationship problems (d = .41), and impact of these problems (d = .59). Significant effects were also found for child-perceived peer victimisation (d = .62), self-esteem (d = .45) and teacher-reported conduct problems (d = .42). Parent-reported effects on emotional, conduct problems and impact of the problems and child-reported effects on self-esteem were clinically relevant. No significant effects of Topper Training were found for prosocial behaviour and bullying. Within-participant t-tests in the intervention group between post-intervention and follow-up indicated that effects extended over a six-month follow-up period. Depression decreased significantly from posttest to follow-up. In conclusion, children with mild to severe internalising and/or externalising problems can benefit from the transdiagnostic Topper Training intervention

"I want to behave prosocially and I can choose to do so": Effectiveness of TIGER (Kanjertraining) in 8- to 11-year-olds

This study examined whether TIGER ("Kanjertraining" in the Netherlands) reduces psychosocial problems in eight- to eleven-year-olds in a mental health-care setting. TIGER is a cognitive behavioural intervention in the peer group, with an additional parent component. Characterizing features include the emphasis on affirming children's prosocial intentions and feelings of responsibility for their own behaviour. To study effectiveness in routine daily practice, a quasi-experimental design with 185 intervention and 39 waiting list control children was used. Results indicated that TIGER significantly reduced externalizing and internalizing problems. Children with clinical-level internalizing problems at pretest benefited more from TIGER than children with subclinical or nonclinical internalizing problems. Effect sizes (between .33 and .46) were in the small to medium range and comparable to behavioural parent-training and cognitive-behavioural therapy. Future interesting topics to study are the long-term effects of TIGER and mechanisms of change

Effects of Kanjertraining (Topper Training) on Emotional Problems, Behavioural Problems and Classroom Climate

Reducing difficulties in social interactions and negative classroom climate at an early age may prevent escalation into severe problems that are harder to treat and save society from the associated costs and risks. Topper Training (Kanjertraining in Dutch) has been widely implemented in Dutch schools and mental healthcare centres as a preventive and curative programme for 4- to 15-year-olds. The programme aims to reduce social problems and to improve classroom climate. Given the scarcity of intervention studies in the Netherlands, it is highly relevant to study the effectiveness of Topper Training. Therefore, the main aim of this dissertation is to study the effectiveness of Topper Training. In addition, the quality of the Topper questionnaire is examined, measuring social functioning of 8- to 13-year-olds. The dissertation starts with a literature review on risk and protective factors for positive social interaction. Topper Training is directed at many of the evidence-based effective elements (i.e., cognitive behavioural strategies, parent involvement, group training) and includes two additional characterizing elements: activating children’s latent intentions to behave prosocially and making children aware of their responsibility for their own behaviour (‘I can choose how to act’). Chapter 3 demonstrates that the Topper questionnaire is able to reliably and validly measure four distinctive aspects of social functioning: Negative intentions, Unhappy & Gloomy, Prosocial and Restless & Disruptive behaviour. Normative data are based on a representative sample of 10,552 primary school children aged 8 to 13 in the Netherlands. Chapters 4, 5, and 6 provide the first indications of the effectiveness of Topper Training in schools and in mental healthcare centres. Chapter 4 describes a quasi-experimental study on 696 children aged 8 to 13. Fourteen disruptive primary school classes in urgent need for help were trained and were compared to fourteen classes of the same schools. Psychologists delivered the program, including a parent evening and 15 hours of training in class with parents. After correction for pre-test differences, significant effects were found for relationship with the teacher, perceived social acceptance, self-esteem, depressed mood and prosocial behaviour.Chapter 5 and 6 examined the effectiveness of Topper Training in a mental healthcare setting directed at eight-to-eleven-year-olds with mild to severe problems in social interaction. Psychologists delivered the programme consisting of 10 lessons of 1,5 hour directed at children and their parents. In Chapter 5 we used a quasi-experimental design on 185 intervention and 39 waitlist control children. Significant effects were found for parent-reported overall problems, internalising, externalizing and social relationship problems, aggression and withdrawn depressed mood. We found no effects for rule breaking and thought problems. In Chapter 6 we used a randomised controlled trial on 77 intervention and 55 waitlist control children. We found significant effects on parent-reported (but not teacher-reported) emotional problems, peer problems, and impact of the problems. Teachers reported a significant effect on conduct problems. No effects were found on prosocial behaviour. Children reported a significant effect on self-worth and child-perceived victimization of bullying. All effects persisted over a 6-month period

Does affirming children's autonomy and prosocial intentions help? A microtrial into intervention component effects to improve psychosocial behavior

Prior research has related children's prosocial behavior to overall well-being, and stimulating prosocial behavior is the aim of many social-emotional skills interventions. This study assessed if affirming children's autonomy stimulates their psychosocial behavior. We conducted a three-arm microtrial with four repeated measures to assess if a social-emotional skills intervention with an autonomy affirmation component had an additive effect on children's behavior as compared to a "regular" intervention focused exclusively on teaching social-emotional skills and a no-treatment control condition. Our sample consisted of 779 children in Grades 4-6 (Mage = 10.61, SD = 0.93). Findings from latent change modeling demonstrated that the social-emotional skills intervention with an autonomy affirmation component yielded superior effects as compared to the "regular" intervention and the no-treatment control condition on the improvement of internalizing and externalizing problem behavior in the three-month period after the intervention. The intervention with autonomy affirmation did not yield superior effects on prosociality and social skills, self-efficacy, and self-esteem or self-perceived competence. The absence of these effects may be attributed to the dosage of the interventions implemented - the affirmation of children's autonomy may require more than four sessions to sort observable effects. Overall, however, the findings of this study provide an initial suggestion that it may be beneficial to affirm children's autonomy and prosocial intentions when enhancing children's behavior