Conceptualisation and conscience assessment in adolescence in forensic mental healthcare: experts’ perspectives

Child and adolescent psychology and psychiatry healthcare guidelines recommend a structured clinical assessment of conscience of juveniles displaying antisocial behaviour to substantiate the allocation of treatment or penal sanctions. The scientific literature on conscience development is accumulating, yet no widely accepted, integrative clinical instrument for assessment of conscience is available. Consequently, clinicians assess conscience, utilising their acquired knowledge and experience. Resulting in a largely intuitive process that varies vastly among professionals. This study aimed to gather and explicate the implicit knowledge of experienced clinicians on the assessment of adolescent conscience. Semi-structured interviews were conducted with seven clinical experts working in various Dutch (forensic) mental health organisations. Using a five-phase systematic and structured content analysis, the framework method was applied to explore the techniques and concepts used by clinical experts. The concepts they used grossly matched the concepts found in the literature. We identified three pivotal domains: empathic capacity, self-conscious emotions, and moral reasoning. Moreover, the data suggested to consider these domains expressing the overarching concept of self-image or identity. These results will enable the design of a clinically based, comprehensive instrument to improve the quality of the assessment of conscience in the context of child and adolescent forensic psychiatric healthcare

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

Time-on-task-effecten bij kinderen met en zonder ADHD: Uitputting van executieve functies of uitputting van motivatie?

Pathways through Adolescenc

<em>Time-on-task</em>-effecten bij kinderen met en zonder ADHD: Uitputting van executieve functies of uitputting van motivatie?

Kinderen met ADHD laten op cognitieve taken een achteruitgang in prestatie over tijd zien (dit is een time-on-task-effect). In deze studie werd onderzocht of dit komt door uitputting van executieve functies of door uitputting van motivatie. De Stop Signal Task (SST) werd twee keer achter elkaar afgenomen bij 42 kinderen met en 54 kinderen zonder ADHD (negen tot dertien jaar). Deze taak genereert zowel uitkomstmaten voor inhibitie als voor aandacht. De helft van de proefpersonen werd tijdens de tweede afname beloond. Multilevel-analyses toonden aan dat time-on-task-effecten groter waren bij kinderen met ADHD dan bij controles, en dat deze effecten deels konden worden teruggedrongen door beloning. De effecten beperkten zich tot het domein van aandacht. Dit toont aan dat er zowel sprake was van uitputting van executieve functies (beloning had immers niet op alle uitkomstmaten effect) als van uitputting van motivatie, waarbij dit laatste kan worden tegengegaan met beloning