The child sexual behavior inventory: Reliability and validity in a Dutch normative and clinical sample.

BACKGROUND: The Child Sexual Behavior Inventory (CSBI) is one of the few instruments available to assess sexual behavior in children. Because of cross-cultural differences in the definition of normal and atypical sexual behaviors, the CSBI is not generalizable to other countries. OBJECTIVE: The current study examined psychometric properties of the Dutch version of the CSBI. PARTICIPANTS AND SETTING: The study represents 3206 children from a normative sample, and 932 children from clinical samples. METHODS: Parents ratings on the CSBI, and questionnaires for psychosocial problems were obtained to assess psychometric properties. RESULTS: Results showed that Dutch parents interpret more CSBI items as developmentally appropriate than USA parents. Reliability coefficients indicated internal consistency (α = .39-.82), test-retest (r = .86, p < .000) and interrater reliability (Cohen's d =0.47, p >.05). Positive correlations between the CSBI total scale and the subscales demonstrated content validity (r = .32-.96, p < .01). Differences between normative and clinical samples on the CSBI total (ηp2 = .01-.65, p < .000), DRSB (ηp2 = .00-.03, p = .00-.38) and SASI scales (ηp2 =.00-.18, p < .01) indicated construct validity. Within the clinical samples, highest associations were found between the CSBI score and convergent measures (r = .64, p < .000). Lowest associations were found between the CSBI scores and divergent measures r = .14-.54, p = n.s.-<.000. CONCLUSIONS: Cross-cultural differences in the perception of developmental appropriate sexual behavior underscore the importance of country-specific normative data. Good psychometric properties of the Dutch version of the CSBI were supported by this study.

A school-based interdisciplinary approach to promote health and academic achievement among children in a deprived neighborhood: study protocol for a mixed-methods evaluation.

BACKGROUND: The large number of children that grow up in poverty is concerning, especially given the negative developmental outcomes that can persist into adulthood. Poverty has been found as a risk factor to negatively affect academic achievement and health outcomes in children. Interdisciplinary interventions can be an effective way to promote health and academic achievement. The present study aims to evaluate a school-based interdisciplinary approach on child health, poverty, and academic achievement using a mixed-method design. Generally taken, outcomes of this study increase the knowledge about effective ways to give disadvantaged children equal chances early in their lives. METHODS: An observational study with a mixed-methods design including both quantitative and qualitative data collection methods will be used to evaluate the interdisciplinary approach. The overall research project exists of three study parts including a longitudinal study, a cross-sectional study, and a process evaluation. Using a multi-source approach we will assess child health as the primary outcome. Child poverty and child academic achievement will be assessed as secondary outcomes. The process evaluation will observe the program's effects on the school environment and the program's implementation in order to obtain more knowledge on how to disseminate the interdisciplinary approach to other schools and neighborhoods. DISCUSSION: The implementation of a school-based interdisciplinary approach via primary schools combining the cross-sectoral domains health, poverty, and academic achievement is innovative and a step forward to reach an ethnic minority population. However, the large variety of the interventions and activities within the approach can limit the validity of the study. Including a process evaluation will therefore help to improve the interpretation of our findings. In order to contribute to policy and practice focusing on decreasing the unequal chances of children growing up in deprived neighborhoods, it is important to study whether the intervention leads to positive developmental outcomes in children. TRIAL REGISTRATION: ( NTR 6571 ) (retrospectively registered on August 4, 2017).

Effects of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) for Young Foster Children with Severe Behavioral Disturbances.

Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) has thus far only been tested for diminishing behavior problems in the US. This study tested relative efficacy of MTFC-P on multiple outcomes against treatment as usual in the Netherlands (TAU; Study I), and regular foster care (Study II). The sample included 55 children that received MTFC-P, 23 children received TAU and 30 children from regular foster care (RFC). Changes in behavioral and relationship functioning, trauma symptoms, hypothalamic-adrenal-pituitary (HPA-) axis functioning, and caregiving stress were assessed via questionnaires, interviews, and salivary cortisol. Outcomes of Study I were evaluated using a randomized controlled design and quasi-experimental design, outcomes of Study II according to non-equivalent group comparison. No evidence was found for relative efficacy of MTFC-P over TAU. A treatment effect was found on trauma symptoms, in favor of TAU. Outcomes of Study II revealed that whereas caregiving stress and secure base distortions were significantly more severe at baseline in MTFC-P compared to RFC, post treatment differences were no longer significant. However, percentages of symptoms of disinhibited attachment and attachment disorder were nearly equal between groups at baseline, while post treatment percentages indicated significantly more symptoms in MTFC. In addition, results revealed a significant difference in the severity of externalizing problems post treatment, in favor of RFC. The results obtained within this study indicate that children in MTFC-P and usual treatment foster care in the Dutch context improved similarly, thus not showing the same advantages that MTFC-P has demonstrated in the US. Results should be interpreted with caution due to lower than planned power. Findings underscore the challenges of testing novel treatments across contexts with highly different child welfare provisions.

Disturbances in attachment: inhibited and disinhibited symptoms in foster children.

BACKGROUND: Previous DSM-versions recognized an inhibited and a disinhibited subtype of the Reactive Attachment Disorder (RAD). The current DSM-5 distinguishes two different disorders, instead of two subtypes of RAD. This study examined whether a split-up of the subtypes is valid. METHOD: In 126 foster children, attachment disorder symptoms were assessed with the Disturbances of Attachment Interview. Forms of pathogenic care were identified based on dossier analyses. Associations between symptoms of attachment disorder with internalizing and externalizing problems (Child Behavior Checklist and Teacher Report Form) were examined. RESULTS: Omnibus tests showed no significant association between type of symptoms and type of pathogenic care. Exploratory analyses did reveal an univariate association between disinhibited symptoms and history of physical abuse. Disinhibited symptoms were associated with more internalizing and externalizing problems (d's < 0.50). CONCLUSION: The distinction of inhibited and disinhibited subtypes of RAD seems valid regarding their emotional and behavioral correlations. Whereas inhibited symptoms lack a correlation, disinhibited symptoms seem to have an externalizing and internalizing correlation. TRIAL REGISTRATION: NTR1747.

The effectiveness of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) for young children with severe behavioral disturbances: study protocol for a randomized controlled trial.

BACKGROUND: Among children placed out of home, behavioral and relationship functioning is often problematic. When placed in foster care, problems tend to persist or even worsen and increase the risk of placement breakdown. Multidimensional Treatment Foster Care for Preschoolers is an intensive behavior-focused program for young foster children (3 to 7 years) aiming to provide children with a positive and stimulating foster family setting and individually tailored behavioral interventions. This study will be the first to examine the effectiveness of Multidimensional Treatment Foster Care for Preschoolers outside the US and to examine the effectiveness across a broader range of problems related to foster care. METHODS: This is a randomized controlled trial, wherein we expect to include 80 child-foster carer dyads. Forty dyads will be assigned to Multidimensional Treatment Foster Care for Preschoolers and 40 to treatment as usual, following pre-randomization. Data to be gathered concern problem behavior, symptoms of attachment disorder, post-traumatic stress symptoms, quality of life, hypothalamic-adrenal-pituitary axis functioning, parental stress and autonomic reactivity, to be collected via questionnaires, observations, interviews, saliva and recording at six time-points over 24 months. To compare treatment outcomes, Fisher's exact tests and repeated measures (mixed models) and independent t-tests will be used. All analyses will be performed following the intention-to-treat principle. DISCUSSION: Examining the generalizability of previous findings in the US and extending these previous findings is a step towards improving knowledge about treatment of young foster children with severe behavioral, emotional and attachment problems. TRIAL REGISTRATION: NTR1747.

Traumatic stress symptomatology after child maltreatment and single traumatic events: different profiles.

The sequelae of child maltreatment tend to extend current posttraumatic stress disorder (PTSD) symptoms. This study examined this assumption, hypothesizing that (a) PTSD and trauma-related symptoms are more severe after single trauma than after child maltreatment; (b) symptoms unrelated to trauma are more severe after child maltreatment than after single trauma; and (c) a comorbid association of clinical PTSD with trauma-related symptoms is more prevalent after single trauma, whereas a comorbid association of clinical PTSD with trauma unrelated symptoms is more prevalent after child maltreatment. The Trauma Symptom Checklist for Children (TSCC) assessed PTSD and trauma-related symptoms in 256 children (83 children exposed to single trauma, 173 to child maltreatment). The Strengths and Difficulties Questionnaire (SDQ) assessed trauma-unrelated symptoms. Single-trauma children reported significantly more severe PTSD and trauma-related symptoms. Significantly more severe trauma unrelated symptoms were reported after child maltreatment. A significant relation was found between clinical PTSD and more severe trauma-related symptoms in both samples. Likelihood of children meeting PTSD symptoms after trauma seems to decrease when traumatization becomes more complex. Findings support our assumption that symptomatology of maltreated children extends current PTSD symptoms.

Multidimensional treatment foster care for preschoolers: early findings of an implementation in the Netherlands.

UNLABELLED: Multidimensional Treatment Foster Care (MTFC) has been shown to be an evidence based alternative to residential rearing and an effective method to improve behavior and attachment of foster children in the US. This preliminary study investigated an application of MTFC for preschoolers (MTFC-P) in the Netherlands focusing on behavioral outcomes in course of the intervention. To examine the following hypothesis: "the time in the MTFC-P intervention predicts a decline in problem behavior", as this is the desired outcome for children assigned to MTFC-P, we assessed the daily occurrence of 38 problem behaviors via telephone interviews. Repeated measures revealed significant reduced problem behavior in course of the program. MTFC-P promises to be a treatment model suitable for high-risk foster children, that is transferable across centres and countries. TRIAL REGISTRATION: Netherlands Trial Register: 1747.