The association between delinquent peer affiliation and disruptive behavior interacts with functional brain correlates of reward sensitivity: a biosocial interaction study in adolescent delinquents.

BACKGROUND: Affiliating with delinquent peers may stimulate the development of antisocial behavior, especially for adolescents who are sensitive to social rewards. The current study examines whether the association between delinquent peer affiliation (DPA) and disruptive behavior interacts with functional brain correlates of reward sensitivity in early onset male adolescents delinquents. METHODS: Childhood arrestees (n = 126, mean age = 17.7 [s.d. 1.6]) completed a DPA questionnaire, and participated in an fMRI study in which reward sensitivity was operationalized through responsiveness of the ventral striatum (VS), amygdala, and medial prefrontal cortex (mPFC) during the monetary incentive delay paradigm (reward anticipation and outcome). Symptoms of disruptive behavior disorders (DBD) were assessed through structured psychiatric interviews (Diagnostic Interview Schedule for Children) with adolescents. RESULTS: DPA had a main effect on DBD symptoms. Adolescents with high VS reward responses showed a stronger significant positive association between DPA and DBD symptoms compared to low VS responders. No evidence for an interaction effect was found for the amygdala and mPFC. Post-hoc analyses revealed the positive association between DPA and DBD was only present in males, with a diminishing effect as age increased. CONCLUSIONS: We found evidence for a biosocial interaction between DPA and reward sensitivity of the VS in relation to DBD symptom severity. This study provides the first evidence of an interaction effect between a brain mechanism and an environmental factor in relation to DBD symptoms, implying that susceptibility to influences of delinquent peers may intertwine with individual biological differences.

Living Situation of Juveniles After Secure Residential Treatment: Exploring the Role of Family Centeredness, Child, and Family Factors.

To promote the return of juveniles to a home-like environment (e.g. living with (foster)parents) after secure residential treatment (SRT), it is important to know which factors are related to this outcome. The current study examined which characteristics of the juvenile, family, and SRT, including family centeredness and use of systemic interventions, are related to the living situation after discharge. For 259 juveniles (mean age 15.82 years, 127 girls) in SRT and their parents, questionnaires were administered at admission, discharge, and 6-months follow-up. Furthermore, information about the living situation before and after SRT was gathered. Higher likelihood of living in a home-like setting after SRT correlated with more furlough moments with parents, receiving a systemic intervention, and a shorter duration of the SRT. Systemic interventions during SRT and spending furlough moments with parents may have a positive impact on returning to a home-like situation after SRT for juveniles.

Relational security: conceptualization and operationalization in small-scale, strengths-based, community-embedded youth justice facilities.

BACKGROUND: Given the developmental vulnerability of justice-involved youth, providing a safe environment in secure facilities is a paramount, yet challenging task. Within this complexity, a sound security framework is key. The security framework exists on three dimensions: physical, procedural and relational security. Existing knowledge points at the importance of a shift in focus on physical and procedural security towards relational security as the core of the security framework. At the same time there is a dearth of knowledge on relational security, particularly in the context of youth justice. This paper explores relational security and its working mechanisms in practice. METHODS: This paper draws on findings of a comprehensive three-year evaluation of three small-scale, community-embedded facilities that are grounded in relational security. The approach of the evaluation was derived from action research, involving a cyclic process alternating between action, research and critical reflection, while engaging all stakeholders in the research process. The action research cycle involved qualitative research (a total of 63 semi-structured interviews) incorporating the perspective of staff, youth and parents. RESULTS: Relational security is grounded in three distinct, but interrelated, elements - staff's basic attitude, a constructive alliance between staff and youth, staff presence - and promotes a safe and therapeutic environment through several mechanisms. CONCLUSIONS: Relational security can be defined in a practical conceptualization; outlining a way of working that guides staff in how to establish a safe and therapeutic environment in secure facilities. This conceptualization finds support in the well-established literature covering the therapeutic alliance and can be substantiated by two aligning theories concerning youth justice strategies: social-ecological theory and self-determination theory. Relational security is not only a way of working, but also a way of being. It encompasses a vision about security and mentality towards justice-involved youth that sees them not merely as 'risks to be managed', but primarly as 'resources to be developed'.

Improving Collaboration Between Youth Peer Support Workers and Non-peer Colleagues in Child and Adolescent Mental Health Services.

The involvement of youth peer workers (YPSWs) in child and adolescent mental health services (CAMHS) stimulates hope, destigmatization, and more culturally and developmentally appropriate support. Nevertheless, the collaboration between YPSWs and non-peer colleagues remains challenging, as it requires services to embed a new type of expert into practice. To stimulate the involvement of YPSWs in practice, this study reports on 27 semi-structured interviews with YPSWs and non-peer colleagues to provide insight into the barriers and facilitators in the collaboration process. The study took place in the Netherlands. A total of 10 interviews with YPSWs, and 17 interviews with non-peer colleagues in different healthcare occupations in CAMHS were conducted. Overall, the participants perceived relatively more barriers compared to facilitators in the collaboration process. Barriers to operate efficiently with YPSWs in multidisciplinary teams included: condescending attitudes and professional stigma towards YPSWs; concerns for YPSW boundaries; bureaucratic and clinical language usage by non-peer colleagues; conflicts due to different sets of expertise; and, lack of role clarity and guidelines for YPSWs. To improve the partnership between YPSWs and non-peer colleagues, participants described the importance of supervision and monitoring of YPSW activities. Moreover, participants also stressed the need for clear guidelines, and introduction and evaluation sessions to facilitate the collaboration process. While YPSWs seem to be an asset to CAMHS, there are a number of barriers to overcome. To overcome these barriers, organizational commitment, supervision (especially from peer colleagues), flexibility by non-peer colleagues, training non-peer staff to support YPSWs, and consistent evaluation of the implementation of YPSWs in services is recommended.

A Tailored Approach for Justice Involved Youth With an Intellectual Disability: The Suitability of a Small-Scale Community-Integrated Approach.

Youngsters with intellectual disabilities are overinvolved within the youth justice system. The aim of this study was to explore the suitability of a small-scale community-integrated approach for justice involved youngsters with intellectual disabilities. This study compared the numbers of transfers, the number, type, and rate of change in incidents, and the possible mediating effect of resilience thereon, between 40 youngsters with and 19 youngsters without intellectual disabilities, placed in a small-scale facility. There were no differences in the number of transfers, the number, type, and rate of change in incidents, and no mediating effect of resilience was found. A small-scale community integrated approach for youth justice facilities can be suited to provide tailored placement for youngsters with intellectual disabilities, given the presence of protective factors and motivation. Both youngsters with and without intellectual disabilities showed a low number of incidents and were able to continue or initiate structural daytime activities.

Resisting aggression in social contexts: The influence of life-course persistent antisocial behavior on behavioral and neural responses to social feedback.

Early adulthood has long been recognized as a potential turning point for the development of antisocial behavior, due to changes in social contexts and ongoing psychological and neurobiological maturation. However, it remains unclear how different developmental trajectories of antisocial behavior, their neural underpinnings, and individual differences in psychopathic traits may help explain the distinct developmental outcomes of individuals who persist in or desist from antisocial behavior in early adulthood - such as how they respond to others in social contexts. Therefore, in the current study, young adults (aged 18-30, 68% male) with a persistent or desistant antisocial trajectory (N = 54), as well as healthy controls (N = 39), completed the Social Network Aggression Task, during which they received positive, neutral, or negative feedback on a personal profile and got the opportunity to retaliate by blasting a loud noise. On a behavioral level, results indicated that in all groups, negative peer feedback evoked higher retaliatory aggression, compared to positive and neutral feedback. On a neural level, when receiving social feedback, individuals with persistent or desistent trajectories showed both similar and dissociable patterns of neural activity; desisting and persisting trajectory groups showed higher activity in the Insula, and the desisting trajectory group showed higher activity in dlPFC. Finally, when participants retaliated, they showed increased dlPFC and ACC activity following positive relative to neutral and negative feedback, where ACC activity correlated most strongly with inhibition of retaliatory responses in the desisting trajectory group. Together, these findings provide novel insights in dissociable patterns of brain activity that may increase our understanding of the mechanisms underlying different developmental trajectories of antisocial behavior.

Additional Value of Peer Informants in Psychological Autopsy Studies of Youth Suicides.

In this study, we examined the feasibility and added value of including peer informants in a psychological autopsy study of youth suicides. Peer semi-structured interview data from 16 cases were analyzed qualitatively and compared to parent data. Results show that peers added information to parents' narratives in general and particularly on social relationships, bullying, school experiences, social media, and family relations. Peers also provided additional information on the presence of certain issues (such as social media contagion) as well as on the emotional impact from certain adverse events that seemed to have functioned as precipitating factors. We conclude that including peers in psychological autopsy studies of youth suicides is feasible and of added value but that more research is desirable. The results initially can be used in the design of psychological autopsies so that the maximum amount of information about each suicide will be learned.

Gender differences in suicide-related communication of young suicide victims.

OBJECTIVES: There is limited insight into gender differences in suicide-related communication (SRC) in youths. SRC is defined as "the act of conveying one's own suicide ideation, intent or behaviours to another person". Increasing our understanding of SRC in youths will enable us to recognize and specify needs of female versus male youths. The current study explores SRC in a sample of Dutch suicide victims aged under 20 and examines gender differences. METHODS: Interview data from a psychological autopsy study of 35 youths who died by suicide in the Netherlands in 2017 were analysed. Qualitative analyses were performed to examine explicit SRC throughout the youths' lives and implicit SRC during the last months prior to suicide. We employed the Constant Comparative Method to explore patterns in the debut, form, frequency, medium, content, type of recipient, and SRC in the last months prior to suicide death. RESULTS: We identified commonalities in the SRC of youths, including the content of suicide notes and an emphasis on suicide method and preparation in the last months. Girls, however, had an earlier debut of SRC, a higher frequency of explicit SRC, and more often directed SRC towards varied types of recipients compared to boys. Moreover, SRC of girls seemed focused on coping and achieving support from others more than SRC of boys. The SRC of boys in comparison to girls was often ambiguous or diluted by "humorous" connotations. CONCLUSION: Unique patterns in SRC of boys and girls posed corresponding challenges for next of kin to interpret communications and respond adequately to SRC. The early debut of girls' SRC highlights the importance of early screening and prevention efforts in girls, while the late debut and ambiguity in boys' SRC implores professionals and next of kin to encourage young males to be unequivocal about suicide ideation or intent.

Presentation and validation of the Abbreviated Self Completion Teen-Addiction Severity Index (ASC T-ASI): A preference-based measure for use in health-economic evaluations.

Economic evaluations of new youth mental health interventions require preference-based outcome measures that capture the broad benefits these interventions can have for adolescents. The Abbreviated Self Completion Teen-Addiction Severity Index (ASC T-ASI) was developed to meet the need for such a broader measure. It assesses self reported problems in seven important domains of adolescents' lives, including school performance and family relationships, and is intended for use in economic evaluations of relevant interventions. The aim of the current study was to present the ASC T-ASI and examine its validity as well as its ability to distinguish between adolescents with and without problems associated with substance use and delinquency. The validation study was conducted in a sample of adolescents (n = 167) aged 12-18 years, who received in- or outpatient care in a youth mental health and (enclosed) care facility in the Netherlands. To examine its feasibility, test-retest reliability, and convergent validity, respondents completed the ASC T-ASI, as well as the EQ-5D-3L and SDQ at baseline and after a two-week interval using a counterbalanced method. The ASC T-ASI descriptive system comprises seven domains: substance use, school, work, family, social relationships, justice, and mental health, each expressing self reported problems on a five-point Likert scale (ranging from having 'no problem' to having a 'very large problem'). The majority of respondents (>70%) completed the ASC T-ASI within 10 minutes and appraised the questions as (very) easy and (very) comprehensible. Test-retest reliability was adequate (Kw values 0.26-0.55). Correlations with the supplementary measures were moderate to high (rs 0.30-0.50), suggesting convergent validity. The ASC T-ASI is a promising and valid measure for assessing self reported problems in important domains in adolescents' lives, allowing benefits beyond health and health-related quality of life to be included in economic evaluations of youth mental health interventions. Future studies of the ASC T-ASI should consider the comprehensiveness of its domains and sensitivity to change.

A multi-method psychological autopsy study on youth suicides in the Netherlands in 2017: Feasibility, main outcomes, and recommendations.

OBJECTIVES: In the Netherlands, there was a sharp increase in the number of suicides among 10- to 19-year-olds in 2017. A multi-method psychological autopsy study (PA) was conducted to assess feasibility, identify related factors, and study the interplay of these factors to inform suicide prevention strategies. METHODS: Coroners identified youth suicides in 2017 in their records and then general practitioners (GPs) contacted the parents of these youths. Over a period of 7 months, 66 qualitative interviews were held with the parents, peers, and teachers, providing information on precipitating factors and five topics involving 35 cases (17 boys and 18 girls, mean age 17 years). Furthermore, 43 parents and care professionals filled in questionnaires to examine risk and care-related factors. Qualitative and quantitative analyses were performed. RESULTS: Although registration problems faced by coroners and resistance to contacting bereaved families by GPs hampered the recruitment, most parents highly appreciated being interviewed. Several adverse childhood experiences played a role at an individual level, such as (cyber) bullying, parental divorce, sexual abuse, as well as complex mental disorders, and previous suicide attempts. Two specific patterns stood out: (1) girls characterized by insecurity and a perfectionist attitude, who developed psychopathology and dropped out of school, and (2) boys with a developmental disorder, such as autism, who were transferred to special needs education and therefore felt rejected. In addition, adolescents with complex problems had difficulty finding appropriate formal care. Regarding potential new trends, contagion effects of social media use in a clinical setting and internet use for searching lethal methods were found. CONCLUSION: This first national PA study showed that, as expected, a variety of mostly complex clusters of problems played a role in youth suicides. An infrastructure is needed to continuously monitor, evaluate, and support families after each youth suicide and thereby improve prevention strategies.

Perspectives on clinical guidelines for severe behavioural problems in children across Europe: a qualitative study with mental health clinicians.

Clinical guidelines for severe behavioural problems (SBPs) in children have recently been developed in several European countries. However, questions emerged regarding their applicability to practice. Our study aimed to provide a first European insight into guidelines' fitness-for-purpose by exploring mental health clinicians' familiarity with, use and perceived value of guidelines for SBPs in children. Participants included 161 clinicians, primarily psychiatrists, from 24 countries. Clinicians completed a semi-structured qualitative questionnaire on existing SBPs guidelines and development of new guidelines where not available. Clinicians' responses were mapped against academic experts' perceptions on SBPs guidelines highlighted in a previous study (Gatej et al. in Eur Psychiatry 57:1-9, 2019). Under half of the clinicians reported being unaware of guidelines. Of these, 37.6% represented countries where guidelines were available according to experts. The remaining half of clinicians who were aware of guidelines on average reported being moderately familiar with their content, perceiving them as moderately useful and using them some of the time. Additionally, 60.8% clinicians agreed that SBPs guidelines need to be developed, as these would create a shared scientific knowledge base and common practice. Guideline improvements included taking a multifactorial approach, creating specific case recommendations, and dissemination efforts. The modest familiarity with and use of guidelines amongst practitioners may highlight guidelines poor fitness-for-purpose, or, alternatively, an underlying confusion around the meaning and purpose of guidelines. Moving forward, efforts should be directed at disseminating clearer definitions of guidelines, addressing existing challenges, and unifying efforts to further develop and audit application of international guidelines for SBPs.

Spontaneous discontinuation of distressing auditory verbal hallucinations in a school-based sample of adolescents: a longitudinal study.

Auditory verbal hallucinations (AVH) can be transiently present in both clinical and healthy adolescent populations. It is not yet fully understood why AVH discontinue in some adolescents and persist in others. The aim of this explorative study is to investigate predictors of spontaneous discontinuation of distressing AVH in a school-based sample of adolescents. 1841 adolescents (mean age 12.4 years, 58% female) completed self-report questionnaires at baseline. The current study included 123 adolescents (7%; 63% female) who reported at least mild distressing AVH at baseline and completed follow-up measurements. LASSO analyses were used to uncover predictors of spontaneous discontinuation of distressing AVH. During follow-up, 43 adolescents (35%) reported having experienced distressing AVH during the last 12 months, while 80 adolescents did not. Spontaneous discontinuation of distressing AVH was predicted by never having used cannabis, parents not being divorced in the past year, never having been scared by seeing a deceased body, less prosocial behaviour, school grade repetition, having the feeling that others have it in for you, having anxiety when meeting new people, having lived through events exactly as if they happened before and having the feeling as if parts of the body have changed. No associations between spontaneous discontinuation of distressing AVH and age or ethnicity were found. Distressing AVH in non-clinical adolescents are mostly transient. Discontinuation was predicted up to a certain extent. However, several predictors were difficult to interpret and do not provide leads for preventive measures, except for discouraging cannabis use.

Correction to: Spontaneous discontinuation of distressing auditory verbal hallucinations in a school­based sample of adolescents: a longitudinal study.

In the Original Publication Table 2 was incorrectly published. The correct table is given below.

Common elements of evidence-based systemic treatments for adolescents with disruptive behaviour problems.

A growing number of evidence-based systemic treatments for adolescents with disruptive behaviour problems exist. However, it is not clear to what extent these treatments have unique and common elements. Identification of common elements in the different treatments would be beneficial for the further understanding and development of family-based interventions, training of therapists, and research. Therefore, the aim of this Review was to identify common elements of evidence-based systemic treatments for adolescents with disruptive behaviour. Several common elements of systemic treatments were identified, showing a strong overlap between the interventions. Investigation of these common mechanisms and techniques could potentially build strong universal systemic treatment and training modules for a broad spectrum of adolescents with problem behaviours.

Psychotic experiences and trauma predict persistence of psychosocial problems in adolescence.

Psychosocial problems during adolescence are heterogenic, rather common, and unstable. At the same time, they are associated with an elevated risk of developing psychiatric disorders later in life. We aimed to describe the trajectories of psychosocial problems during adolescence and examine potential markers of persistence as compared to remission of these problems. At baseline, 1841 adolescents (51.4% female) were included. Of these adolescents, 1512 (mean age = 12.6 [range 11-14 years]; 52.8% female) completed the first and second self-report questionnaires on psychosocial problems (measured with the Strengths and Difficulties Questionnaire), psychotic experiences, trauma, self-esteem and somatic symptoms at two time points over a 1-year period. Regression analyses were used to examine the association between potential predictors and the trajectory of psychosocial problems (remitting versus persistent). Four trajectories were distinguished: 75.6% of the sample showed no problems (the 'none' trajectory), 11.9% were in a 'remitting' trajectory, 9.7% were in an 'incident' trajectory and 2.8% were in the 'persistent' trajectory. Hallucinatory experiences and trauma at baseline were significantly associated with persistence of psychosocial problems compared to those with remitting psychosocial problems. Low rather than high self-esteem was associated with lower risk for persistent problems. Risk of persistence of psychosocial problems increased with accumulation of predictors. Psychotic, especially hallucinatory, experiences and trauma predict persistence of psychosocial problems in adolescents. This underlines the need to assess psychotic experiences and trauma in mental health screening programs.

Psychotic experiences among ethnic majority and minority adolescents and the role of discrimination and ethnic identity.

PURPOSE: Research shows that the prevalence of psychiatric problems is higher in ethnic minority youth compared to native youth. This school-based screening study of early adolescents' mental health in the Netherlands examined differences in prevalence of psychotic experiences in ethnic minority youth compared to their Dutch peers. Moreover, we investigated the association between psychotic experiences, ethnic identity, and perceived discrimination. METHODS: A cohort of 1194 ethnic majority and minority adolescents (mean age 13.72, SD 0.63) filled-out questionnaires on psychotic experiences (including delusional and hallucinatory experiences), perceived group and personal discrimination, and ethnic identity. RESULTS: Apart from lower levels of hallucinatory experiences in Turkish-Dutch adolescents, prevalence of psychotic experiences did not differ between ethnic minority and majority adolescents. Perceived personal discrimination was associated with the presence of psychotic experiences (including delusional and hallucinatory experiences) (OR 2.30, 95% CI 1.22-4.34). This association was stronger for delusional experiences (OR 2.94, 95% CI 1.43-6.06) than for hallucinatory experiences (OR 1.65, 95% CI 0.73-3.72). No significant associations were found between perceived group discrimination and psychotic experiences. A weak ethnic identity was associated with higher risk for reporting psychotic experiences (OR 2.04, 95% CI 1.14-3.66), particularly hallucinatory experiences (OR 3.15, 95% CI 1.54-6.44). When looking at specific ethnic identity categories, marginalization, compared to separation, was associated with a threefold risk for reporting psychotic experiences (OR 3.26, 95% CI 1.33-8.03). Both marginalisation (OR 3.17, 95% CI 1.04-9.63) and assimilation (OR 3.25, 95% CI 1.30-8.13) were associated with a higher risk for hallucinatory experiences. CONCLUSIONS: These results underline the protective effect of ethnic identity against mental health problems. Future research should focus on interventions that focus on strengthen social identity.

Awareness and perceptions of clinical guidelines for the diagnostics and treatment of severe behavioural problems in children across Europe: A qualitative survey with academic experts.

BACKGROUND: Severe behavioural problems (SBPs1) in childhood are highly prevalent, impair functioning, and predict negative outcomes later in life. Over the last decade, clinical practice guidelines for SBPs have been developed across Europe to facilitate the translation of scientific evidence into clinical practice. This study outlines the results of an investigation into academic experts' perspectives on the current prevalence, implementation, and utility of clinical guidelines for SBPs in children aged 6-12 across Europe. METHODS: An online semi-structured questionnaire was completed by 28 psychiatry and psychology experts from 23 countries. RESULTS: Experts indicated that approximately two thirds of the included European countries use at least an unofficial clinical document such as textbooks, while nearly half possess official guidelines for SBPs. Experts believed that, although useful for practice, guidelines' benefits would be maximised if they included more specific recommendations and were implemented more conscientiously. Similarly, experts suggested that unofficial clinical documents offer a wide range of treatment options to individualise treatment from. However, they stressed the need for more consistent, evidence-based clinical practices, by means of developing national and European clinical guidelines for SBPs. CONCLUSIONS: This study offers a preliminary insight into the current successes and challenges perceived by experts around Europe associated with guidelines and documents for SBPs, acting as a stepping stone for future systematic, in-depth investigations of guidelines. Additionally, it establishes experts' consensus for the need to develop official guidelines better tailored to clinical practice, creating a momentum for a transition towards European clinical guidelines for this population.

Antisocial Behavior and Victimization Over 2-Year Follow-Up in Subgroups of Childhood Arrestees.

Not only are childhood onset offenders at high risk of becoming serious persistent offenders, they are also at high risk of becoming victimized themselves. Furthermore, studies in the general population suggest that a combined perpetrator-victim group can be distinguished from a perpetrator-only and a victim-only group on individual and family risk factors. The current study investigated the co-occurrence of offending and victimization among first-time arrestees and the 2-year predictive value of previously found clusters of dynamic risk factors of offending. Childhood first-time arrestees (N = 308; Mage = 10.3, SD = 1.45) were clustered into three groups based on dynamic risk factors of offending in the individual, peer, school, and family domains: a pervasive high, an externalizing intermediate, and a low problem group. Police records and self-report data on re-offending and victimization of these children were collected over a 2-year follow-up period. Compared with the low problem group, the prevalence of re-offending was higher in both the externalizing intermediate group and the pervasive high group. The pervasive high group was most likely to display co-occurring future antisocial behavior and victimization. These findings emphasize that attention should be paid to victimization in addition to future antisocial behavior, especially if additional internalizing and family problems are present. Furthermore, the differences in re-offending and victimization between subgroups of childhood onset offenders stress the need for specific interventions tailored to the risk profile of a child.

Transdiagnostic school-based intervention for adolescents with early persistent psychiatric symptoms: An initial single-group effect study.

AIM: Mental health intervention programs for adolescents generally focus on specific symptoms, such as anxiety or depression. Psychiatric symptoms in adolescence are often heterogeneous, transient and shift over time. These characteristics require a transdiagnostic approach with emphasis on positive psychological development. This study aimed to examine the feasibility and effectiveness of Mastermind, a novel transdiagnostic intervention targeting general underlying mechanisms of psychiatric symptoms in adolescents. METHODS: Adolescents were screened for psychiatric symptoms with the Strengths and Difficulties Scale in a school-based program in two consecutive years. Adolescents were eligible for the intervention when they had psychiatric symptoms at both screening assessments. Participants received an 8 weeks program containing elements of empowerment and attention bias modification. Psychiatric symptoms were assessed before the start of the intervention, immediately after the intervention and at 6-month follow-up. RESULTS: A total of 241 adolescents were eligible for the intervention, of whom 80 participated (mean age 12.5 years). Generalized Estimating Equations, adjusted for gender and educational level, showed a decrease of negative attention bias, psychotic, anxiety, depression and behavioural symptoms immediately after intervention. The effects remained at follow-up. Overall risk for psychiatric disorders, distress and low self-esteem had decreased at follow-up. CONCLUSIONS: A simple two-step school-based screening can identify adolescents with persistent psychiatric symptoms. The Mastermind transdiagnostic group intervention may be effective to reduce psychiatric symptoms, enhance self-esteem and lower the risk for developing psychiatric disorders.

Multidimensional family therapy in adolescents with a cannabis use disorder: long-term effects on delinquency in a randomized controlled trial.

BACKGROUND: Substance use and delinquency are considered to be mutual risk factors. Previous studies have shown that multidimensional family therapy (MDFT) is effective in tackling both conditions on the short term. The current study examines the long-term effects of MDFT on criminal offending. METHODS: 109 adolescents with cannabis use disorder and comorbid problem behavior were randomly assigned to either MDFT or cognitive behavioral therapy (CBT). Police arrest data were collected for 6 years: 3 years prior to and 3 years after treatment entry. Using survival analysis and repeated measure General Linear Models (rmGLM), the two treatment groups were compared on number of arrests, type of offence, and severity of offence. Moderator analyses looking at age, disruptive behavior disorders, history of crimes, family functioning, and (severe) cannabis use were conducted (rmGLM). RESULTS: While police arrest rates increased in the 3 years before treatment, the rates decreased substantially after the start of both treatments. No differences were found between the treatment groups with respect to either time to first offence from the start of the treatment or changes in frequency or severity of offending over time. A treatment effect trend favoring MDFT was found for property offending in the subgroup of adolescents with high baseline-severity of cannabis use. CONCLUSIONS: Across a follow-up period of 3 years, MDFT and CBT were similarly effective in reducing delinquency in adolescents with a cannabis use disorder.Trial registration ISRCTN51014277, Registered 17 March 2010-Retrospectively registered, http://www.isrctn.com/ISRCTN51014277.