Looking into the crystal ball: quality of life, delinquency, and problems experienced by young male adults after discharge from a secure residential care setting in the Netherlands.

BACKGROUND: Adolescents in residential care are a vulnerable population with many problems in several life areas. For most of these adolescents, these problems persist after discharge and into adulthood. Since an accumulation of risk factors in multiple domains increases the likelihood of future adverse outcomes, it would be valuable to investigate whether there are differences in life after residential care between subgroups based on multiple co-occurring risk factors. AIMS AND HYPOTHESIS: The aim of this exploratory follow-up study is to explore differences between young adults-classified in four risk profiles-in relation to life after discharge from a secure residential care setting. It is hypothesised that young adults with a profile with many risks in multiple domains will experience more problems after discharge, such as (persistent) delinquency, compared to young adults with a profile with lower risks. METHODS: Follow-up data were collected from 46 former patients of a hospital for youth forensic psychiatry and orthopsychiatry in the Netherlands. In order to illustrate these young adults' life after discharge, self-reported outcome measures divided into five domains (i.e., quality of life, daily life, social life, problems, and delinquency) were used. Differences between four classes based on pre-admission risk factors, which were identified in a previous study by latent class analysis, were explored by three (non-)parametric statistical tests. RESULTS: Life after discharge for most young adults was characterised by close friends and a high quality of life, but also by substance abuse, professional support, debts, and delinquency. Only a few significant differences between the classes were found, primarily between young adults with risk factors in the individual, family, school, and peer domains and young adults in the other three classes. CONCLUSIONS: Young adults experience a high quality of life after discharge from secure residential care, despite the presence of persistent problems. Some indications have been found that young adults with risk factors in four domains are at greatest risk for persistent problems in young adulthood. Because of the high amount of persistent problems, residential treatment and aftercare should focus more on patients' long-term needs.

Quality of life, delinquency and psychosocial functioning of adolescents in secure residential care: testing two assumptions of the Good Lives Model.

BACKGROUND: In this study, two assumptions derived from the Good Lives Model were examined: whether subjective Quality of Life is related to delinquent behaviour and psychosocial problems, and whether adolescents with adequate coping skills are less likely to commit delinquent behaviour or show psychosocial problems. METHOD: To this end, data of 95 adolescents with severe psychiatric problems who participated in a four-wave longitudinal study were examined. Subjective Quality of Life was assessed with the ten domains of the Lancashire Quality of Life Profile and coping skills with the Utrecht Coping List for Adolescents. RESULTS: Results showed that adolescents who reported a lower Quality of Life on the health domain had more psychosocial problems at follow-up. No relationship was found between Quality of Life and delinquent behaviour. In addition, active and passive coping were associated with delinquent behaviour and psychosocial functioning at follow-up. CONCLUSIONS: Based on the results of this longitudinal study, the strongest support was found for the second assumption derived from the Good Lives Model. Adolescents with adequate coping skills are less likely to commit delinquent behaviour and have fewer psychosocial problems at follow-up. The current study provides support for the use of strength-based elements in the treatment programmes for adolescents in secure residential care.

EEG theta and beta power spectra in adolescents with ADHD versus adolescents with ASD + ADHD.

Attention problems are common in youngsters with attention deficit hyperactivity disorder (ADHD) as well as in adolescents with combined autism spectrum disorder (ASD) and ADHD. However, it is unknown whether there is psychophysiological overlap and/or a difference in electroencephalogram (EEG) power spectra between ADHD and comorbid ASD and ADHD (ASD + ADHD), on and off stimulant medication. To explore potential differences and overlap, measures of theta and beta power in adolescents diagnosed with ADHD (n = 33) versus adolescents with combined ASD + ADHD (n = 20), categorized by stimulant medication use (57 % of the total sample), were compared. EEG measures were acquired in three conditions: (1) resting state, eyes closed (2) resting state, eyes open and (3) during an oddball task. In addition, performance on the d2 attention test was analyzed. Adolescents with ADHD displayed more absolute theta activity than adolescents with ASD + ADHD during the eyes open and task conditions, independent of stimulant medication use. In addition, only the adolescents with ADHD showed an association between diminished attention test performance and increased theta in the eyes open condition. Results of the current study suggest that although there is behavioral overlap between ADHD characteristics in adolescents with ADHD and adolescents with combined ASD + ADHD, the underlying psychophysiological mechanisms may be different. Adolescents with ASD + ADHD exhibited fewer of the EEG physiological signs usually associated with ADHD, although there was an overlap in attentional problems between the groups. This may indicate that treatments developed for ADHD work differently in some adolescents with ASD + ADHD and adolescents with ADHD only.

Cardiac reactivity and stimulant use in adolescents with autism spectrum disorders with comorbid ADHD versus ADHD.

A large number of youngsters with autism spectrum disorders (ASD) display comorbid attention deficit/hyperactivity disorder (ADHD) symptoms. However, previous studies are not conclusive whether psychophysiological correlates, like cardiac reactivity, are different for ASD with comorbid ADHD (ASD+) compared to ADHD. Therefore, the current study investigated (dis)similarities in cardiac reactivity and attention task performance. In a clinical sample, adolescents diagnosed with ASD+ (n = 20) versus ADHD (n = 36) and stimulant medication use (56 %) were compared during a baseline with eyes closed and task performance. Results for cardiac reactivity were similar for both diagnostic groups. Stimulant-medicated adolescents showed decreased adaptation of LF/HF ratio and faster reaction times than stimulant-free adolescents. The current study underlines the psychophysiological overlap of ADHD symptoms in adolescents with ASD+ and adolescents with ADHD.

Profiles of individually defined recovery of people with major psychiatric problems.

BACKGROUND: Research on factors associated with individually defined recovery is limited. Several phases of recovery have been described in the literature. Individuals in these distinct phases have different characteristics and problems. AIMS: To identify classes of people with major psychiatric problems who have comparable profiles of individually defined recovery, to relate these classes to the phases of recovery as described by Spaniol, Wewiorsky, Gagne, and Anthony (2002), and to associate the classes to demographic and psychiatric characteristics, and health-related variables. METHODS: Data of 333 participants with major psychiatric problems were used. A latent class analysis was conducted on the mean scores of four proxy measures of recovery. RESULTS: Three well-defined classes were found that differed on the recovery measures. The classes differed significantly on variables corresponding to Spaniol's phases of recovery (Spaniol et al., 2002) and on health care utilization, health care needs and anxiety disorder, but not on demographic variables. CONCLUSIONS: It is possible to identify classes of people with major psychiatric problems who have comparable profiles of individually defined recovery that seem to correspond to phases of recovery. More knowledge of the characteristics of people in different phases of recovery will contribute to more fine-tuned and recovery-oriented health care.

Predicting young adult social functioning from developmental trajectories of externalizing behaviour.

BACKGROUND: The long-term consequences of child and adolescent externalizing problems often involve a wide spectrum of social maladaptation in adult life. The purpose of this study was to describe the predictive link of child and adolescent externalizing developmental trajectories to social functioning in adulthood. METHOD: Social functioning was predicted from developmental trajectories of parent-reported aggression, opposition, property violations and status violations that were defined in a longitudinal multiple birth cohort study of 2,076 males and females aged 4-18 years. Social functioning was assessed using self-reports by young adults aged 18-30 years. Linear and logistic regression analyses were used to describe the extent to which developmental trajectories are prospectively related to social functioning. RESULTS: Children with high-level trajectories of opposition and status violations reported more impaired social functioning as young adults than children with high-level trajectories of aggression and property violations. Young adults who showed onset of problems in adolescence reported overall less impaired social functioning than individuals with high-level externalizing problems starting in childhood. Overall, males reported more impaired social functioning in adulthood than females. However, females with persistent high-level externalizing behaviour reported more impairment in relationships than males with persistent high-level externalizing behaviour. CONCLUSION: The long-term consequences of high levels of opposition and status violations in childhood to serious social problems during adulthood are much stronger than for individuals who show only high levels of aggressive antisocial behaviours.

Perceived parental rearing of bipolar offspring.

OBJECTIVE: To explore the impact of growing up with a parent with a bipolar disorder. First, we compared parental rearing behavior perceived by young adult offspring of bipolar parents with parental rearing behavior perceived by same aged young adults from the general population. Secondly, we examined the associations between perceived parental rearing behavior and parental psychopathology and psychopathology in offspring. METHOD: Subjects were 129 offspring of 80 bipolar parents and their spouses and 1122 young adults from the general population. In offspring the Structured Clinical Interview for DSM-IV was used to assess DSM-IV diagnoses and the EMBU was used to assess perceived parental rearing in both groups. RESULTS: In general, offspring growing up in a family with a bipolar parent perceived their mothers as less rejecting, more emotionally warm and less overprotecting and their fathers as less emotionally warm and less overprotecting compared with young adults from the general population. Perceived rejection was related to psychopathology in offspring. CONCLUSION: Overall, parental rearing in families with a parent with a bipolar disorder is not more dysfunctional, as perceived by their offspring, than in families from the general population. Offspring with a bipolar disorder perceive their parents as more rejecting.

Measuring quality of life in children referred for psychiatric problems: psychometric properties of the PedsQL 4.0 generic core scales.

OBJECTIVE: The aim of this study was to assess the psychometric properties of the Dutch translation of the Pediatric Quality of Life Inventory (PedsQL 4.0) generic core scales and assess its usefulness in measuring quality of life (QoL) in a child psychiatric population. METHODS: Reliability and validity of the PedsQL were assessed in 310 referred children (ages 6-18 years) and a comparison group consisting of 74 non-referred children (ages 7-18 years), and the parents in both groups. RESULTS: Confirmatory factor analysis resulted in a four-factor solution. Internal consistency reliability for the PedsQL Total Scale Score (alpha = 0.84 child self-report, alpha = 0.87 parent proxy-report), Psychosocial Health Score (alpha = 0.70 child self-report, alpha = 0.81 parent proxy-report), and most subscale scores were acceptable for group comparisons. Correlations between scores of fathers and mothers were large. Criterion-related validity was demonstrated by significantly lower PedsQL scores for referred vs. non-referred children. Significant correlations between PedsQL scales and measures of psychopathology showed convergent validity. Small correlations between PedsQL scales and intelligence of the child evidenced discriminant validity. CONCLUSION: The PedsQL seems a valid instrument in measuring QoL in children referred for psychiatric problems.

Preschool developmental pathways to preadolescent internalizing and externalizing problems.

The present study investigated longitudinal pathways from specific early preschool behavioral problems (ages 2-3 years) to internalizing and externalizing problems in preadolescence (ages 10-11 years), and the role of social problems at school entry (ages 4-5 years) in such pathways. Path analyses were performed using both parent and teacher reports in a sample of 251 to 346 children from the general population, depending on the availability of parent and teacher data at each time of assessment. Structural equation modeling revealed homotypic internalizing and externalizing pathways, predictions from early preschool externalizing problems to later internalizing problems, and negative predictive paths from early internalizing problems to externalizing problems in preadolescence. Cross-informant predictions spanning 8 years were found between parent-reported aggression and overactivity at ages 2-3 years and teacher-reported externalizing problems at ages 10-11 years. Further, results showed that boys' pathways were more complex and showed greater predictive validity than pathways for girls, and that social problems at school entry played a significant role in pathways to internalizing problems, but only for boys. The results are discussed from a developmental psychopathology perspective.

Zygosity diagnosis in young twins by parental report.

This study reports on zygosity determination in twins of childhood age. Parents responded to questionnaire items dealing with twin similarity in physical characteristics and frequency of mistaking one twin for another by parents, relatives and strangers. The accuracy of zygosity diagnosis was evaluated across twins aged 6, 8, and 10 and across parents. In addition, it was examined whether the use of multiple raters and the use of longitudinal data lead to an improvement of zygosity assignment. Complete data on zygosity questions and on genetic markers or blood profiles were available for 618 twin pairs at the age of 6 years. The method used was predictive discriminant analyses. Agreement between zygosity assigned by the replies to the questions and zygosity determined by DNA markers/blood typing was around 93%. The accuracy of assignment remained constant across age and parents. Analyses of data provided by both parents and collected over multiple ages did not result in better prediction of zygosity. Details on the discriminant function are provided.