Expectant parents with intellectual disabilities in child protection: Risk factors for child safety.

BACKGROUND: Newborns of parents with intellectual disabilities face higher risks in their environment for child unsafety, despite parents' good intentions. To help parents prevent unsafe circumstances, a good understanding of the risk factors faced by these parents is needed. METHODS: This casefile study examined (1) which risk factors were present for expectant parents with intellectual disabilities in child protection, (2) which domains of risk factors, and (3) whether a cumulation of risk factors was related to child safety. RESULTS: Expectant parents with intellectual disabilities in child protection before the child was born often experienced a cumulation of risk factors. Child, family, and care factors best predicted child safety. A cumulation of risk factors over multiple life domains increased the risks for child unsafety. CONCLUSIONS: To reduce the risks of unsafe parenting conditions for newborns, preventive interventions for expectant parents with intellectual disabilities should address their needs from an ecological perspective.

Interactive virtual reality training to improve socio-emotional functioning in adolescents with developmental language disorders: A feasibility study.

Methods to effectively improve socio-emotional functioning by adolescents with developmental language disorders (DLD) are scarce. Current methods to improve socio-emotional functioning in adolescents with other neurobiological disorders seem less suitable, as these methods are highly language based. This study therefore examined the feasibility of the virtual reality (VR) training for socio-emotional skills: 'InterAction'. The aims of the present study were to (1) examine whether interactive VR is a feasible training method for adolescents with DLD; (2) investigate adolescents' appreciation of the VR training; (3) examine whether the virtual reality training facilitates the participants' sense of presence during social practice situations in an interactive digital world; and (4) explore whether adolescents socio-emotional skills improved during the six-session training. A sample of nine adolescents (13-16 years) with DLD reported on their presence in VR contexts and their appreciation toward the VR training. They also completed weekly self-reports on their socio-emotional functioning. Results indicated that 'InterAction' was a feasible method to practice socio-emotional functioning with adolescents with DLD. Adolescents highly appreciated the VR training. In addition, adolescents rated the sense of presence as high in the VR training. The individual trajectories showed that improvements in the trained skills varied both between and within participants. The results were also not uniform between the specific skills trained. The findings suggest that interactive virtual reality training may be a promising tool for improving socio-emotional functioning in adolescents with DLD. Future studies should examine the positive indications of this study in a larger sample.

Treating children's aggressive behavior problems using cognitive behavior therapy with virtual reality: A multicenter randomized controlled trial.

This multicenter randomized controlled trial investigated whether interactive virtual reality enhanced effectiveness of Cognitive Behavioral Therapy (CBT) to reduce children's aggressive behavior problems. Boys with aggressive behavior problems (N = 115; Mage = 10.58, SD = 1.48; 95.7% born in Netherlands) were randomized into three groups: CBT with virtual reality, CBT with roleplays, or care-as-usual. Bayesian analyses showed that CBT with virtual reality more likely reduced aggressive behavior compared to care-as-usual for six of seven outcomes (ds 0.19-0.95), and compared to CBT with roleplays for four outcomes (ds 0.14-0.68). Moreover, compared to roleplays, virtual reality more likely enhanced children's emotional engagement, practice immersion, and treatment appreciation. Thus, virtual reality may be a promising tool to enhance CBT effectiveness for children with aggressive behavior problems.

Detecting social information processing profiles of boys with aggressive behavior problems: An interactive virtual reality approach.

Children with aggressive behavior problems may aggress for different reasons, requiring tailored assessment and treatment. The aim of this study was to test whether it is possible to detect distinct social information processing (SIP) profiles among boys with aggressive behavior problems. We therefore conducted Latent Profile Analyses on boys' SIP patterns assessed in interactive virtual reality. Additionally, we examined the discriminant validity of these SIP profiles by comparing them on theoretically relevant child characteristics (i.e., temperament, executive functioning, aggressive belief systems, punishment insensitivity, sensation seeking). We presented boys (N = 181; ages 7-13) with a virtual classroom where they could play games with virtual peers. They reported on their SIP in four virtual reality scenarios, designed to assess reactive and proactive aggressive SIP. Results revealed four distinct SIP profiles: a general reactive SIP profile, a situation-specific reactive SIP profile, a mixed reactive-proactive SIP profile, and a nonaggressive SIP profile. Planned contrasts revealed that boys with these SIP profiles differed in temperament, aggressive belief systems, and punishment insensitivity, but not in executive functioning and sensation seeking. Overall, findings suggest that boys differ in the exact SIP patterns underlying their aggressive behavior, providing inroads to tailor interventions to children's individual needs.

Capturing mechanisms of change: Weekly covariation in anger regulation, hostile intent attribution, and children's aggression.

Interventions for children's aggression typically target assumed underlying mechanisms, such as anger regulation and hostile intent attribution. The expectation here is that targeting these mechanisms will result in within-person changes in aggression. However, evidence for these mechanisms is mostly based on between-person analyses. We, therefore, examined whether within-person changes in adaptive anger regulation and hostile intent attribution covaried with within-person changes in children's aggression. Children (N = 223; age 7-12; 46% boys) filled out four weekly report measures to assess adaptive anger regulation, hostile intent attribution, and aggression. The psychometric properties of these novel measures were adequate. Results of multi-level analyses revealed within-person effects: weekly changes in adaptive anger regulation and hostile intent attribution covaried with changes in children's aggression. This corresponded with between-person findings on the same data: children with lower levels of adaptive anger regulation and higher levels of hostile intent attribution reported more aggression than other children. These findings support the idea that targeting anger regulation and hostile intent attribution in interventions may lead to changes in individual children's aggression.

Interactive Virtual Reality versus Vignette-Based Assessment of Children's Aggressive Social Information Processing.

This study examined whether interactive Virtual Reality (VR) provides a more ecologically valid assessment of children's aggressive social information processing (SIP) and aggressive responses than a standard vignette-based assessment. We developed a virtual classroom where children could meet and play games with virtual peers. Participants were boys (N = 184; ages 7-13) from regular education and special education for children with disruptive behavior problems. They reported on their SIP in four scenarios (i.e., two instrumental gain and two provocation scenarios) presented through both interactive VR and vignettes. Teachers reported on children's real-life aggressive behavior and reactive and proactive motives for aggression. Results demonstrated that children found the interactive VR assessment more emotionally engaging and immersive than the vignette-based assessment. Moreover, compared to vignettes, the interactive VR assessment evoked higher levels of aggressive SIP and responses in provocation scenarios only. Results supported the enhanced predictive validity of the interactive VR assessment of children's aggressive SIP and responses, which predicted children's real-life aggression above and beyond the vignette-based assessment with 2 to 12% additional explained variance. Similar results were found for children's real-life reactive and proactive motives for aggression, with 3 to 12% additional variance explained by interactive VR above and beyond vignettes. Interactive VR did not, however, evoke larger individual differences (i.e., variances) in children's aggressive SIP and responses than vignettes. Together, these findings suggest that interactive VR provides a more ecologically valid method to assess children's aggressive SIP and responses than hypothetical vignettes.

Using virtual reality to treat aggressive behavior problems in children: A feasibility study.

Evidence-based cognitive behavioral therapies (CBTs) for children with aggressive behavior problems have only modest effects. Research is needed into new methods to enhance CBT effectiveness. The aims of the present study were to (1) examine whether interactive virtual reality is a feasible treatment method for children with aggressive behavior problems; (2) investigate children's appreciation of the method; and (3) explore whether children's aggression decreased during the ten-session treatment. Six boys (8-12 years) participated at two clinical centers in the Netherlands. Newly developed weekly reports were collected on treatment feasibility (therapist-report), treatment appreciation (child report), and children's aggression (child/parent report). Results supported treatment feasibility: therapists delivered on average 98% of the session content, provided more than the recommended practice time in virtual reality, experienced few technical issues, and were satisfied with their treatment delivery. Children highly appreciated the treatment. Parents reported decreases in children's aggression over the treatment period (i.e., between week 1 and week 10), but children did not. The promising findings of this feasibility study warrant randomized controlled trials to determine whether interactive virtual reality enhances CBT effectiveness for children with aggressive behavior problems.

Emotion regulation training as a treatment element for externalizing problems in adolescence: A randomized controlled micro-trial.

Improving interventions for externalizing problems in adolescence may require determining which treatment elements actually produce change. In this micro-trial, we tested a treatment element addressing one widely-hypothesized mechanism underlying externalizing problems: emotion regulation. We tested whether emotion regulation could be improved via training, whether adolescents who received such training would subsequently show reduced externalizing problems, and which training approach and sequence was most effective. We randomized 108 adolescents with elevated externalizing problems (71.3% boys, Mage = 13.66, SD = 1.10) to a control condition or an experimental condition teaching emotion regulation through either a cognitive or behavioral approach, in alternated sequences. Effects of the modules were assessed before and after the modules, and with weekly assessments. The results showed a positive effect of the experimental training on self-reported use of adaptive emotion regulation strategies. However, self-reported externalizing problems decreased more in the control condition than in the experimental condition. No mediation, approach (cognitive versus behavioral) or sequence (cognitive-behavioral versus behavioral-cognitive sequence) effects were found. These findings illustrate that change in a proposed mechanism may not be accompanied by change in targeted problems; this highlights the importance of testing the hypothesized impact of specific treatment elements on targeted mental health problems. TRIAL REGISTRATION: This trial was registered in the Dutch Trial Register (NTR7334, July 10th, 2018) and the study protocol was published (te Brinke, Schuiringa, Menting, Dekovic, & de Castro, 2018).

Interactive virtual reality assessment of aggressive social information processing in boys with behaviour problems: A pilot study.

Children's aggressive behaviour is partly determined by how they process social information (e.g., making hostile interpretations or aiming to seek revenge). Such aggressive social information processing (SIP) may be most evident if children are emotionally engaged in actual social interactions. Current methods to assess aggressive SIP, however, often ask children to reflect on hypothetical vignettes. This pilot study therefore examined a new method that actually involves children in emotionally engaging social interactions: interactive virtual reality (VR). We developed a virtual classroom where children could play games with virtual peers. A sample of boys (N = 32; ages 8-13) from regular and special education reported on their SIP in distinct VR contexts (i.e., neutral, instrumental gain and provocation). They also completed a standard vignette-based assessment of SIP. Results demonstrated good convergent validity of interactive VR assessment of SIP, as indicated by significant moderate to large correlations of VR-assessed SIP with vignette-assessed SIP for all SIP variables except anger. Interactive VR showed improved measurement sensitivity (i.e., larger variances in SIP compared to vignettes) for aggressive responding, but not for other SIP variables. Discriminant validity (i.e., distinct SIP patterns across contexts) of interactive VR was supported for provocation contexts, but not for instrumental gain contexts. Last, children were more enthusiastic about the VR assessment compared to the vignette-based assessment. These findings suggest that interactive VR may be a promising tool, allowing for the assessment of children's aggressive SIP in standardized yet emotionally engaging social interactions.

Hostile Intent Attribution and Aggressive Behavior in Children Revisited: A Meta-Analysis.

To test specific hypotheses about the relation between hostile intent attribution (HIA) and children's aggressive behavior, a multilevel meta-analysis was conducted on 111 studies with 219 effect sizes and 29.272 participants. A positive association between HIA and aggression was found, but effect sizes varied widely between studies. Results suggested that HIA is a general disposition guiding behavior across a broad variety of contexts, whereas the strength of the relation between HIA and aggression depends on the level of emotional engagement. The relation is stronger for more reliable HIA measures, but is not stronger for reactive aggression or co-morbid attention-deficit hyperactivity disorder than for aggression in general. The importance of understanding specific moderators of effect size for theory development is discussed.

Does Parent-Child Discussion of Peer Provocations Reduce Young Children's Hostile Attributional Bias?

Two studies investigated whether parent-child discussion of peer provocations reduces young children's hostile attributional bias. Study 1 (N = 109, age 4-7)-an observational study-showed that parent-child discussion of nonhostile attributions (when reading a picture book) predicted reductions in children's hostile attributional bias from pre- to postdiscussion. Study 2 (N = 160, age 4-6)-an experimental study-showed that stimulating parents to discuss either nonhostile attributions or normative beliefs (vs. a control condition) reduced children's hostile attributional bias in response to hypothetical vignettes, but not in response to a staged peer provocation. These findings suggest that by framing social situations, parents may help their children perceive less hostility in their social worlds.

Effectiveness of an individual school-based intervention for children with aggressive behaviour: a randomized controlled trial.

BACKGROUND: For elementary school-children with aggressive behaviour problems, there is a strong need for effective preventive interventions to interrupt the developmental trajectory towards more serious behaviour problems. AIM: The aim of this RCT-study was to evaluate a school-based individual tailor-made intervention (Stay Cool Kids), designed to reduce aggressive behaviour in selected children by enhancing cognitive behavioural skills. METHOD: The sample consisted of 48 schools, with 264 fourth-grade children selected by their teachers because of elevated levels of externalizing behaviour (TRF T-score>60), randomly assigned to the intervention or no-intervention control condition. RESULTS: The intervention was found to be effective in reducing reactive and proactive aggressive behaviour as reported by children, mothers, fathers or teachers, with effect sizes ranging from .11 to .32. Clinically relevant changes in teacher-rated externalizing behaviour were found: the intervention reduced behaviour problems to (sub) clinical or normative levels for significantly more children than the control condition. Some aspects of problems in social cognitive functioning were reduced and children showed more positive self-perception. Ethnic background and gender moderated intervention effects on child and teacher reported aggression and child response generation. CONCLUSIONS: The results of this study demonstrate the effectiveness on outcome behaviour and child cognitions of an individual tailor-made intervention across informants under real-world conditions.