Unravelling the Longitudinal Relations Between Developmental Milestones, General Psychopathology, and Personality Functioning in a Youth Clinical Sample.

Personality functioning, general psychopathology, and developmental milestones achievement are critical domains in the field of young people's mental health; however, no prior research has considered these variables jointly or examined the temporal dynamics between them. To fill these gaps, the present study aimed to investigate the longitudinal associations between the above constructs in a clinical sample of Dutch youth. 525 outpatients (72.5% women; age range: 12-26 years, M = 18.8 ± 2.83) diagnosed with different psychological difficulties were recruited from specialized mental health care services in The Netherlands. They completed self-report measures assessing personality functioning, psychopathological symptoms, and the achievement of youth-specific developmental milestones. Data were collected on three occasions within a year and modelled using a Cross-Lagged Panel Model approach. The levels of personality dysfunction, general psychopathology, and developmental milestones achievement were found to fluctuate from one wave to the other. Personality dysfunction and general psychopathology were positively interrelated at each time point, while both constructs were negatively associated with developmental milestones achievement. Importantly, difficulties achieving developmental milestones predicted a worsening in personality functioning 6 months later. This result would suggest that the achievement of developmental milestones precedes personality functioning, supporting the importance of interventions promoting age-adequate functioning in youth.

Social information processing, normative beliefs about aggression and parenting in children with mild intellectual disabilities and aggressive behavior.

BACKGROUND: High levels of aggressive behavior in children with mild intellectual disabilities to borderline intellectual functioning (MID-BIF) are associated with deviant social information processing (SIP) steps. The current study investigated deviant SIP as a mediating mechanism linking both children's normative beliefs about aggression and parenting to aggressive behavior in children with MID-BIF. Additionally, the mediating role of normative beliefs about aggression in linking parenting and deviant SIP was investigated. METHODS: 140 children with MID-BIF in community care in the Netherlands, their parent(s) or caretaker(s), and their teacher participated in this cross-sectional study. Structural equation modeling was performed to test mediations. Models were run separately for parent and teacher reports of aggression, and included three deviant SIP steps (interpretation, response generation, response selection). RESULTS: A total indirect effect through deviant SIP steps was found from normative beliefs about aggression to teacher-reported aggression, but not to parent-reported aggression. An indirect effect was found from positive parenting through normative beliefs about aggression to deviant SIP. CONCLUSION: The results of this study suggest that, next to deviant SIP and parenting, normative beliefs about aggression may be a relevant intervention target for children with MID-BIF and aggressive behavior.

Therapist alliance building behavior and treatment adherence for dutch children with mild intellectual disability or borderline intellectual functioning and externalizing problem behavior.

BACKGROUND: Psychological interventions targeting children with mild intellectual disability or borderline intellectual functioning (MID-BIF) are suggested to be effective in reducing their externalizing problem behavior, but less is known about the specific treatment processes that may be associated with these effects. AIMS: The current study investigated whether the treatment processes of observed treatment adherence (i.e., the degree to which a therapist sticks to the protocol of a treatment and provides the treatment as intended) and observed therapist alliance-building behavior (TA-BB; i.e., behavior contributing to the affective bond between the therapist and the client) predicted treatment outcomes in a group behavioral parent training combined with group child cognitive behavior therapy targeting externalizing problem behavior in children with MID-BIF. METHODS AND PROCEDURES: Seventy-two children (aged 9-18; Mage = 12.1) and their parents in The Netherlands received the intervention program. They reported on children's externalizing behavior, parenting practices and the parent-child relationship by questionnaires at pre-test and post-test, and the observed treatment processes were coded by audio tapes of therapeutic sessions. OUTCOMES AND RESULTS: The results showed high levels of both treatment adherence (M = 2.49; SD = 0.20; range 1 - 3) and TA-BB (M = 4.11; SD = 0.32; range 1 - 5). Additionally, repeated measures analyses revealed that levels of treatment adherence significantly predicted the improvement of the parent-child relationship (F(1, 66) = 5.37; p = .024) and that levels of TA-BB significantly predicted the decrease of parent reported externalizing problem behavior (F(1, 66) = 9.89; p = .002). CONCLUSIONS AND IMPLICATIONS: The current study suggested that optimal treatment processes are important for treatment outcomes in an intervention targeting children with MID-BIF.

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).

Emotion regulation and angry mood among adolescents with externalizing problems and intellectual disabilities.

BACKGROUND AND AIMS: Cognitive behavior therapy targeting emotion regulation is found to be effective in decreasing externalizing problems, but little is known about the emotion regulation capacities of adolescents with externalizing problems and Mild Intellectual Disabilities or Borderline Intellectual Functioning (MID-BIF). Therefore, the aim of this study was to compare emotion (i.e., anger) regulation capacities, angry mood level and angry mood variability between two groups: adolescents with externalizing problems and MID-BIF and adolescents with externalizing problems and average intelligence (AIQ). METHODS AND PROCEDURES: Participants in the MID-BIF (n = 42, Mage = 15.52, SD = 1.43) and AIQ (n = 39, Mage = 13.67, SD = 1.06) group completed questionnaires about emotion regulation difficulties, emotion regulation strategies, and angry mood. OUTCOMES AND RESULTS: Adolescents in the MID-BIF group reported fewer emotion regulation difficulties, fewer maladaptive regulation strategies, and lower levels of angry mood than adolescents in the AIQ group. No between-group differences in angry mood variability were found. Lastly, adolescents in the MID-BIF group reported to use more behavioral than cognitive regulation strategies. CONCLUSIONS AND IMPLICATIONS: These findings provide a starting point in understanding emotion regulation and angry mood of adolescents with externalizing problems and MID-BIF and show that it is important to consider differences between cognitive and behavioral regulation processes.

Effectiveness of an Intervention for Children with Externalizing Behavior and Mild to Borderline Intellectual Disabilities: A Randomized Trial.

This study evaluated the effectiveness of Standing Strong Together (SST), a combined group based parent and child intervention for externalizing behavior in 9-16 year-old children with mild to borderline intellectual disabilities (MBID). Children with externalizing behavior and MBID (IQ from 55 to 85) (N = 169) were cluster randomly assigned to SST combined with care as usual or to care as usual only. SST led to a significant benefit on teacher reported but not on parent reported externalizing behavior. SST had significant effects on parent rated positive parenting and the parent-child relationship. The present study shows that a multicomponent group based intervention for children with MBID is feasible and has the potential to reduce children's externalizing behavior and improve both parenting behavior and the parent-child relationship.

Executive functions and processing speed in children with mild to borderline intellectual disabilities and externalizing behavior problems.

Several studies suggest impaired executive functions (EFs) in children with externalizing behavior problems and average intelligence (e.g., IQ > 85). Even though children with mild to borderline intellectual disabilities (MBID) are at higher risk of developing externalizing behavior problems compared to children with average intelligence, it is not yet clear if impaired EFs are also associated with the occurrence of externalizing behavior problems in children with MBID. In the current study, we therefore assessed three EF components (inhibition, cognitive flexibility, and working memory) as well as processing speed in children with MBID and externalizing behavior problems (n = 71) versus children with MBID with no such problems (n = 70). This was accomplished using a well-established computerized test battery. Even after IQ was controlled for, the children with MBID and externalizing behavior problems showed more impaired working memory performance. Differences for inhibition performance and processing speed were also found but less consistent across the tasks used to measure these aspects of EF. Cognitive flexibility was not more impaired in children with both MBID and externalizing behavior problems relative to children with MBID only. Our findings highlight working memory as a potential target to enhance the treatment of children with MBID and externalizing behavior problems.

Parenting and the parent-child relationship in families of children with mild to borderline intellectual disabilities and externalizing behavior.

This cross-sectional study examined the association between parenting behavior, the parent-child relationship, and externalizing child behavior in families of children with mild to borderline intellectual disabilities (MBID). The families of a child with MBID and accompanying externalizing behavior problems (n=113) reported more positive discipline and physical punishment but less involvement, less positive parenting, less monitoring, a lower sense of parenting competence, less acceptance of the child, and less closeness to the child than the families of a child with MBID and no accompanying externalizing behavior problems (n=71). The parent-child relationship was most strongly associated with externalizing child behavior, over and above parenting behaviors. In addition, the parent-child relationship was found to be associated with parenting behavior, over and above the child's externalizing behavior. Our results highlight the importance of both the parent-child relationship and parenting behavior in connection with the occurrence of externalizing behavior problems on the part of children with MBID. Parenting behavior and the parent-child relationship may thus be promising targets for interventions with this group of children.