A.M. Willemen

Efficacy of psychosocial group intervention for children with chronic illness and their parents.

OBJECTIVE: To investigate the efficacy of a cognitive-behavioral group intervention for children with chronic illnesses and to test the effect of an added parent component. METHODS: Children (n = 194) and their parents participated in a multicenter randomized clinical trial comparing a child-only intervention and a parent-child intervention to a wait-list control group. Primary outcomes were parent- and self-reported internalizing and externalizing problems; secondary outcomes were child disease-related coping skills (information seeking, relaxation, social competence, medical compliance, and positive thinking). Assessments took place at baseline and at 6- and 12-month follow-ups. Intention-to-treat mixed-model analyses were performed to test the difference in change in outcomes. RESULTS: The intervention had a positive effect on changes in parent-reported internalizing problems, child-reported externalizing problems, information seeking, social competence, and positive thinking. The additional effect of parental involvement was observed on parent-reported internalizing problems, child-reported externalizing problems, information seeking, and social competence. Illness severity and illness type did not moderate the effects. There were no intervention effects on child-reported internalizing problems, parent-reported externalizing problems, relaxation, or medical compliance. Of the families in the wait-list control group, 74% sought alternative psychological support during the intervention period. CONCLUSIONS: This RCT supports the efficacy of a protocol-based group intervention for children with chronic illnesses and their parents. Adding a parental component to the intervention contributed to the persistence of the effects. Future research should focus on moderating and mediating effects of the intervention.

Adverse Childhood Experiences of Referred Children Exposed to Intimate Partner Violence: Consequences for their Wellbeing

OBJECTIVE This study investigated the relationships among Adverse Childhood Experiences (ACEs) in a high risk clinical sample of Dutch children whose mothers were abused by an intimate partner, and the severity of behavioral and emotional problems and trauma symptoms. METHODS The study population comprised 208 children (M=7.81 years, SD=2.39, range 2-12) who were referred to mental health and welfare institutions after reported Intimate Partner Violence (IPV). At intake, caregivers, children, and teachers completed questionnaires on Adverse Childhood Experiences, behavior and emotional problems, and trauma symptoms. RESULTS The results showed that child witnesses of IPV were also exposed to other adverse experiences, such as abuse, household dysfunction and neglect. The mean number of ACEs was 5.08 (range 2-9). Twenty percent of the children in this sample experienced seven ACEs or more. The number of ACEs children were exposed to was unrelated to the level of emotional and behavioral problems, except for trauma related symptoms reported by parents. CONCLUSIONS This study shows that children who witnessed Intimate Partner Violence were also exposed to other adverse experiences. The results of this study may imply that in this high-risk clinical sample of children exposed to IPV, additional adverse experiences have a limited relationship to psychological outcomes. PRACTICE IMPLICATIONS A thorough assessment and inclusion of all Adverse Childhood Experiences is necessary for a comprehensive treatment program.

Physiological regulation of stress in referred adolescents: the role of the parent-adolescent relationship.

BACKGROUND Psychopathology in youth appears to be linked to deficits in regulating affective responses to stressful situations. In children, high-quality parental support facilitates affect regulation. However, in adolescence, the role of parent-child interaction in the regulation of affect is unclear. This study examined physiological reactivity to and recovery from stress in adolescents at risk for psychopathology, and their associations with internalising and externalising problems and parent-adolescent interactions. METHODS A total of 99 adolescents (M = 13.57 years, SD = 1.83) with a history of mental health problems underwent the Alarm Stress Task and were reunited with their primary caregiver after the stressor, while the physiological responses of the parasympathetic (respiratory sinus arrhythmia) and sympathetic (pre-ejection period) systems were measured. The quality of parent-adolescent interaction was determined from observations of secure-base seeking and providing during the task. Affect regulation was measured as physiological reactivity and recovery after the stressor. RESULTS Adolescents with high levels of externalising problems and low levels of secure-base support showed weaker parasympathetic reactivity and recovery. Higher level of adolescent secure-base seeking was associated with stronger sympathetic reactivity and recovery. CONCLUSIONS Secure-base interactions between parents and adolescents facilitate physiological regulation of stress, especially for adolescents with externalising symptomatology.

Change in psychopathology in referred children: the role of life events and perceived stress.

BACKGROUND This study examined the relation between stress and change in emotional and behavioural problems in children and adolescents referred for mental health services. METHOD At three waves across four years, children and their parents (N = 310, mean age at the first wave = 11.26 years, SD = 3.18) reported emotional and behavioural problems, as well as stressful life events (parent report) and perceived stress (child report). RESULTS Major life events before referral were associated with higher levels of parent-reported internalising and externalising problems at referral. Life events after referral were associated with a slower recovery from internalising problems. The associations between stressful life events and the course of parent- and self-reported problems were mediated by childrens subjective feelings of stress. CONCLUSION Stressful life events appear to interfere with recovery from internalising problems in the years after referral through increasing the experience of stress in daily life.

Peer Victimization in Dutch School Classes of Four‐ to Five‐Year‐Olds: Contributing Factors at the School Level

This research was designed to examine how factors within young childrens environment (e.g., school factors, neighborhood) contribute to explaining peer victimization. The sample comprised 2,003 children (between 4 and 5 years of age) from 98 classrooms in 23 elementary schools in the Netherlands. Teachers were asked to complete a questionnaire on exposure to victimization for each child. Multilevel analyses revealed that gender and social climate of the school were directly related to victimization. Furthermore, results indicated that peer victimization in boys was less prevalent when they attended smaller schools. In low‐SES neighborhoods victimization scores were significantly lower when schools had implemented clear antibullying policies. Finally, variation among school classes appeared to be strongly associated with victimization, even more so than variation among schools. These findings support broadening the focus beyond the individual child at risk.

Changes in Parenting Self-Efficacy and Mood Symptoms in the Transition to Parenthood: A Bidirectional Association

SYNOPSIS Objective. Anxiety and depressive symptoms are assumed to relate to parenting self-efficacy in the context of changes and adaptations taking place in the transition to parenthood. The aim of this study was to elucidate the direction of effects. Design. Participants were 822 first-time expectant women who filled out questionnaires on depressive and anxiety symptoms and parenting self-efficacy at 32 weeks of pregnancy and at 3 and 12 months postpartum. Results. From 32 weeks of pregnancy to 3 months postpartum, parenting self-efficacy increased, whereas anxiety and depressive symptoms decreased. Multivariate response models showed that higher prenatal parenting self-efficacy was associated with more decreases in anxiety and depressive symptoms; lower prenatal mood symptoms were associated with more increases in parenting self-efficacy to 3 months postpartum. Higher postpartum parenting self-efficacy at 3 months predicted less increase in trait anxiety from 3 to 12 months postpartum. Conclusions. Parenting self-efficacy appears to be a result of mental health and a predictor for the course of mental health in first-time mothers. These results highlight the importance of focusing on both factors for intervention and prevention efforts.

Mediators and Treatment Factors in Intervention for Children Exposed to Interparental Violence.

Changes in childrens emotion differentiation, coping skills, parenting stress, parental psychopathology, and parent–child interaction were explored as mediators of treatment factors in two selective preventive group interventions for children exposed to interparental violence (IPV) and their parents. One hundred thirty-four IPV-exposed children (ages 6–12 years, 52% boys) and their parents were randomized to an IPV-focused or common factors community-based group intervention and completed baseline, posttest, and follow-up assessments for posttraumatic stress (PTS). A multilevel model tested mediators that included childrens ability to differentiate emotions and coping skills, parenting stress, parental psychopathology, and parent–child interactions. In both conditions, exposure to nonspecific factors, specific factors unrelated to IPV and trauma-specific intervention factors was coded from videotaped child and parent sessions. Improved parental mental health mediated the link between greater exposure to nonspecific treatment factors and decreases in PTS symptoms. In addition, an increase in emotion differentiation and a decrease in parenting stress were associated with a decrease in PTS symptoms. Greater exposure to trauma-specific factors in child sessions was associated with a small decrease in emotion differentiation, an increase in coping skills, and a decrease in PTS symptoms over time. Greater exposure to nonspecific treatment factors in child and parent sessions was associated with more positive parent–child interaction. Parental mental health appears to be an important mechanism of change that can be promoted through exposure to nonspecific factors in parent intervention. For children, the effect of greater exposure to trauma-specific factors in intervention is less clear and may not have clear benefits.

Neuroticism and extraversion in relation to physiological stress reactivity during adolescence

The current study examined mean level and change in extraversion and neuroticism across adolescence in relation to physiological stress reactivity to social evaluation. Adolescents (n=327) from the Dutch general population reported on personality measures at five annual assessments. At age 17 years, adolescents participated in a psychosocial stress procedure characterized by social evaluation during which cortisol, heart rate, pre-ejection period (PEP) and heart rate variability were assessed. Dual latent growth curve models were fitted in which the intercepts (mean level) and slopes (change) of personality across adolescence predicted the intercepts (baseline) and slopes (reactivity) of the physiological stress measures. Most comparisons revealed no relation between personality and stress reactivity. Adolescents with higher mean level scores on extraversion did show lower cortisol reactivity. Adolescents with higher mean level neuroticism scores showed higher PEP reactivity. Our findings lend partial support for a relation between personality and physiological stress reactivity.

Social support moderates the effects of stress on sleep in adolescents

Academic expectations and demands become primary sources of stress during adolescence, negatively affecting sleep. To cope with stress, adolescents may turn to social support figures. The present study tested the extent of main and moderating effects of various sources of social support on the association between stress and sleep. Adolescents (n = 202, meanage 14.6 years, standard deviation = 0.71) reported on academic stress, sleep, and support using questionnaires during a low‐ and high‐stress period, defined by the absence or presence of examinations, respectively. Inquiries were made regarding social support from parents, friends, and class supervisor. During both stress periods, academic stress was associated negatively with sleep quality and positively with sleep reduction. Social support increased sleep quality and lowered sleep reduction. In addition, social support moderated the effects of academic stress on sleep, thus improving sleep quality and lowering sleep reduction. Moderating effects were stronger during a period of high stress. The present study showed that adolescents can benefit from stress moderation through social support by improvements of sleep quality and sleep reduction. Such moderating effects should be taken into account when studying stress and sleep. Implications and recommendations based on these findings are discussed.

Physiological reactivity to stress and parental support: comparison of clinical and non‐clinical adolescents

An Alarm Stress Task was developed to study affect regulation in the context of parent-child interactions in adolescents (mean age = 12.72, standard deviation = 2.06) with (n = 20) and without (n = 20) mental health problems. Changes in heart rate (HR), preejection period (PEP) and respiratory sinus arrhythmia (RSA) were used as indicators of affect regulation. HR increased, and PEP and RSA decreased significantly in reaction to a suggested failure on a simple task, indicating that this procedure induced affective arousal in adolescents. During reunion with the parent, RSA increased significantly. Support seeking on reunion was associated with stronger parasympathetic reactivity during stress and reunion, consistent with the model that the parasympathetic system is involved when affect is regulated by social engagement. Quality of parent-adolescent interactive behaviour was overall lower in the clinical sample. Individual and relationship-based processes of affect regulation may be simultaneously assessed, highlighting the continuing importance of the parent-child relationship in adolescence for affect regulation and mental health.