Marc J. Noom

Conceptual Analysis and Measurement of Adolescent Autonomy

The aim of the present study was to examine the concept of adolescent autonomy. A conceptual analysis of different theoretical perspectives has resulted in an integrative model of attitudinal, emotional, and functional autonomy. Attitudinal autonomy refers to the cognitive process of choosing and defining a goal. Emotional autonomy refers to the affective process of feeling confident about ones own choices and goals. Functional autonomy refers to the regulatory process of developing a strategy to achieve these goals. The empirical value of this model was tested by developing a questionnaire assessing adolescent autonomy. Subjects were 400 adolescents between 12 and 18 years old. Confirmatory factor analyses (LISREL 8) provided evidence for the 3 hypothesized dimensions.

The Relation Between Insecure Attachment and Child Anxiety: A Meta-Analytic Review

Attachment theory suggests that childrens attachment insecurity plays a key role in the development of anxiety. In the present study we evaluated the empirical evidence for the link between insecure attachment and anxiety from early childhood to adolescence. A meta-analysis of 46 studies, from 1984 to 2010, including 8,907 children, was conducted. The results show an overall effect size of r = .30, indicating that attachment is moderately related to anxiety. Moderator analyses indicated that ambivalent attachment showed the strongest association with anxiety. Further, the relation was stronger during adolescence, when attachment and anxiety were measured through questionnaires, when the informant was the child, when attachment was measured as internal working model, in cross-sectional studies, and in studies conducted in Europe. No difference was found between studies that measured anxiety as symptoms or as a disorder, and when different kinds of anxiety were considered.

Self-Efficacy and Emotional Adjustment as Precursors of Smoking in Early Adolescence

The aim of this study was to examine the associations between self-efficacy, emotional adjustment, and smoking in a large sample of early adolescents cross-sectionally and short-term longitudinally. A prospective sample was used consisting of 1861 12–13-year-olds at 11 secondary schools. Questionnaires were administered at baseline and at a follow-up 6 months after the baseline assessment. Findings showed that higher depressive mood, low self-esteem, and low self-efficacy appeared to be related to enhanced levels of smoking in cross-sectional analyses. Short-term longitudinal analyses indicated that depressive mood and self-esteem were only related to the onset of smoking in girls. In three out of four cross-sectional analyses, self-efficacy × emotional adjustment interactions revealed that in particular adolescents with low levels of self-efficacy and low levels of emotional adjustment are likely to smoke.

Feasibility of mentalization-based treatment for adolescents with borderline symptoms: a pilot study.

Mentalization-based treatment (MBT) is an evidence-based treatment for adults suffering from borderline personality disorder. Different adaptations of MBT for adolescents have been described, but almost none of these have been systematically evaluated so far. This article presents pilot data from a feasibility study of an adaptation of inpatient MBT for adolescents with borderline symptoms (MBT-A). Preliminary outcome results were examined in a pilot study including 11 female adolescents (aged 14-18 years) in a mental health care center in the Netherlands. Maximum treatment duration was 12 months and patients were assessed at start and at 12 months after start of treatment. Outcome measures included symptom severity (Brief Symptom Inventory), personality functioning (Severity Indices of Personality Problems), and quality of life (EuroQol). Results showed significant decreases in symptoms, and improvements in personality functioning and quality of life at 12 months after start of treatment. Effect sizes (d) ranged from .58 to 1.46, indicating medium to large effects. In total, 91% of the adolescents showed reliable change on the BSI, and 18% also moved to the functional range on the BSI. The results of this feasibility study are promising and encourage further research concerning the efficacy of MBT in adolescents with borderline symptoms, although some problems with implementation suggest that an outpatient variant of MBT for adolescents might be as effective while at the same time reducing potential iatrogenic effects of inpatient treatment for this age group.

Basic Trust: An Attachment-Oriented Intervention Based on Mind-Mindedness in Adoptive Families

Objectives: We evaluated a new attachment-oriented intervention aimed at improving parental mind-mindedness, promoting positive parent–child relationships, and reducing child psychopathology in families with adopted children. Method: The sample consisted of 20 families with adopted children (2–5 years of age). After the pretest, the intervention was conducted, followed by a posttest, 6 months later. Results: Positive medium-to-large changes between pretest and posttest were found in children’s insecure attachments to their mothers, disorganized attachments to both their parents and conduct problems. Finally, mothers who had spent more time with their adopted children perceived less peer problems in their children after the intervention. Conclusion: Basic Trust is a promising intervention for improving parent–child relationships in adoptive families and decreasing attachment and conduct problems.

Day hospital Mentalization-based treatment versus intensive outpatient Mentalization-based treatment for patients with severe borderline personality disorder: protocol of a multicentre randomized clinical trial

BackgroundBorderline personality disorder (BPD) is associated with a high socioeconomic burden. Although a number of evidence-based treatments for BPD are currently available, they are not widely disseminated; furthermore, there is a need for more research concerning their efficacy and cost-effectiveness. Such knowledge promises to lead to more efficient use of resources, which will facilitate the effective dissemination of these costly treatments. This study focuses on the efficacy and cost-effectiveness of Mentalization-Based Treatment (MBT), a manualized treatment for patients with BPD. Studies to date have either investigated MBT in a day hospitalization setting (MBT-DH) or MBT offered in an intensive outpatient setting (MBT-IOP). No trial has compared the efficacy and cost-effectiveness of these MBT programmes. As both interventions differ considerably in terms of intensity of treatment, and thus potentially in terms of efficacy and cost-effectiveness, there is a need for comparative trials. This study therefore sets out to investigate the efficacy and cost-effectiveness of MBT-DH versus MBT-IOP in patients with BPD. A secondary aim is to investigate the association between baseline measures and outcome, which might improve treatment selection and thus optimize efficacy and cost-effectiveness.Methods/DesignA multicentre randomized controlled trial comparing MBT-DH versus MBT-IOP in severe BPD patients. Patients are screened for BPD using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and are assessed before randomization, at the start of treatment and 6, 12, 18, 24, 30 and 36 months after the start of treatment. Patients who refuse to participate will be offered care as usual in the same treatment centre. The primary outcome measure is symptom severity as measured by the Brief Symptom Inventory. Secondary outcome measures include parasuicidal behaviour, depression, substance use, social, interpersonal, and personality functioning, attachment, mentalizing capacities, and quality of life. All analyses will be conducted based on the intention-to-treat principle. Cost-effectiveness will be calculated based on costs per quality-adjusted life-year.DiscussionThis multisite randomized trial will provide data to refine criteria for treatment selection for severe BPD patients and promises to optimize (cost-)effectiveness of the treatment of BPD patients.Trial registrationNTR2292. Registered 16 April 2010.

Predictors of outcome in outpatients with anxiety disorders: The Leiden routine outcome monitoring study

Little is known about the predictors of outcome in anxiety disorders in naturalistic outpatient settings. We analyzed 2-year follow-up data collected through Routine Outcome Monitoring (ROM) in a naturalistic sample of 917 outpatients in psychiatric specialty care in order to identify factors predicting outcome. We included patients with panic disorder with or without agoraphobia, agoraphobia without panic, social phobia, or generalized anxiety disorder. Main findings from Cox regression analyses demonstrated that several socio-demographic variables (having a non-Dutch ethnicity [HR = 0.71)], not having a daily occupation [HR = 0.76]) and clinical factors (having a diagnosis of agoraphobia [HR = 0.67], high affective lability [HR = 0.80] and behavior problems [HR = 0.84]) decreased chances of response (defined as 50% reduction of anxiety severity) over the period of two years. Living with family had a protective predictive value [HR = 1.41]. These results may imply that factors that could be thought to limit societal participation, are associated with elevated risk of poor outcome. A comprehensive ROM screening process at intake may aid clinicians in the identification of patients at risk of chronicity.

Psychotic-like symptoms as a risk factor of violent recidivism in detained male adolescents

Abstract The aim of this study was to prospectively examine whether psychotic-like symptoms (PLSs) are positively associated with violent recidivism and whether this relation is stronger when PLSs co-occur with substance use disorders (SUDs). Participants were 224 detained male adolescents from all youth detention centers in Flanders. The Diagnostic Interview Schedule for Children was used to assess PLSs and the number of SUDs. Two to 4 years later, information on official recidivism was obtained. Although hallucinations were unrelated to violent recidivism, paranoid delusions (PDs) and threat/control override delusions (TCODs) were negatively related to violent recidivism. The relation between PLSs and violent recidivism did not become stronger in the presence of SUDs. Detained youths with PLSs do not have a higher risk for violent recidivism than detained youths without PLSs. In contrast, by identifying detained youths with PDs or TCODs, clinicians are likely to identify youths with a low risk for future violent crimes.

Betrokken ouders verbeteren de hulpverlening: Een onderzoek naar nieuw residentieel zorgaanbod

SamenvattingDe effectiviteit van de jeugdzorg is voor verbetering vatbaar. Zo wordt er nog weinig gewerkt met bewezen effectieve methodieken. Er is echter discussie over de vraag of de invoering van dergelijke methodieken zal leiden tot verbetering; vaak wordt gesteld dat algemeen werkzame factoren belangrijker zijn. Een studie van het Nederlands Jeugdinstituut laat zien dat de rol van algemeen werkzame factoren en specifieke methodieken nog onvoldoende is ontrafeld. Het beeld dat algemeen werkzame factoren belangrijker zijn, is gebaseerd op schattingen en op in het verleden behaalde resultaten. Er zijn aardig wat aanwijzingen dat specifieke methodieken wel degelijk nut hebben. Zaak dus om er meer mee te werken.

Introduction to the special section on child and adolescent psychotherapy research

Anna Freud National Centre for Children and Families, London, UK; Psychology Department, Universidad de Chile, Santiago, Chile; Clinical Psychology Doctoral Program, Long Island University, Brooklyn, NY, USA; Department of Developmental Psychology and Socialisation, University of Padua, Padova, Italy; Department of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands; School of Social Work Mount Scopus Campus Jerusalem, Hebrew University, Jerusalem, Israel & Child and Adolescent Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany