Youth Interventions: Theory, Research, and Practice – Lecture summary (UNIVERSITY OF AMSTERDAM)

This bundle contains all the lectures of the course "Youth Interventions: Theory, Research, and Practice" given at the "University of Amsterdam". All the lectures have the corresponding articles incorporated in there.

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Youth Intervention: Theory, Research, and Practice – Lecture 0 (UNIVERSITY OF AMSTERDAM)

There are several major principles of youth interventions:Children and young people rarely refer themselvesChildren are rarely treated in isolationThere is a chance to intervene earlyThere is almost always a lot of heterogeneityDevelopment has to be taken into account Children not referring themselves leads to problems with client motivation and problem awareness. There are three levels of youth intervention:Universal (i.e. targets whole population)Selective (i.e. targets youth with certain risk)Indicated (i.e. targets youth already showing symptoms).Treatment refers to targeting youth with symptoms at (sub)clinical level or those with a diagnosis. Heterogeneity in complaints exist because of three reasons:There is ongoing development in youth and this makes the complaints more likely to cause problems and more heterogeneous. There are more people involved and this makes complaints more heterogeneous.The DSM criteria are less clear in youth.The question is always where one should intervene when a child presents with complaints. Efficacy refers to whether an intervention works in a controlled, laboratory setting. Effectiveness refers to whether an intervention works in clinical practice. An evidence-based intervention refers to an intervention where there is at least some evidence regarding the efficacy and effectiveness. However, there is no clear guideline for when something is evidence-based as it is a continuum. Most include at least two studies with the following:Careful specification of the patient population.Random assignment of participants to conditions.Use of treatment manuals that document the procedures.Multiple outcome measures including a measure for the disorder.Statistically significant differences between treatment and comparison group after treatment.Replication of outcome effects. There are several ways in which a treatment can be considered well-established:Superiority to placebo or other...

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Youth Intervention: Theory, Research, and Practice – Lecture 1 (UNIVERSITY OF AMSTERDAM)

Children should have at least five symptoms for a period of two weeks including either the first or the second one to be diagnosed with major depressive disorder:Feeling or appearing depressed, sad, tearful, or irritable.Not enjoying things as much as they used to.Changes in appetite and/or weight.Sleeping more or less than usual.Feeling tired or having less energy.Feeling like everything is their fault or not being good at anything.Having more trouble concentrating.Psychomotor retardation or agitation.Having thoughts of suicide or wanting to die.There are also some secondary symptoms:Caring less about school or not doing well at school.School refusal.Spending less time with friends or in after-school activities.Somatic complaints in general.Physical complaints (e.g. headaches; stomach aches) are more common in children. Substance use (e.g. alcohol; drugs) is more common in adolescence. The prevalence of major depressive disorder is 2.8% in school-age children (i.e. 6-12 years) and 5-6% in adolescents (i.e. 13-18 years). However, compared to adults, children and adolescents are still underdiagnosed and undertreated. The general guideline for mild to moderate depression is psychosocial treatment. For severe depression, the guideline is a combination of psychosocial treatments and medication. However, one should be cautious with using medication with children and adolescents as there is an increased suicide risk with medication use. This may be because the medication increases impulsiveness. It should always be used in the context of extensive case conceptualization and in consultancy with a psychiatrist.Beck’s cognitive theory of depression states that depression is the result of negative cognitions. There are automatic negative interpretations of ambiguous situation and cognitive errors (e.g. “bad things happen because of me”). This leads to negative schemes (e.g. “I am unlovable) which leads to depression. The negative...

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Youth Intervention: Theory, Research, and Practice – Lecture 2 (UNIVERSITY OF AMSTERDAM)

There are three learning paths to fear:Modelling (i.e. modelling and positive reward)This holds that fear develops as a result of imitation and stories (i.e. imitation).Classical conditioning (i.e. systematic desensitization)This holds that fear develops through associative learning.Operant conditioning (i.e. exposure)This holds that fear develops through gratification and reward.There are three intervention techniques for anxiety:Cognitive-behavioural therapyModellingExposureThe information processing theory holds that attention, interpretation and memory biases will lead to problematic cognitions. This means that an ambiguous situation (e.g. “seeing children laugh”) could be interpreted negatively (e.g. “they are laughing at me”) and this could lead to a memory bias (e.g. “I only remember people laughing at me when I wore this t-shirt”). All treatment protocols for anxiety treatment starts psychotherapy. Next, the child is prepared for exposure by doing cognitive therapy or relaxation technique. Afterwards, there is conduct of modelling and exposure.Cognitive-behavioural therapy is the most evidence-based prevention and treatment method for anxiety disorders. The recovery rate for anxiety disorders after using CBT is approximately 60%. There are several principles (i.e. steps) of cognitive therapy for anxiety:Cognitive restructuring (e.g. going from anxious thoughts to more healthy, neutral thoughts).Recognize the situation-thought-feeling and registering this.Differentiation between feelings (e.g. fear thermometer).Detecting negative thoughts.Challenging negative thoughts.Formulate helping thoughts (e.g. “I can do it”).Learn to apply thoughts in the form of self-talk when confronting fear objects.The goal of CBT is cognitive restructuring. Children also receive homework in CBT. The situation-thought feeling (the five G’s) is used to give insight for the client and is a tool for the therapist regarding treatment...

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Youth Intervention: Theory, Research, and Practice – Lecture 3 (UNIVERSITY OF AMSTERDAM)

Autism spectrum disorder is characterized by deficits in social communication and restricted, repetitive and/or sensory behaviours or interests. The severity levels should be specified.In the 1970s, only 1.5% of the children with ASD achieved normal functioning. About 35% showed good adjustment but required some degree of supervision. The majority (i.e. 60%) remained severely handicapped. About 50% remained non-verbal throughout their lives. Currently, this is less than 10%. However, ASD does not need to be a life-long disabling condition. About 25% of the children can lose the diagnosis after treatment and most children can achieve positive outcomes with treatment. Children who lose the diagnosis will become similar to typically developing children. There are several criteria for when an intervention is successful:Reduction in symptoms (e.g. less repetitive behaviours).Developmental improvements (e.g. learning to speak).Reduction in problem behaviours (e.g. fewer temper tantrums).Better coping with daily expectations (e.g. attending regular education).However, when an intervention is truly successful depends on the goals of the parents and the child. The intervention should aim to improve on these goals and should thus be matched to their goals. Lovaas’ discrete trial training (DTT) demonstrated that behaviour modification treatment could lead to positive outcomes for children with ASD. This training makes use of operant techniques and breaks skills into small component and teaches the child one component at a time. According to Lovaas, children with ASD are unsuccessful in learning skills from the natural environment and the environment should thus include potent reinforcers and should be simplified. This means that every small step is rewarded. Though the training seems effective, there is a lack of generalization of learned skills (1), it leads to avoidance behaviour (2), there is a lack of spontaneity (3) and there is an...

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Youth Intervention: Theory, Research, and Practice – Lecture 4 (UNIVERSITY OF AMSTERDAM)

There are several guidelines for treating children with ADHD:Always start with psychoeducation.Offer behavioural parent and/or teacher training.Offer medication in severe cases or when the previous interventions were not effective.Behavioural intervention cannot be supported as a front-line treatment for core ADHD symptoms. This is especially the case in studies where the outcomes are blinded. However, parenting practices and conduct problems improve after behavioural interventions and this is often the main reason for referral, meaning that behavioural interventions serve their goal. Improving parents’ behaviour towards their children may improve child behaviour and improve the quality of the parent-child relationship.Children who receive behavioural consultation are less likely to receive medication later that year. If they do receive medication, the dosages are lower compared to children who did not receive behavioural consultation. Using a low-intensity behavioural intervention as a first-line treatment reduces or eliminates the need for medication in children with ADHD. There are several reasons why it is important to reduce the need for medication:Parents prefer non-pharmacological interventions.Medication does not lead to improvement on all domains (i.e. it does not normalize functioning).Medication does not improve outcomes on the long-term.The long-term compliance is low. The long-term safety of medication is unclear.There are frequent side-effects of medication. Adding medication secondary to initial behavioural treatment leads to better outcomes on primary outcomes than the other way around. Parents who began treatment with behavioural parent training had better attendance than those assigned to receive training after medication. The cost of starting with a low-intensity behavioural intervention is also lower. It is thus important to start with behavioural intervention.Behaviour modification is teaches skills to...

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Youth Intervention: Theory, Research, and Practice – Lecture 5 (UNIVERSITY OF AMSTERDAM)

When treating criminals in the past, severe punishments were used. Later, phrenology was used to diagnose people and electro convulsion therapy was used to treat people with a criminal history. Durkheim stated that every society gets the criminality that it deserves. The cost of incarceration is higher than that of rehabilitation. Martinez stated that people who commit crimes should be locked up. According to him, it is impossible to treat criminals. Early (humane) treatment for criminals consisted of CBT. It was focused on treating the symptoms and did not include the families. Static risk factors refer to risk factors that cannot be changed and are fixed. Dynamic risk factors refer to risk factors that are malleable. The interaction between risk and protective factors and the interaction between the individual and the environment is essential for criminality. The age crime curve refers to criminal activity increasing during adolescence and peaking during late adolescence. This could be due to the maturity gap (i.e. a well-developed affective brain circuitry and a less developed prefrontal cortex control centre in the brain, combined with adult responsibilities). The outcome of therapy is influenced by several factors:40% of treatment outcomes is determined by factors outside of therapy (e.g. positive relationship with the partner).30% of treatment outcomes is determined by common elements.15% of treatment outcomes is determined by placebo effects.15% of treatment outcomes is determined by specific methodology. There is a lot of innovation in the therapy of juvenile delinquents. This includes real-time biofeedback treatment and virtual reality treatment. Group therapy consists of treatment of aggression (1), improving social skills (2), making moral choices (3) and help meetings (4). However, it can lead to a lot of peer contagion, making it typically ineffective. There are different forms of systemic treatments:Functional family...

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Youth Intervention: Theory, Research, and Practice – Lecture 6 (UNIVERSITY OF AMSTERDAM)

Traditionally, a specific learning disability (SLD) referred to a discrepancy of one to two standard deviations between intellectual functioning and academic functioning. However, the amount of discrepancy was arbitrary (1), older children were favoured (2), higher IQs were favoured (3) and it was failure-based (4). Currently, the definition holds that achievement in key academic areas is substantially below the age norm and in excess of sensory deficits, linguistic processes, attention and memory. The prevalence is 2 to 10%.Response to intervention (RTI) refers to a tiered system in which a failure to respond to an intervention is the criterium for identification of specific learning disabilities. This indicates the need for more specific and intensive intervention. First, there is screening for risk (e.g. simple tests of basic pre-reading skills) and assessment of family history of reading and language difficulties. After this, there are several tiers:Tier 1 intervention (i.e. trained classroom teachers).This includes assessment and possible modification of the language programme in a classroom to ensure that the instruction is addressing the individual needs of all the children in the classroom. Tier 2 intervention (i.e. additional one-on-one instruction and small groups).This includes a small-group intervention for children whose literacy difficulties are not resolved by appropriate adjustments to the classroom instructional programme.Tier 3 intervention (i.e. special education classroom).This includes a more intensive intervention (e.g. fewer children; daily one-to-one tutoring) for children who continue to perform poorly.In the Netherlands, there are three different but similar tiers:Tier 1This includes a high quality classroom instruction.Tier 2This includes additional teaching in class by teacher or additional instruction by a reading specialist, either individually or in a small group.Tier 3This includes the help of a...

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Youth Intervention: Theory, Research, and Practice – Lecture 7 (UNIVERSITY OF AMSTERDAM)

For a personality disorder to be diagnosed in adolescence, the problems have to be present for a year. There are four main areas of deficit:Affective dysregulationImpulsivityInstable relationshipsIdentity problemsThere are several symptoms of borderline personality disorder (BPD):Chronic feelings of emptiness.Emotional instability in reaction to-day events (e.g. intense episodic sadness) usually lasting a few hours and only rarely more than a few days.Frantic efforts to avoid real or imagined abandonment.Identity disturbance with markedly or persistently unstable self-image or sense of self.Impulsive behaviour in at least to areas that are self-damaging (e.g. spending; sex; substance abuse; reckless driving; binge eating).Inappropriate or intense anger or difficulty controlling anger.Pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation.Recurrent suicidal behaviour, gestures, threats or self-harming behaviour.Transient, stress-related paranoid ideation or severe dissociative symptoms.It is essential to assess how severe the symptoms are. The guidelines for personality disorder are treatment using DBT (1), mentalization-based treatment (2) or schema-focused therapy (3). In dialectical behaviour therapy (DBT) there is a constant search for balance between the different theories on which it is based:Cognitive behavioural therapy (CBT)This includes analysis (1), problem solving (2), gradual exposure (3), skills training (4), contingency management (5) and cognitive modifications (6). MindfulnessThis includes learning to stay still (1), learning to have the mind in the now (2), learning to observe without judgement (3), learning to verbalise (4) and radical acceptance of one’s current situation. It has a focus on acceptance and validation of behaviours as it occurs as well as a focus on relationships and interventions on therapy-interfering behaviour....

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Youth Intervention: Theory, Research, and Practice – Lecture 8 (UNIVERSITY OF AMSTERDAM)

Trauma refers to a normal response to an abnormal event. About 14% of the children exposed to a trauma develop PTSD. The probability of developing PTSD increase the longer and more severe the traumatic events are. PTSD includes several symptoms:Intrusion symptoms (e.g. nightmares; flashbacks)Avoidance behaviourNegative alterations in cognitions and mood (e.g. the world is unsafe)Alterations in arousal and reactivity (e.g. poor concentration)The symptoms need to last for at least a month. For late-onset PTSD, the symptoms need to have an onset of 6 months after the traumatic event. The intrusion symptoms in children are represented in pretend play (e.g. playing the traumatic experience). Regressive behaviour (e.g. going back a developmental step) is common in children with PTSD. There are several risk factors to develop PTSD:Direct exposure to life threats.Being separated from parents during or shortly after the traumatic event.Serious bodily injury.Losing a loved one.Witnessing cruelties or violence.Experiencing the use of weapon.Violation of the physical integrity of a child.A known perpetrator.A negative intention of the perpetrator.There are also several secondary sources of stress as a risk factor:Suffering great material losses.Lack of basic facilities.Moving houses.A shocking event with a long aftermath of stress.Pedagogical shortcomings in parents. There are also several risk factors in children:Level of development.Temperament.Quality of attachment relationships.Guilt about the trauma.Previous traumatic experiences.Existing problems or psychopathology.Strong emotional reaction right after the traumatic event.Ehler and Clarke’s cognitive model of PTSD states that persistent PTSD only occurs if individuals process the traumatic event and/or consequences in a way which produces a sense of serious, current threat. People with persistent PTSD are unable to see the trauma as a time-limited event that...