Deze longitudinale studie onderzocht in welke mate huwelijksstress en externaliserend probleemged... more Deze longitudinale studie onderzocht in welke mate huwelijksstress en externaliserend probleemgedrag van jongeren zich in samenhang ontwikkelen en in hoeverre ouderlijke competentiebeleving een verklarende rol speelt in deze samenhang. Moeders en vaders van 369 gezinnen (46,1 % jongens, MleeftijdT1 = 7,7 jaar) vulden drie maal vragenlijsten in (2001, 2007, 2009). De resultaten lieten allereerst zien dat een sterkere daling van huwelijksstress in de loop van acht jaar samenhing met een sterkere daling van externaliserend probleemgedrag. Ten tweede werd de mediërende rol van competentiegevoelens niet bevestigd. Ten derde was meer huwelijksstress gerelateerd aan een lagere competentiebeleving en hing, andersom, een lagere competentiebeleving samen met meer huwelijksstress, in de loop van zes jaar. Tot slot was meer externaliserend probleemgedrag gerelateerd aan meer huwelijksstress en een lagere ouderlijke competentiebeleving tijdens de adolescentie. Verbanden waren analoog voor moeders en vaders. Resultaten bevestigen dat gezinsinterventies gericht op het versterken van ouderlijke competentiegevoelens en opvoedgedrag aandacht zouden moeten besteden aan steun en stress in de huwelijksrelatie.
Background: Home visiting programs are widely endorsed for preventing child maltreatment. Yet, kn... more Background: Home visiting programs are widely endorsed for preventing child maltreatment. Yet, knowledge is lacking on what and how individual program components are related to the effectiveness of these programs. Objective: The aim of this meta-analysis was to increase this knowledge by summarizing findings on effects of home visiting programs on child maltreatment and by examining potential moderators of this effect, including a range of program components and delivery techniques. Methods: A literature search yielded 77 studies (N=48,761) examining the effectiveness of home visiting programs, producing 174 effect sizes. In total, 35 different program components and delivery techniques were coded. Results: A small but significant overall effect was found (d=0.135, 95 % CI (0.084, 0.187), p<0.001). Programs that focused on improving parental expectations of the child or parenthood in general (d = 0.308 for programs with this component versus d = 0.112 for programs without this component), programs targeting parental responsiveness or sensitivity to a child's needs (d = 0.238 versus d = 0.064), and programs using video-based feedback (d = 0.397 versus d = 0.124) yielded relatively larger effects. Providing practical and instrumental assistance was negatively associated with program effectiveness (d=0.044 versus d = 0.168). Further, program effects were larger when percentages of non-Caucasians/non-Whites in samples and follow-up durations increased. Conclusions: In general, home visiting programs can prevent child maltreatment only to a small extent. However, implementing specific components and techniques can improve program effectiveness.
Longitudinal effects of parental and child personality characteristics on parenting １ This study ... more Longitudinal effects of parental and child personality characteristics on parenting １ This study examined which parent and adolescent Big Five characteristics were related to parenting. Mothers (N = 467) and fathers (N = 428) reported on their personality using the Five Factor Personality Inventory, adolescents (N = 475) assessed their personality with the Hierarchical Personality Inventory for Children. Two types of parenting, overreactive discipline and warmth, were assessed two years later by parent self-reports, partner-reports and adolescent-reports, from which multi-informant factors were created. Results indicate that parental personality was more relevant for predicting overreactivity, and parent and adolescent personality were similarly relevant for predicting warmth. Associations were mostly similar for mothers and fathers of daughters and sons. Particularly parent and adolescent agreeableness, parent emotional stability, and adolescent extraversion were important predictors for both parenting behaviors. This knowledge about the individual characteristics that explain why parents parent the way they do can help the development of effective, individualized parenting interventions.
The aim of the current meta-analysis was to aggregate concurrent and longitudinal empirical resea... more The aim of the current meta-analysis was to aggregate concurrent and longitudinal empirical research on associations between the interparental relationship and both children's maladjustment (i.e., externalizing and internalizing symptoms) and children's responses to interparental conflict (i.e., emotional, behavioral, cognitive, and physiological). Based on major theoretical frameworks, we distinguished between six dimensions of the interparental relationship: relationship quality, conflict frequency, hostile, disengaged, and unconstructive forms of conflict, and child-related conflict. A final selection of 169 studies for child maladjustment and 61 studies for child responses to conflict were included. The findings revealed by the expansive and fine-grained approach of this meta-analysis support and challenge theoretical hypotheses about the relative predictive value of dimensions of the interparental relationship for children's functioning. Although hostility was specifically more strongly associated with children's externalizing behavior and emotional responses to conflict, disengaged and unconstructive conflict behavior posed similar risks for the other domains of child functioning. In addition, relationship quality, conflict frequency, and child-related conflict warrant more attention in theoretical frameworks, as these dimensions posed similar risks to child functioning as the different forms of conflict. Moreover, most associations between the interparental relationship and child functioning endured over time. Also, developmental and gender differences appeared to depend on the specific forms of interparental conflict and the domain of child functioning. In sum, the results support the growing consensus that prevention and intervention programs aimed at children's mental health could benefit from an alternative or additional focus on the interparental relationship. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
The aim of the study was to map clinical patterns of dystonia and choreoathetosis and to assess t... more The aim of the study was to map clinical patterns of dystonia and choreoathetosis and to assess the relation between functional classifications and basal ganglia and thalamus lesions in participants with dyskinetic cerebral palsy (CP). METHODS In this cross-sectional study, 55 participants with dyskinetic CP (mean age 14y 6mo, SD 4y 1mo; range 6-22y) were assessed with the Dyskinesia Impairment Scale and classified with the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS). RESULTS Dystonia and choreoathetosis are simultaneously present. Median levels of dystonia (70.2%) were significantly higher than levels of choreoathetosis (26.7%) and both were significantly higher during activity than at rest (both p<0.01). High correlations were found between dystonia levels and GMFCS level (Spearman's rank correlation coefficient, r S =0.70; 95% confidence interval [CI] 0.53-0.81; p<0.01) and MACS (r S =0.65; 95% CI 0.47-0.81; p<0.01), and fair correlation with CFCS (r s =0.36; 95% CI=0.11-0.57; p<0.05). No significant correlation was found between choreoathetosis levels and motor classifications. Finally, higher choreoathetosis levels were found in participants with pure thalamus and basal ganglia lesions (p=0.03) than mixed lesions, but not for dystonia (p=0.41). INTERPRETATION Dystonia and choreoathetosis increase during activity. However, dystonia predominates and seems to have a larger impact on functional abilities. Our findings further suggest that choreoathetosis seems to be more linked to pure thalamus and basal ganglia lesions than dystonia.
Eating problems, such as food selectivity or picky eating, are thought to be an epiphenomenon of ... more Eating problems, such as food selectivity or picky eating, are thought to be an epiphenomenon of autism spectrum disorders (ASD). Yet eating problems are also common in the general pediatric population and overlap with ASD symptoms. However, the temporal association between ASD symptoms and eating problems is poorly understood. This study examines the bidirectional association between ASD symptoms and eating problems across child development, and investigates whether these associations differ by child sex. Participants (N = 4,930) were from the population-based Generation R Study. Parents reported their child's ASD symptoms and eating problems using the Child Behavior Checklist at 5 assessments from toddlerhood to adolescence (1.5 to 14 years, 50% girls). A Random Intercept Cross-Lagged Panel Model was used to examine the lagged associations between ASD symptoms and eating problems at the within-person level, controlling for stable, trait-like differences at the between-person l...
Background & aims: Children with cerebral palsy (CP) are at risk for under-nutrition. The Europea... more Background & aims: Children with cerebral palsy (CP) are at risk for under-nutrition. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines identified anthropometric nutritional red flags for neurologically impaired children: weight for age z-score (WFA) < À2, triceps skinfold (TSF) or arm muscle area (AMA) < 10th centile and faltering weight. This study aimed to (1) evaluate the nutritional status of Flemish children and adolescents with CP using different anthropometric indicators; (2) assess the prevalence of nutritional red flags and (3) identify risk factors for low anthropometric parameters. Methods: This study was a prospective, longitudinal observational study recruiting children and adolescents with CP (2e20 years) in 9 specialized Flemish centres. Measurements were performed at baseline (t 1 , n ¼ 325), after 6 (t 2 , total n ¼ 268) and 12 months (t 3 , total n ¼ 191). WFA z-scores were based on Flemish growth charts; TSF, subscapular skinfolds (SSF) and AMA compared with US reference data. Weight faltering was defined as !0.5 decrease in weight SDS at t 2 or t 3. Results: At t 1 50 patients (15.4%) were classified as gross motor function classification system (GMFCS) 1, 95 (29.2%) as GMFCS 2, 49 (15.1%) as GMFCS 3, 54 (16.6%) as GMFCS 4, and 77 (23.7%) as GMFCS 5. The overall median (Q1; Q3) age was 11.7 (8.2; 15.9) years; 61.5% were boys and 22 (6.8%) had a gastrostomy (17 (22.1%) of GMFCS 5 group). The median (Q1; Q3) WFA z-score was À1.13 (À2.6; À0.1); 71.4% of the GMFCS 5 children had a WFA z-score < À2. The median (Q1; Q3) MUAC z-score was 0.17 (À0.7; 1.0); 16.9% of the GFMCS 5 children had MUAC z-score < À2. Median (Q1; Q3) TSF and SSF z-scores were respectively À0.01 (À0.8; 0.9) and 0.27 (À0.3; 0.9). All anthropometric indices tended to decrease with increasing GMFCS (p < 0.001). At t 1 42.1% had at least one nutritional red flag, at t 2 40.3% and at t 3 41.4%. Of those with at least one nutritional red flag at t 1 or t 2 , respectively 14.7% and 18.8% suffered weight loss 6 months later. A GMFCS >2 and dysphagia were associated with a higher risk for lower scores of nearly all nutritional indices. Conclusions: Underweight was detected in almost three quarters of CP patients with GMFCS 5 classification, whereas deficits in subcutaneous fat and arm muscle reserve were observed in one fifth. Nutritional red flags, present in about 40% of the Flemish CP children, were apparently not successfully addressed in clinical practice, since up to one-fifth of CP patients with warning signs lost even further weight in the following 6 months. Beside a GMFCS >2, dysphagia was one of the most common conditions influencing the presence of low nutritional indices.
Journal of the American Academy of Child & Adolescent Psychiatry, 2018
High co-occurrence of externalizing and internalizing problems may underlie inconsistent findings... more High co-occurrence of externalizing and internalizing problems may underlie inconsistent findings regarding the relation between heart rate and psychopathology. In this study, heart rate measures are examined in relation to a general dysregulation profile, studied from both a variable-and person-centered approach. Method: The sample (N = 182) consisted of 8-12-year-old children referred for externalizing behaviors and typically-developing children (M age = 9.70, SD = 1.26, 75.8% boys). Resting heart rate (HR rest) was assessed during a 3-minute resting period. Heart rate reactivity (HR reactivity) was assessed during an emotionally evoking Go/No-Go task. Results: From a variable-centered approach, a bifactor model was fitted with a general factor of dysregulation underlying symptoms of anxiety/depression, aggression and attention problems. HR rest was positively associated with dysregulation and specific aggression. From a personcentered approach, a latent profile analysis was used to identify different psychopathology classes: normative (n = 92), predominantly-aggressive (n = 69) and dysregulated (n = 14). The latter was characterized by co-occurring elevated levels of anxiety/depression, aggression and attention problems. HR rest was elevated in the predominantly-aggressive class and HR reactivity was elevated in the dysregulated class. Conclusions: High HR rest , or (trait-like) overarousal seems to be associated with dysregulation rather than uniquely with low externalizing or high internalizing symptomatology. Additionally, HR rest predicted higher aggression and HR rest was elevated in the predominantly-aggressive class. High HR reactivity , or enhanced emotional reactivity, might be characteristic for a clinically relevant dysregulated subgroup. Assessment of heart rate could provide additional knowledge on individual differences that can help refine diagnostics and intervention efforts.
Social Psychiatry and Psychiatric Epidemiology, Sep 22, 2020
Purpose A vast amount of studies suggest that internalizing or externalizing problems are related... more Purpose A vast amount of studies suggest that internalizing or externalizing problems are related to individual functioning, and often co-occur. Yet, a focus on their additive and interactive effects is scarce. Furthermore, most research has focused on a limited number of developmental domains and mostly on maladaptive functioning. Therefore, the current prospective study examined whether early childhood (ages 4-8) internalizing and externalizing problems and their interaction were related to a broad range of (mal)adaptive functioning outcomes in emerging adulthood (ages 20-24). Methods Data from the Flemish Study on Parenting, Personality and Development were used. At Time 1 (1999) mothers of 374 children (45% boys) and fathers of 357 children (46% boys) rated internalizing and externalizing problems through the Child Behavior Checklist. Outcomes in emerging adulthood were measured through self-reports 16 years later across the following domains: psychological functioning, social functioning, work, physical health, and self-concept. Results Early externalizing problems were related to maladaptive outcomes on the psychological and social domains. With regard to adaptive functioning, externalizing problems were associated with lower satisfaction regarding general health on the physical domain. Early internalizing problems were not associated with any emerging adulthood outcomes. The interaction of (father reported) internalizing and externalizing problems was related to aggressive behavior. Conclusion Early childhood externalizing problems were associated with maladaptive and adaptive functioning over a time span of 16 years. The results add to studies on the implementation of prevention and intervention programs in early childhood and to the value for developing personalized interventions.
Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 2017
Background: The Dimensional Assessment of Personality Pathology-Short Form for Adolescents (DAPP-... more Background: The Dimensional Assessment of Personality Pathology-Short Form for Adolescents (DAPP-SF-A) is an ageadapted version of the DAPP Basic Questionnaire (DAPP-BQ). The psychometric properties of this questionnaire were established by Tromp and Koot. However, norming data are currently available exclusively for Dutch adolescents. Objective: The main aim of this study was to provide community-based norming data for the DAPP-SF-A in Flemish adolescents and separately for boys and girls. The second aim was to compare the Flemish norms with the Dutch norms. Method: The sample consisted of 425 adolescents (52% girls), aged 16 to 21 years (mean, 18.6; SD, 1.16), from the general Flemish population. In 2012, all respondents completed the DAPP-SF-A and the Youth Self-Report as a part of the longitudinal Flemish Study on Parenting, Personality, and Development. Results: Internal consistency reliabilities of the lower-order dimensions were acceptable to good (α ranged from 0.71 to 0.87, median=0.85, mean item-rest correlations ranged from 0.44 to 0.67). The lower-order dimensions showed distinctive mean patterns for boys and girls, with higher scores for girls on Affective Instability and Insecure Attachment [effect sizes (d) were both 0.35] and higher scores for boys on all lower-order dimensions of Dissocial Behavior, Inhibitedness, and three lowerorder dimensions of Emotional Dysregulation (d ranged from 0.21 to 0.79). The comparison of the Flemish scores with the Dutch scores showed substantial inter-cultural differences (d ranged from 0.13 to 1.78). Conclusions: The DAPP-SF-A shows satisfactory reliability in a Flemish community-based sample of adolescents. Furthermore, given the differences between boys and girls, the use of gender-based norms seems appropriate. Finally, substantial differences with the Dutch general population norms warrant the use of separate norms in Flemish adolescents.
Deze longitudinale studie onderzocht in welke mate huwelijksstress en externaliserend probleemged... more Deze longitudinale studie onderzocht in welke mate huwelijksstress en externaliserend probleemgedrag van jongeren zich in samenhang ontwikkelen en in hoeverre ouderlijke competentiebeleving een verklarende rol speelt in deze samenhang. Moeders en vaders van 369 gezinnen (46,1 % jongens, MleeftijdT1 = 7,7 jaar) vulden drie maal vragenlijsten in (2001, 2007, 2009). De resultaten lieten allereerst zien dat een sterkere daling van huwelijksstress in de loop van acht jaar samenhing met een sterkere daling van externaliserend probleemgedrag. Ten tweede werd de mediërende rol van competentiegevoelens niet bevestigd. Ten derde was meer huwelijksstress gerelateerd aan een lagere competentiebeleving en hing, andersom, een lagere competentiebeleving samen met meer huwelijksstress, in de loop van zes jaar. Tot slot was meer externaliserend probleemgedrag gerelateerd aan meer huwelijksstress en een lagere ouderlijke competentiebeleving tijdens de adolescentie. Verbanden waren analoog voor moeders en vaders. Resultaten bevestigen dat gezinsinterventies gericht op het versterken van ouderlijke competentiegevoelens en opvoedgedrag aandacht zouden moeten besteden aan steun en stress in de huwelijksrelatie.
Background: Home visiting programs are widely endorsed for preventing child maltreatment. Yet, kn... more Background: Home visiting programs are widely endorsed for preventing child maltreatment. Yet, knowledge is lacking on what and how individual program components are related to the effectiveness of these programs. Objective: The aim of this meta-analysis was to increase this knowledge by summarizing findings on effects of home visiting programs on child maltreatment and by examining potential moderators of this effect, including a range of program components and delivery techniques. Methods: A literature search yielded 77 studies (N=48,761) examining the effectiveness of home visiting programs, producing 174 effect sizes. In total, 35 different program components and delivery techniques were coded. Results: A small but significant overall effect was found (d=0.135, 95 % CI (0.084, 0.187), p<0.001). Programs that focused on improving parental expectations of the child or parenthood in general (d = 0.308 for programs with this component versus d = 0.112 for programs without this component), programs targeting parental responsiveness or sensitivity to a child's needs (d = 0.238 versus d = 0.064), and programs using video-based feedback (d = 0.397 versus d = 0.124) yielded relatively larger effects. Providing practical and instrumental assistance was negatively associated with program effectiveness (d=0.044 versus d = 0.168). Further, program effects were larger when percentages of non-Caucasians/non-Whites in samples and follow-up durations increased. Conclusions: In general, home visiting programs can prevent child maltreatment only to a small extent. However, implementing specific components and techniques can improve program effectiveness.
Longitudinal effects of parental and child personality characteristics on parenting １ This study ... more Longitudinal effects of parental and child personality characteristics on parenting １ This study examined which parent and adolescent Big Five characteristics were related to parenting. Mothers (N = 467) and fathers (N = 428) reported on their personality using the Five Factor Personality Inventory, adolescents (N = 475) assessed their personality with the Hierarchical Personality Inventory for Children. Two types of parenting, overreactive discipline and warmth, were assessed two years later by parent self-reports, partner-reports and adolescent-reports, from which multi-informant factors were created. Results indicate that parental personality was more relevant for predicting overreactivity, and parent and adolescent personality were similarly relevant for predicting warmth. Associations were mostly similar for mothers and fathers of daughters and sons. Particularly parent and adolescent agreeableness, parent emotional stability, and adolescent extraversion were important predictors for both parenting behaviors. This knowledge about the individual characteristics that explain why parents parent the way they do can help the development of effective, individualized parenting interventions.
The aim of the current meta-analysis was to aggregate concurrent and longitudinal empirical resea... more The aim of the current meta-analysis was to aggregate concurrent and longitudinal empirical research on associations between the interparental relationship and both children's maladjustment (i.e., externalizing and internalizing symptoms) and children's responses to interparental conflict (i.e., emotional, behavioral, cognitive, and physiological). Based on major theoretical frameworks, we distinguished between six dimensions of the interparental relationship: relationship quality, conflict frequency, hostile, disengaged, and unconstructive forms of conflict, and child-related conflict. A final selection of 169 studies for child maladjustment and 61 studies for child responses to conflict were included. The findings revealed by the expansive and fine-grained approach of this meta-analysis support and challenge theoretical hypotheses about the relative predictive value of dimensions of the interparental relationship for children's functioning. Although hostility was specifically more strongly associated with children's externalizing behavior and emotional responses to conflict, disengaged and unconstructive conflict behavior posed similar risks for the other domains of child functioning. In addition, relationship quality, conflict frequency, and child-related conflict warrant more attention in theoretical frameworks, as these dimensions posed similar risks to child functioning as the different forms of conflict. Moreover, most associations between the interparental relationship and child functioning endured over time. Also, developmental and gender differences appeared to depend on the specific forms of interparental conflict and the domain of child functioning. In sum, the results support the growing consensus that prevention and intervention programs aimed at children's mental health could benefit from an alternative or additional focus on the interparental relationship. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
The aim of the study was to map clinical patterns of dystonia and choreoathetosis and to assess t... more The aim of the study was to map clinical patterns of dystonia and choreoathetosis and to assess the relation between functional classifications and basal ganglia and thalamus lesions in participants with dyskinetic cerebral palsy (CP). METHODS In this cross-sectional study, 55 participants with dyskinetic CP (mean age 14y 6mo, SD 4y 1mo; range 6-22y) were assessed with the Dyskinesia Impairment Scale and classified with the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS). RESULTS Dystonia and choreoathetosis are simultaneously present. Median levels of dystonia (70.2%) were significantly higher than levels of choreoathetosis (26.7%) and both were significantly higher during activity than at rest (both p<0.01). High correlations were found between dystonia levels and GMFCS level (Spearman's rank correlation coefficient, r S =0.70; 95% confidence interval [CI] 0.53-0.81; p<0.01) and MACS (r S =0.65; 95% CI 0.47-0.81; p<0.01), and fair correlation with CFCS (r s =0.36; 95% CI=0.11-0.57; p<0.05). No significant correlation was found between choreoathetosis levels and motor classifications. Finally, higher choreoathetosis levels were found in participants with pure thalamus and basal ganglia lesions (p=0.03) than mixed lesions, but not for dystonia (p=0.41). INTERPRETATION Dystonia and choreoathetosis increase during activity. However, dystonia predominates and seems to have a larger impact on functional abilities. Our findings further suggest that choreoathetosis seems to be more linked to pure thalamus and basal ganglia lesions than dystonia.
Eating problems, such as food selectivity or picky eating, are thought to be an epiphenomenon of ... more Eating problems, such as food selectivity or picky eating, are thought to be an epiphenomenon of autism spectrum disorders (ASD). Yet eating problems are also common in the general pediatric population and overlap with ASD symptoms. However, the temporal association between ASD symptoms and eating problems is poorly understood. This study examines the bidirectional association between ASD symptoms and eating problems across child development, and investigates whether these associations differ by child sex. Participants (N = 4,930) were from the population-based Generation R Study. Parents reported their child's ASD symptoms and eating problems using the Child Behavior Checklist at 5 assessments from toddlerhood to adolescence (1.5 to 14 years, 50% girls). A Random Intercept Cross-Lagged Panel Model was used to examine the lagged associations between ASD symptoms and eating problems at the within-person level, controlling for stable, trait-like differences at the between-person l...
Background & aims: Children with cerebral palsy (CP) are at risk for under-nutrition. The Europea... more Background & aims: Children with cerebral palsy (CP) are at risk for under-nutrition. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines identified anthropometric nutritional red flags for neurologically impaired children: weight for age z-score (WFA) < À2, triceps skinfold (TSF) or arm muscle area (AMA) < 10th centile and faltering weight. This study aimed to (1) evaluate the nutritional status of Flemish children and adolescents with CP using different anthropometric indicators; (2) assess the prevalence of nutritional red flags and (3) identify risk factors for low anthropometric parameters. Methods: This study was a prospective, longitudinal observational study recruiting children and adolescents with CP (2e20 years) in 9 specialized Flemish centres. Measurements were performed at baseline (t 1 , n ¼ 325), after 6 (t 2 , total n ¼ 268) and 12 months (t 3 , total n ¼ 191). WFA z-scores were based on Flemish growth charts; TSF, subscapular skinfolds (SSF) and AMA compared with US reference data. Weight faltering was defined as !0.5 decrease in weight SDS at t 2 or t 3. Results: At t 1 50 patients (15.4%) were classified as gross motor function classification system (GMFCS) 1, 95 (29.2%) as GMFCS 2, 49 (15.1%) as GMFCS 3, 54 (16.6%) as GMFCS 4, and 77 (23.7%) as GMFCS 5. The overall median (Q1; Q3) age was 11.7 (8.2; 15.9) years; 61.5% were boys and 22 (6.8%) had a gastrostomy (17 (22.1%) of GMFCS 5 group). The median (Q1; Q3) WFA z-score was À1.13 (À2.6; À0.1); 71.4% of the GMFCS 5 children had a WFA z-score < À2. The median (Q1; Q3) MUAC z-score was 0.17 (À0.7; 1.0); 16.9% of the GFMCS 5 children had MUAC z-score < À2. Median (Q1; Q3) TSF and SSF z-scores were respectively À0.01 (À0.8; 0.9) and 0.27 (À0.3; 0.9). All anthropometric indices tended to decrease with increasing GMFCS (p < 0.001). At t 1 42.1% had at least one nutritional red flag, at t 2 40.3% and at t 3 41.4%. Of those with at least one nutritional red flag at t 1 or t 2 , respectively 14.7% and 18.8% suffered weight loss 6 months later. A GMFCS >2 and dysphagia were associated with a higher risk for lower scores of nearly all nutritional indices. Conclusions: Underweight was detected in almost three quarters of CP patients with GMFCS 5 classification, whereas deficits in subcutaneous fat and arm muscle reserve were observed in one fifth. Nutritional red flags, present in about 40% of the Flemish CP children, were apparently not successfully addressed in clinical practice, since up to one-fifth of CP patients with warning signs lost even further weight in the following 6 months. Beside a GMFCS >2, dysphagia was one of the most common conditions influencing the presence of low nutritional indices.
Journal of the American Academy of Child & Adolescent Psychiatry, 2018
High co-occurrence of externalizing and internalizing problems may underlie inconsistent findings... more High co-occurrence of externalizing and internalizing problems may underlie inconsistent findings regarding the relation between heart rate and psychopathology. In this study, heart rate measures are examined in relation to a general dysregulation profile, studied from both a variable-and person-centered approach. Method: The sample (N = 182) consisted of 8-12-year-old children referred for externalizing behaviors and typically-developing children (M age = 9.70, SD = 1.26, 75.8% boys). Resting heart rate (HR rest) was assessed during a 3-minute resting period. Heart rate reactivity (HR reactivity) was assessed during an emotionally evoking Go/No-Go task. Results: From a variable-centered approach, a bifactor model was fitted with a general factor of dysregulation underlying symptoms of anxiety/depression, aggression and attention problems. HR rest was positively associated with dysregulation and specific aggression. From a personcentered approach, a latent profile analysis was used to identify different psychopathology classes: normative (n = 92), predominantly-aggressive (n = 69) and dysregulated (n = 14). The latter was characterized by co-occurring elevated levels of anxiety/depression, aggression and attention problems. HR rest was elevated in the predominantly-aggressive class and HR reactivity was elevated in the dysregulated class. Conclusions: High HR rest , or (trait-like) overarousal seems to be associated with dysregulation rather than uniquely with low externalizing or high internalizing symptomatology. Additionally, HR rest predicted higher aggression and HR rest was elevated in the predominantly-aggressive class. High HR reactivity , or enhanced emotional reactivity, might be characteristic for a clinically relevant dysregulated subgroup. Assessment of heart rate could provide additional knowledge on individual differences that can help refine diagnostics and intervention efforts.
Social Psychiatry and Psychiatric Epidemiology, Sep 22, 2020
Purpose A vast amount of studies suggest that internalizing or externalizing problems are related... more Purpose A vast amount of studies suggest that internalizing or externalizing problems are related to individual functioning, and often co-occur. Yet, a focus on their additive and interactive effects is scarce. Furthermore, most research has focused on a limited number of developmental domains and mostly on maladaptive functioning. Therefore, the current prospective study examined whether early childhood (ages 4-8) internalizing and externalizing problems and their interaction were related to a broad range of (mal)adaptive functioning outcomes in emerging adulthood (ages 20-24). Methods Data from the Flemish Study on Parenting, Personality and Development were used. At Time 1 (1999) mothers of 374 children (45% boys) and fathers of 357 children (46% boys) rated internalizing and externalizing problems through the Child Behavior Checklist. Outcomes in emerging adulthood were measured through self-reports 16 years later across the following domains: psychological functioning, social functioning, work, physical health, and self-concept. Results Early externalizing problems were related to maladaptive outcomes on the psychological and social domains. With regard to adaptive functioning, externalizing problems were associated with lower satisfaction regarding general health on the physical domain. Early internalizing problems were not associated with any emerging adulthood outcomes. The interaction of (father reported) internalizing and externalizing problems was related to aggressive behavior. Conclusion Early childhood externalizing problems were associated with maladaptive and adaptive functioning over a time span of 16 years. The results add to studies on the implementation of prevention and intervention programs in early childhood and to the value for developing personalized interventions.
Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 2017
Background: The Dimensional Assessment of Personality Pathology-Short Form for Adolescents (DAPP-... more Background: The Dimensional Assessment of Personality Pathology-Short Form for Adolescents (DAPP-SF-A) is an ageadapted version of the DAPP Basic Questionnaire (DAPP-BQ). The psychometric properties of this questionnaire were established by Tromp and Koot. However, norming data are currently available exclusively for Dutch adolescents. Objective: The main aim of this study was to provide community-based norming data for the DAPP-SF-A in Flemish adolescents and separately for boys and girls. The second aim was to compare the Flemish norms with the Dutch norms. Method: The sample consisted of 425 adolescents (52% girls), aged 16 to 21 years (mean, 18.6; SD, 1.16), from the general Flemish population. In 2012, all respondents completed the DAPP-SF-A and the Youth Self-Report as a part of the longitudinal Flemish Study on Parenting, Personality, and Development. Results: Internal consistency reliabilities of the lower-order dimensions were acceptable to good (α ranged from 0.71 to 0.87, median=0.85, mean item-rest correlations ranged from 0.44 to 0.67). The lower-order dimensions showed distinctive mean patterns for boys and girls, with higher scores for girls on Affective Instability and Insecure Attachment [effect sizes (d) were both 0.35] and higher scores for boys on all lower-order dimensions of Dissocial Behavior, Inhibitedness, and three lowerorder dimensions of Emotional Dysregulation (d ranged from 0.21 to 0.79). The comparison of the Flemish scores with the Dutch scores showed substantial inter-cultural differences (d ranged from 0.13 to 1.78). Conclusions: The DAPP-SF-A shows satisfactory reliability in a Flemish community-based sample of adolescents. Furthermore, given the differences between boys and girls, the use of gender-based norms seems appropriate. Finally, substantial differences with the Dutch general population norms warrant the use of separate norms in Flemish adolescents.
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Papers by peter prinzie