This thesis describes an experimental study with a between-subjects and within-subjects design on the possibility to train inferential skills by using expository video. Over the past years the...Show moreThis thesis describes an experimental study with a between-subjects and within-subjects design on the possibility to train inferential skills by using expository video. Over the past years the level of reading comprehension among Dutch students decreases. A low motivation may perhaps explain this downward trend. One way to increase the motivation of Dutch students could be by using digital resources. Inferential skills are crucial during reading to create a mental representation of the text. This is an important part of reading comprehension. This research focusses on the progression in inferential skills of students, when these skills are taught using expository video. The progression made is compared to the progression in inferential skills of students who were taught inferential skills using expository text, and students in the control condition. Furthermore, the relation between this progression and the level of reading fluency was studied. Participants were 105 Dutch student (age 8 to 11 years) in grade six from four different primary schools. They were randomly assigned to one of the conditions, namely video condition, text condition and control condition, where they received either eight trainings with expository video or text, or no training at all. The inferential skills of all participants were tested using a pretest and a posttest, before and after the training was given. Results show that the training, either with expository video or text, is not effective in teaching inferential skills to Dutch students in grade six. In addition was the level of reading fluency not related to the effectivity of the training with expository video or text.Show less
Background: Childhood emotional maltreatment by a primary caregiver is a key predictor for PTSD symptoms, yet limited research explores connections with specific symptoms, especially in children....Show moreBackground: Childhood emotional maltreatment by a primary caregiver is a key predictor for PTSD symptoms, yet limited research explores connections with specific symptoms, especially in children. Literature reports gender differences on emotional maltreatment and the experience of PTSD, so it is worth investigating the existence of differences when looking at separate symptoms. Objective: This study aims to investigate the correlation between childhood emotional maltreatment and PTSD symptomatology and identify gender differences in children and adolescents. Method: A sample of 237 children (mean age 15.5) with PTSD symptoms from a Dutch mental health institution (2012-2015) underwent assessment using anonymous questionnaires. Network analysis examined partial correlations between emotional abuse, neglect, intrusions, avoidance, arousal, and negative mood. Results: The network analysis showed a high correlation between emotional abuse and most PTSD symptoms. However, emotional neglect only exhibited a strong association with emotional abuse. Gender differences in how emotional maltreatment and PTSD symptoms interacted were found. Girls reported higher PTSD symptoms and emotional maltreatment than boys. Conclusions: This study highlights the important role of childhood emotional maltreatment in the development of PTSD, among children and adolescents. These results emphasize the need for the customization of PTSD treatment based on the type of maltreatment and gender.Show less
There are many instruments available to measure parental sensitivity, however each has its own limitations. In search of a more efficient instrument, an adapted mini-MBQS is proposed, in which...Show moreThere are many instruments available to measure parental sensitivity, however each has its own limitations. In search of a more efficient instrument, an adapted mini-MBQS is proposed, in which parents sort the cards instead of professionals. In this study, parent’s accuracy to report about their own parental sensitivity with this adapted Q-sort was explored. Additionally, it has been explored whether sex of the parent and parental reflective functioning influence parent’s accuracy on the Q-sort. To answer these questions, two online home visits were conducted with twenty parent-child pairs. During the home visits parent and child played together. Afterwards, the parent sorted the Q-sort about how sensitive s/he thought s/he was to the child during the play task. The play task was recorded and later coded on parental sensitivity with the Ainsworth Maternal Sensitivity Scale by a professional. Furthermore, parents filled in a questionnaire between the two online home visits, which contained questions about the family’s background and parental reflective functioning. The results from parent-reported and observed sensitivity were compared, which showed a positive, but weak and non-significant correlation of .22, suggesting a mismatch between parent’s own judgement and that of a professional about the level of sensitive parenting. Next, two ANCOVAs were conducted and showed that sex of the parent (F (1,16) < .01; p = .95) and parental reflective functioning (F (1,16) = .06; p = .81) did not moderate the relationship between observed and parent-reported sensitivity. From these results, it can be concluded that parents are not accurate when reporting about their parental sensitivity with the Q-sort. In addition, the results showed that gender or self-reported level of parental reflective functioning do not influence this accuracy. Therefore, it is not recommended to use the current form of the adapted MBQS as an instrument to measure parental sensitivity.Show less
Parental sensitivity refers to the degree to which parents are aware of their child’s signals, and respond quickly and appropriately to those signals. This parental sensitivity plays an important...Show moreParental sensitivity refers to the degree to which parents are aware of their child’s signals, and respond quickly and appropriately to those signals. This parental sensitivity plays an important role in raising children. In this study, correlations between sensitive parenting, parental self-confidence in raising children, child temperament and child age were investigated. Twenty-one parents participated in an online meeting in which they played for eight minutes with their 3-5 year-old child. Two to four weeks after the first meeting, parents participated in a second online meeting in which they also played for eight minutes with their child. After the first meeting, parents filled in a questionnaire about their sensitivity, their self-confidence in raising their child, and child temperament. The following questions were investigated: ‘are parental self-confidence in raising children and parental sensitivity correlated?’; ‘is child temperament or parental self-confidence in raising children more closely correlated with parental sensitivity?’; and ‘to what extent does child temperament affect the correlation between child age and parental sensitivity?’. Using a correlation, multiple regression and moderator analysis, no correlations were found. Parental sensitivity was not correlated to parental self-confidence in raising children, child temperament or child age. These results indicate that interventions for increasing parental sensitivity must not focus on parental self-confidence or child temperament, but for example on how parents can practice sensitive parenting or how parents can react sensitively when their child is angry.Show less
Teenagers spend a lot of time online, which may cause worry to their parents as the internet can bring a lot of risks. To protect their children from these dangers, parents might implement rules or...Show moreTeenagers spend a lot of time online, which may cause worry to their parents as the internet can bring a lot of risks. To protect their children from these dangers, parents might implement rules or restrictions of phone use for their teenagers. These restrictions can keep them away from risky apps or reduce their time online. However, it is unknown if these restrictions result in less encounters of dangerous situations. This study focusses specifically on exposure to sexual content online. The aim of this study is to find out if there is a relation between phone restrictions someone might have had while growing up and exposure to sexual online content. Participants were asked to anonymously fill in an online questionnaire about their online experiences and possible phone restrictions. Using this data, an ordinal regression analysis was used to examine the relation between the presence of phone restrictions and the exposure to sexual content online. In addition, this study looks if there is a relation between what type of restriction someone might have had and the type of online exposure to sexual content: unwanted exposure and wanted exposure for the participant. The results of this study have found no significant effect, implying there is no relationship between the presence of phone restrictions and exposure to online sexual content. Furthermore, no evidence was found to indicate a relationship between the type of restrictions and wanted exposure to online sexual content. Only a significant, positive relationship was found between a limited screen time and wanted exposure to online sexual content.Show less
During this study, the decision-making process of ‘de Jeugdbeschermingstafel’ in complex divorce was examined. ‘De Jeugdbeschermingstafel’ from the Netherlands is a multidisciplinary meeting there...Show moreDuring this study, the decision-making process of ‘de Jeugdbeschermingstafel’ in complex divorce was examined. ‘De Jeugdbeschermingstafel’ from the Netherlands is a multidisciplinary meeting there professionals from various fields and parents come together to assess and discuss the well-being and safety of a child or young person who may be at risk. At ‘de Jeugdbeschermingstafel’, an assessment is conducted to determine the necessity of conducting a counsil investigation (‘raadsonderzoek’). It was examined whether this decision-making differs between families with a high or low socioeconomic status who are going through a complex divorce. The main question of study was: ‘To what extent is a complex divorce related to a custody investigation, and is this relationship moderated by the socioeconomic status of parents?’ To investigate this question a correlational research design was used. For this study, various research requests from ‘de Jeugdbeschermingstafel’ across the Netherlands were investigated. These research requests had been anonymized, read and coded. Seventy-one requests of investigations have been utilized. The distribution between complex divorce and non-complex divorce cases, as well as between socio-economic disadvantage and no socio-economic disadvantage could be improved. It was expected that a counseling investigation would be chosen more often for families going through complex divorce than for families without complex divorces, particularly in cases of high socioeconomic status, as these divorces tend to be more prolonged. Results showed that ‘de Jeugdbeschermingstafel’ does not indicate custody investigation more often for families with complex divorces, than it does in families without complex divorces. Furthermore, this relationship is not moderated by the socioeconomic status of families. However, due to the use of a small sample, this conclusion may be challenging to generalize to the broader population.Show less
Background. Traumatic Brain Injury (TBI) is one of the most common forms of Acquired Brain Injury (ABI), and has a high incidence rate across the world. Following TBI, many patients experience...Show moreBackground. Traumatic Brain Injury (TBI) is one of the most common forms of Acquired Brain Injury (ABI), and has a high incidence rate across the world. Following TBI, many patients experience cognitive complaints, as well as physical complaints about their health. Their general wellbeing can also be an issue. Fortunately, for most patients these complaints typically improve over time. This study investigates patients’ memory, concentration, energy, as well as general wellbeing, over time. Methods. Patients received questionnaires about their health and wellbeing every three months following hospital release, with the main goal to track their health and wellbeing after TBI. That data was used for this research. Energy, concentration, and memory were all measured by one question in the questionnaire. General wellbeing was measured by taking the average ratings of all questions on the questionnaire. Analyses were done with three and six questionnaires over time, using repeated measures ANOVAs. Descriptive statistics were used from the first questionnaire. Results. This study found that while patients rated all these measures on average positively, they still did not feel the same as before the injury, and most experienced hindrances in daily life. When looking at the ANOVAs with three questionnaires, there was a significant improvement on concentration, energy, as well as general wellbeing over time. For all of these, most improvement took place between the first and the second questionnaires. Memory did not change significantly over time. None of the ANOVAs with six questionnaires had any significant changes over time. Conclusion. This study shows that patients may suffer from long-lasting effects of TBI. It questions whether more should be done for these patients following hospital release, to alleviate symptoms. This study has limitations concerning selection bias and drop out.Show less
Anxiety disorders are highly prevalent in young children, underscoring the need for early prevention. To prevent anxiety disorders in young behaviourally inhibited children a parent-focused...Show moreAnxiety disorders are highly prevalent in young children, underscoring the need for early prevention. To prevent anxiety disorders in young behaviourally inhibited children a parent-focused prevention program called ‘Cool Little Kids’ has been developed. Previous research indicated that both parental engagement and parental anxiety can influence the effectiveness of such programs. Yet, research on the interplay between these factors is limited. Therefore, we investigated the mediating effect of engagement on the relationship between parental anxiety and the effectiveness of ‘Cool Little Kids’. The current study is part of the CLK research project performed by Leiden University. Participants were parents of behaviourally inhibited children between the ages of two and six (N = 42). Parents were interviewed before and after the training about the anxiety of the child, completed a questionnaire about their own anxiety, and were observed during the training to assess parental engagement. Mediation analyses were performed to investigate our hypotheses. No significant meditating effects between parental anxiety, parental engagement and the reduction of the child’s anxiety were found. However, results indicated that parental anxiety had a negative effect on the reduction of the child’s social anxiety. This suggests that CLK should possibly be adapted towards anxious parents of socially anxious children. Furthermore, parental engagement positively influenced the reduction of the child’s separation anxiety. This could be explained by the more central role of parents in separation anxiety but can also suggest that CLK is more suitable for reducing separation anxiety symptoms compared to symptoms of specific phobias and social anxiety and therefore needs adaptation. These results should be handled with care because the current study had several limitations, like a small sample, no control group and many analyses were performed without correction. So, extensive research is necessary to confirm our findings. In conclusion, our findings suggest that in general, parental anxiety and parental engagement do not influence the reduction of the child’s anxiety after CLK. Prevention programs such as CLK are essential to prevent anxiety disorders from occurring and therefore research is needed to improve the effectiveness of these programs.Show less
Advance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally...Show moreAdvance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally accepted in Western countries and has a positive effect on end-of-life care for people with dementia. However, culture affects expectations and preferences regarding end-of-life care and decision making. This study compared the acceptability of and preference for two types of ACP interventions for patients with dementia in health care providers from the Netherlands, the US and Japan. One intervention focused on concrete treatment orders in which the patient makes specific decisions. The other focused on what the patient finds important in life, resulting in global goals of care. A total of 125 participants were assessed by means of a structured interview and a questionnaire. Participants found both types of ACP acceptable, in general and per country. A multinomial logistic regression analysis indicated no significant difference in acceptability of the concrete or the global ACP approach between countries when adjusted for age and gender. However, age was a significant predictor of acceptability of the concrete ACP approach (2 (2, 123) = 6.32, p = .042), with older participants being less likely to find it acceptable compared to not finding it acceptable (W(8) = 5.50, p = 0.019). Participants preferred the global ACP approach for patients with dementia. A multinomial logistic regression analysis indicated no significant differences in preference between countries when adjusted for age and gender in general. However, Dutch participants were less likely to prefer the global ACP approach (W(8) = 5.18, p = .023). The relationship between country and preference was not influenced by whether participants most strongly considered what the patient with dementia wants for themselves, what the patient’s family wants or what they as the health care provider want for their patient when making medical decisions. ACP is generally regarded as an acceptable form of care for patients with dementia by health care providers across countries. Future research could more specifically determine which cultural or demographic aspects affect health care providers’ views on different ACP approaches.Show less
This thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and...Show moreThis thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and subjectively. Previous studies have established that a long delay occurs between the onset of mood symptoms in BD and the first form of treatment received, estimates ranging between 6 and 11 years. Cognitive impairments in the domains of executive functions, processing speed and memory were found to persist in BD patients even during euthymia. Such cognitive impairments burden BD patients, prevent them from regaining an appropriate level of general functioning and diminish their quality of life. Thus, in order to determine whether treatment delay impacts the cognitive impairments present in BD, 69 participants were followed over the course of one year, at three different time points. The participants took part in clinical interviews, and then were asked to complete multiple measures, such as the YMRS, the QIDS, four WAIS subscales (Block Design, Arithmetic, Information and Digit symbol), and the Cognition subscale of the WHODAS. The average treatment delay found in the current sample was 14.53 years. The results of the current study suggest that longer treatment delays did not significantly predict worse cognitive functioning in BD patients, either when measured subjectively, or when measured objectively.Show less
In the Netherlands, children are interrogated using the Dutch child interrogation method ‘the scenariomodel’. Surprisingly, this method does not consider the impact of children's personality traits...Show moreIn the Netherlands, children are interrogated using the Dutch child interrogation method ‘the scenariomodel’. Surprisingly, this method does not consider the impact of children's personality traits, despite literature indicating that these traits play a central role in their perspectives and can therefore influence the course of the interrogation and their testimony. This correlational study investigated the extent to which the personality trait 'shyness' plays a role in the course of the child interrogation according to the scenariomodel and in the quality of the witness statement. The research target group are children under the age of 12 who are victims of online sexual abuse. Participants (N = 23) underwent an ethically responsible simulation of online sexual abuse and a simulation of a child interrogation according to the scenariomodel. The transcripts of the interrogations were coded to first examine the quality of the testimony based on three indicators: accuracy of the statement, completeness of the statement and the amount of forensic information. And second to investigate the course of the interrogation based on the resistance that children show. Shyness was measured with a questionnaire. The study anticipated that shy children exhibit more resistance and provide lower quality testimonials due to their susceptibility to suggestiveness and social discomfort during interrogations. However, the results showed no significant correlations between shyness and the quality indicators of the testimony, nor between shyness and resistance. A mediating effect of resistance on the quality of the testimony was therefore also excluded. This suggests that the scenariomodel may be resistant to the negative influences of this personality trait and can be used without concern for interrogating shy children who have been victims of online sexual abuse. However, due to important limitations of the study, firm conclusions cannot be drawn and follow-up research is necessary.Show less
Suicidal ideation is more prevalent in people with Borderline Personality Disorder. Negative self-conscious emotions, such as shame and guilt, may be related to this relationship. In this study the...Show moreSuicidal ideation is more prevalent in people with Borderline Personality Disorder. Negative self-conscious emotions, such as shame and guilt, may be related to this relationship. In this study the relationship between suicidal ideation and borderline personality traits was explored. Shame and guilt were analysed as possible mediators. The Personality Assessment Inventory – Borderline Scale was used to assess borderline personality traits, and Ecological Momentary Assessment was used to gather data on suicidal ideation, guilt and shame four times a day, over the course of three weeks via an app. The sample consisted of (N = 82) adults with a history of a suicide attempt or moderate-to-severe suicidal ideation in the past year. The relationships were analysed using a parallel mediation model consisting of multiple multilevel regression analyses. All steps of the model showed significant relationships. The last step showed that instead of typical mediation, the model indicated suppression, because of an increase in the association between borderline personality traits and suicidal ideation when accounting for shame and guilt. More research is necessary to explore the possible cause of these findings.Show less
This research aims to investigate the topology of the brain during reward processing and the influence of dopamine and norepinephrine on this network. So far, most research about reward processing...Show moreThis research aims to investigate the topology of the brain during reward processing and the influence of dopamine and norepinephrine on this network. So far, most research about reward processing has concentrated on specific brain areas and connections between particular regions, rather than the brain's organization and architecture. By investigating this organisation, gaps in our understanding of the brain architecture can be addressed, which could in turn lead to a better understanding of pathologies that disrupt the brain’s architecture. It is hypothesized that the brain will be more integrated during reward processing, and that increased dopamine and norepinephrine activity will result in a more integrated brain organisation. To test this prediction, the Global Efficiency (GE) of a total of 132 Regions of Interest (ROIs) and BOLD- activity of the Substantia Nigra/Ventral Tegmental Area (SN/VTA) and the Locus Coeruleus (LC) were obtained during a reward processing task, which 38 participants completed. During a functional magnetic resonance imaging (fMRI) scan, participants completed a reward- emotion recognition test. As predicted, in the reward condition, the paired t-test showed a higher GE in comparison to the no-reward condition in several nodes, mostly in the default mode network. These findings imply that the brain is more integrated when processing reward than when it is not processing reward. However, the catecholamines showed no significant correlation with this integration. Future research is needed to investigate the topology and influence of different catecholamines in more detail. The implications of these findings will be discussed.Show less
Background Alzheimer's dementia (AD) and mild cognitive impairment (MCI) are neurodegenerative conditions associated with cognitive decline. Previous research suggests that motor impairments are...Show moreBackground Alzheimer's dementia (AD) and mild cognitive impairment (MCI) are neurodegenerative conditions associated with cognitive decline. Previous research suggests that motor impairments are also present in individuals with MCI and AD. This thesis study aims to evaluate motor sequence learning abilities in patients with amnestic MCI (aMCI) and AD compared to healthy controls. This thesis study also explores the relationship between amyloid-β burden, a known biomarker for MCI and AD, and motor sequence learning to study whether such motor learning could also be a behavioral biomarker. This is because measuring amyloid-β is very costly and invasive, and thus the search for other biomarkers is important. Methods A cross-sectional design was employed, and participants included 28 AD patients, 33 aMCI patients, and 53 healthy controls. Motor sequence learning was assessed using a computerized task measuring reaction time and accuracy per trial, and with this information the rate and final amount of learning was calculated, i.e. how fast and how much information the participants are able to learn, respectively. Amyloid-β burden was measured using PET imaging, with higher burden reflecting more severity of the symptoms of aMCI and AD. Results The final amount of learning was not different amongst the groups, and the rate of learning was only significantly different between the AD and aMCI groups, with the AD groups showing a faster rate of learning. The AD and healthy control group did not, however, differ significantly in terms of rate of learning. The amount of amyloid-β in the brain was not associated with motor sequence learning abilities. Conclusion The findings suggest that motor sequence learning abilities are preserved in individuals with aMCI and AD, both in terms of how fast and how much they learn. In fact, patients with AD showed a faster rate of learning than patients with aMCI, although this was not found when comparing the AD patients with the healthy individuals. It is possible that this finding is because patients had more to learn by the end of the task than the aMCI group given that their memory is worse, and displayed a faster rate of learning due to this. This thesis study also suggests that motor sequence learning is not a behavioral biomarker for aMCI and AD. The search for less invasive and more easily measurable biomarkers continues to be imperative.Show less
