Specific projects

This page provides details on the projects conducted by this lab.

Cognitive risk factors of school refusal in adolescence

Marija Maric , MSc, PhD-student

While we know that CBT is often an effective treatment for the internalizing problems of young people, we still do not know how CBT works. What are the mechanisms via which treatment-related change is achieved, and which parts of CBT bring about the most change? This is the issue of ‘mediation’ of treatment outcome.

This project aims to investigate the following research questions: (i) Are various methods for assessing cognitions differentially effective in age, gender, and ethnic groups of children and adolescents?; (ii) What is the role of cognitions (i.e., automatic thoughts and cognitive errors) in anxiety-based school refusal: predictors, moderators, or mediators of school refusal?; (iii) Do cognitions mediate CBT for school refusal in adolescence? 

The study of cognitive risk factors in school refusal that mediate treatment outcome can inform the development of more efficient and effective treatments for young people. Identification of mediators may not only enhance the treatment structure, but may also advance our understanding of the nature of clinical disorders. For example, if a treatment is found to affect a particular process, then we know more about the importance of this process in the maintenance of the disorder.

Supervisors: David Heyne,Robert Vermeiren, P. Michiel Westenberg

Developmental Influences on the Process and Outcomes of CBT: Do cognitive and psychosocial developmental factors affect treatment delivery and outcome?

Floor Sauter, MA, PhD-student

Conventional treatment outcome studies with young people tend to focus exclusively on ‘improvements’ (e.g., improvements in diagnostic status and/or symptomatology). Until recently, treatment outcome researchers have given little systematic attention to the developmental variables which may be associated with treatment outcome for young people. We know virtually nothing about the extent to which a young person’s level of development in a certain sphere (e.g., cognitive development; psychosocial development) influences treatment outcome. It is also uncommon for treatment manuals to include detailed descriptions of developmentally-relevant adaptations to treatments for young people.

Clinicians and researchers postulate that specific developmental capacities are prerequisite to engagement in the cognitive therapeutic techniques incorporated within CBT. Exemplary capacities include self-reflection and social perspective-taking. The degree to which a young person has developed these capacities may facilitate or limit their participation in cognitive therapy. This project represents the first effort to incorporate standardized pre-treatment assessments of clinically-relevant cognitive capacities such as self-reflection and abstract reasoning.

Developmental factors are investigated as moderators of treatment outcome; that is, as factors which influence the extent to which CBT for school refusal is associated with reductions in anxiety and in negative cognition. In addition, the extent to which developmental factors are associated with the non-specific aspects of CBT is investigated. For example, are young people with a greater capacity for self-reflection likely to report a stronger alliance with the therapist, and greater satisfaction with treatment, relative to young people with a lower capacity for self-reflection? In the future, we will be able to make more specific and research-based recommendations about the most effective ways to tailor cognitive therapeutic techniques to the developmental capacities of individual young people receiving treatment. 

Supervisors: David Heyne and P. Michiel Westenberg

Conducting a functional analysis of school refusal: How reliable and valid are the Dutch versions of the SRAS-R?

David Heyne, PhD 

School refusal is often described as ‘heterogeneous’. It may present in different ways (e.g., together with separation anxiety, or with depression), and the factors associated with the onset and continuation of school refusal vary considerably from one case to the next (e.g., avoiding social-evaluative situations at school; enjoying activities and privileges when at home during the school day). This ‘heterogeneity’ may present a challenge to education and mental health professionals who are often confronted with the task of quickly understanding the problem and making appropriate recommendations for intervention. 

The need to develop a sound system for determining intervention-relevant differences among school refusers fuelled the development of the School Refusal Assessment Scale (SRAS; Kearney & Silverman, 1993) and its recent revision (SRAS-R; Kearney, 2002). This questionnaire (with separate versions for the young person and their parents) was developed to provide a standardized functional analysis of the behaviours of school refusers. That is, it helps professionals to identify the factors maintaining a young person’s difficulty attending school. This information is then used to support the identification of interventions which are most likely to address these maintenance factors. As such, the SRAS-R represents an important development in the availability of intervention-relevant assessment tools. The fact that the instrument has been translated into German and French reflects the perceived utility of this systematic functional approach to understanding and responding to school refusal. 

In this project we have developed and are evaluating the Dutch translation of the SRAS-R. School attendance problems are not uncommon in The Netherlands, and the availability of a psychometrically sound translation of this important tool is likely to be of benefit to education and mental health professionals alike. Administration of the questionnaire with referred and non-referred school refusers and their parents will shed light on the reliability and validity of the SRAS-R-NL (School Refusal Assessment Scale – Dutch Version).

Measuring self-efficacy among school refusers and their parents: How reliable and valid are the SEQ-SS and the SEQ-RSAP?

David Heyne, PhD 

The measurement of cognitive-related factors such as self-efficacy beliefs is held to be important in treatment outcome research with young people, including treatment outcome research with school refusers. Clinical evidence suggests that school refusers have low expectations about their ability to cope with social- and emotional-related problems, and that increases in school attendance are often accompanied by enhanced levels of self-efficacy. However, the temporal relationship between changes in self-efficacy and changes in school attendance are yet to be directly tested; for example, does CBT effect a change in a school refuser’s self-efficacy, such that the young person is then more likely to return to school, or is it that increased school attendance effects a change in the young person’s self-efficacy associated with attending school?

The Self-Efficacy Questionnaire for School Situations (SEQ-SS; Heyne et al., 1998) is a self-report instrument which was designed to assess children’s and adolescents’ perceived ability to handle anxiety provoking situations associated with school attendance and non-attendance (e.g., “How sure are you that you could handle questions from others about why you’ve been away from school?”). It has been used in clinical settings to determine targets of intervention during cognitive and behaviour therapy. It is also a promising tool in treatment-outcome research, to evaluate mid-treatment and post-treatment changes in self-efficacy. Thus, the SEQ-SS has been extended and translated for use in the @school project, yielding the SEQ‑SS‑NL. A parallel questionnaire, the Self-Efficacy Questionnaire for Responding to School Attendance Problems (SEQ-RSAP) has been developed for use with the parents of school refusers, to assess their self-efficacy in relation to helping their child attend school regularly and without difficulty (e.g., “If my child has difficulty attending school, I know what can be done to address this”). This research project investigates the reliability and validity of the SEQ‑SS-NL and the SEQ-RSAP.

 
Last Modified: 27-04-2009