This study examined the efficacy of experiential play therapy in reducing behavioral problems among children with Conduct Disorder (CD). Between December 2022 and May 2024, a prospective clinical trial was conducted with 20 children aged 7-12 years (10 females, 10 males) diagnosed with CD according to DSM-5 criteria. The intervention involved eight weekly, 45-minute experiential play therapy sessions. The Aberrant Behavior Checklist (ABC) measured changes in behavioral symptoms before therapy, after the fourth session, and following the eighth session. No pharmacological treatment was provided. Structured and free-play activities aimed to encourage emotional expression, social interaction, and problem-solving skills. Experiential play therapy led to significant reductions in core behavioral symptoms. Hyperactivity decreased from 14.2±8.5 to 1.9±2.3 and lethargy from 15.8±6.3 to 1.9±2.6 by the eighth session (both p < 0.001). Other problematic behaviors also declined significantly (5.2±2.4 to 0.7±0.7, p < 0.001). The total Aberrant Behavior Checklist score dropped markedly from 35.4±13.7 to 4.5±5.0 (p < 0.001), reflecting substantial clinical improvement. Children with separated parents had higher baseline hyperactivity (22.8±5.1 vs. 12.0±7.9, p = 0.012) and total scores (51.0±4.2 vs. 31.6±12.4, p < 0.001). Although children with parents together and children with separated parents both improved significantly, differences in hyperactivity were no longer significant by the eighth session (p = 0.363). Repetitive and self-injurious behaviors did not show significant change. These findings underscore the value of experiential play therapy for managing conduct-related challenges during the intervention period, with observable benefits across the early and later sessions. Further research should examine longer follow-up outcomes, investigate family support, and explore integration with other therapies to optimize results.
Depressive Symptoms in Adolescence: On the Significance of Impaired Personality Functioning, Intrapsychic Conflicts, Defense Styles, and Mentalizing Ability According to psychodynamic theories, early relational experiences with primary caregivers shape the development of fundamental psychological capacities. Adverse relational experiences can lead to impaired personality functioning (psychic structure), intrapsychic conflicts, maladaptive defense styles, and limitations in mentalizing abilities, which in turn are associated with an increased risk of depressive symptoms. The aim of this study is to examine the contribution of these psychodynamic constructs to the prediction of depressive symptoms in adolescents and to investigate group differences between youths with and without depressive symptoms. N = 606 adolescents aged 16-21 years (M = 18.49, SD = 1.70; 69.1% female) took part in an online survey. Depressive symptoms were assessed using the PHQ-8, personality functioning with the OPD-KJ2 Structure Questionnaire, conflicts with the OPD-KJ2 Conflict Questionnaire, defense styles with the DSQ-22-A, and mentalizing abilities with the RFQ-6. The multiple regression analysis showed that greater impairment of personality functioning (β = .70) and lower adaptive defense styles (β = -.07) significantly predicted the severity of depressive symptoms (R2 = .55). The MANCOVA revealed significant group differences across all psychodynamic variables: adolescents with depressive symptoms reported greater impairments in all four dimensions of personality functioning and in mentalizing ability, higher conflict levels, as well as lower adaptive and higher maladaptive defense styles compared to the control group. These findings support psychodynamic theories and highlight the relevance of assessing psychodynamic constructs for clinical decision-making and treatment planning.
LARS&LISA in the Municipal Health Strategy - Description of a Project for the City-Wide Implementation of a Prevention Programme in Schools Given the high prevalence of mental health problems, their prevention in children and adolescents is an urgent task. In Braunschweig, a city-wide survey of adolescents as part of Communities That Care (CTC) revealed elevated levels of depressive symptoms, prompting a search for evidence-based, universal prevention measures. The CTC Steering Committee chose the universal, school-based, cognitive behavioral depression prevention program LARS&LISA. This article presents the theoretical foundations, development, content, and evidence of LARS&LISA and describes the first two phases of a community project ("PsyWo") for the citywide implementation of the program. The project includes the recruitment, training, and supervision of group leaders, as well as organization, implementation, and evaluation of the program. In project phase 1, group leaders received intensive training, and the program was implemented in nine school classes in parallel. Phase 2 focused on preparing the city-wide implementation while optimizing the use of human resources. To this end, the group leader training was shortened and effort needed to prepare for the sessions in schools was optimized. To date, over 50 group leaders have been trained and almost 600 adolescents in 14 schools and 34 classes have been reached. This project demonstrates the high potential of municipal, evidence- based, universal prevention as well as challenges for the city-wide implementation of prevention programs such as LARS&LISA.
Digital Psychotherapy for Depression in Children and Adolescents: Evidence-Based Efficacy, Conditions and Recommendations for Clinical Practice Depressive disorders in childhood and adolescence are among the most common mental disorders, often follow a recurrent course, and are associated with substantial individual, social, and economic consequences. Against the background of limited treatment success and multiple barriers to help-seeking, digital psychotherapeutic interventions are increasingly being discussed as a potentially low-threshold and scalable addition to routine care. Based on 13 meta-analyses, this article provides a narrative overview of the effectiveness of digital interventions for depressive symptoms and disorders in children and adolescents and situates these findings within relevant ethical, legal, and clinical practice frameworks. Overall, the evidence suggests predominantly small to moderate effects, particularly for cognitive behavioral therapy-based and guided self-management interventions. However, the interpretability of these findings is limited by the heterogeneity of interventions, predominantly subclinical samples, methodological shortcomings, and the limited evidence on adverse effects. For AIbased and especially large language model (LLM)-based applications, the evidence remains very limited, while ethical and legal requirements are particularly demanding. In Germany, no reimbursable digital health applications are currently available for minors with depressive disorders. Digital interventions may meaningfully complement care, but their use requires careful evaluation of effectiveness, safety, data protection, and clinical suitability.
"It Would have been Better if I had Never been Born" - Suicidality in Early Childhood Depressive Disorders and its Association with Externalizing Symptoms Empirical evidence on suicidality in early childhood (< 9 years) and on the role of comorbid externalizing symptoms in depressive disorders remains limited. We aimed to examine how externalizing symptoms, as assessed by multiple informants, are associated with suicidality in young children with depression. In a clinical help-seeking sample of 61 children (3-8 years) with depressive disorders, suicidality was assessed using a clinical interview (Preschool Age Psychiatric Assessment, PAPA) with the primary caregiver. Externalizing symptoms were assessed via child report (Berkeley Puppet Interview), parent report (Child Behavior Checklist 4-18), and (kindergarten) teacher report (Teacher Report Form 5-18). Criteria for suicidality (PAPA) were met by 39.3 % of the children. Suicidal ideation was reported for 21.3 %, suicide attempts for 3.3 %, and no child exhibited a suicide plan. In multiple regression analyses controlling for sociodemographic variables and child and parental depressive symptoms, higher levels of externalizing symptoms reported by the child and the mother were significantly associated with suicidality. The findings indicate that suicidality is a frequent phenomenon in early childhood depression and is associated with comorbid externalizing symptoms. To clarify the meaning of suicidal statements in early childhood, an individual case-based approach is required, as illustrated by a case study.
There are indications that the phenomenon of school absenteeism has increased in Germany in recent years. Problematic absenteeism is often associated with psychological, family, or social problems and serious developmental risks. In 2021, the Rhein-Erft-Kreis health department established a multi-professional clearing house for school absenteeism, led by child and adolescent psychiatrists, which supports students and their families in finding their way back to school. Between 2021 and October 2025, 163 families received intensive counseling and support. In almost half of the cases, school absenteeism was already clearly chronic and had persisted for more than a year. The majority of children and adolescents (59 %) were between 14 and 16 years old. The gender ratio was almost balanced. The counseling focused on process-oriented case management, interdisciplinary consultations (round tables), and the establishment and utilization of support services. Half of the cases (52 %) could only be reached through outreach work (home visits, appointments/accompaniment to schools), and 87 % had at least one (suspected) psychiatric diagnosis. In cases of long-term school absenteeism, outpatient reintegration was only partially successful. Of 98 cases in which the clearing house attempted gradual outpatient reintegration, 64 % (40 cases partially and 23 cases completely) were reintegrated within the counseling period. In almost half (44 %) of all counseling cases, it was necessary to initiate partial/full inpatient or inpatient-equivalent measures, in 8 cases against the child's will (& sect; 1631b BGB). The results show how important it is for schools to continuously monitor absenteeism, intervene at an early stage, and implement preventive measures to counteract chronic school absenteeism. In cases of problematic absenteeism, process-oriented case management and a multidisciplinary approach, as well as intensive parental counseling and flexible outreach services, are important at the action level.
This article develops initial considerations for the development of a conceptual framework for the prevention and coping with school absenteeism, which understands (hospital) schools as systems that promote development. The aim of the article is to combine theoretical and regional findings into a practice-oriented framework that conceptually brings together prevention and intervention along clear lines of responsibility, cooperation logic, and needs-oriented support principles. The starting point is the classification of school absenteeism as a multifactorial phenomenon with high relevance for mental health, educational biographies, and institutional transitions. Based on a presentation of the current state of research, different forms of school absenteeism and school avoidance behaviour are differentiated and the need for early, coordinated prevention and intervention measures is highlighted. For contextualization, findings from two regional, descriptive studies from the "Markischer Kreis" are used (teachers' perspective on massive school absenteeism; school management's perspective on organizational challenges). The combination of both studies reveals, in particular, delayed problem recognition, inconsistent definition and procedural standards, and deficits in interinstitutional cooperation. Building on this, KoopASSIST (a municipal cooperation and control instrument) and PowerBase (a psychological-pedagogical intervention approach based on the consistency theory of basic psychological needs) are two complementary approaches currently in development that combine structural control and individual support. The article concludes with implications for research and practical school development at the interfaces between schools, youth welfare services, and child and adolescent psychiatric care.
School absenteeism is an umbrella term for any form of absence, regardless of the reason. Absence means missing out on learning content and social interaction, thereby increasing the risk of dropping out of school, youth unemployment and the development of mental illness. In order to tackle school absenteeism, it is necessary to have a good understanding of the concept and to be able to diagnose symptoms and comorbid disorders. Numerous interventions and preventive measures have been developed. Initial data from the USA show that amongst other interventions the introduction of School Attendance Teams (SATs) in schools can lead to an improvement in school attendance rates. Schools are strategically well placed to intervene when problems arise. In line with the On the Frontline for Attendance (OTFA) concept, SATs may reduce absenteeism by applying the basic models of the Multidimensional MultiTiered System of Support (MD-MTSS) and the Response to Intervention (RtI) model. Continuous absenteeism tracking (RtI) allows early detection of emerging non-attendance and implementation of interventions. The severity or duration of absences determines the measures to be implemented (MD-MTSS). Three levels of severity are distinguished, which can be applied at school, class, and student level. This facilitates the allocation of preventive school-wide and individual interventions, taking into account the individual school culture and the student concerned.
Multidisciplinary Cooperation on School Absenteeism - Coordination of Support by the Public There are indications that the phenomenon of school absenteeism has increased in Germany in recent years. Problematic absenteeism is often associated with psychological, family, or social problems and serious developmental risks. In 2021, the Rhein-Erft-Kreis health department established a multi-professional clearing house for school absenteeism, led by child and adolescent psychiatrists, which supports students and their families in finding their way back to school. Between 2021 and October 2025, 163 families received intensive counseling and support. In almost half of the cases, school absenteeism was already clearly chronic and had persisted for more than a year. The majority of children and adolescents (59 %) were between 14 and 16 years old. The gender ratio was almost balanced. The counseling focused on process-oriented case management, interdisciplinary consultations (round tables), and the establishment and utilization of support services. Half of the cases (52 %) could only be reached through outreach work (home visits, appointments/accompaniment to schools), and 87 % had at least one (suspected) psychiatric diagnosis. In cases of long-term school absenteeism, outpatient reintegration was only partially successful. Of 98 cases in which the clearing house attempted gradual outpatient reintegration, 64 % (40 cases partially and 23 cases completely) were reintegrated within the counseling period. In almost half (44 %) of all counseling cases, it was necessary to initiate partial/full inpatient or inpatientequivalent measures, in 8 cases against the child's will (& sect; 1631b BGB). The results show how important it is for schools to continuously monitor absenteeism, intervene at an early stage, and implement preventive measures to counteract chronic school absenteeism. In cases of problematic absenteeism, process-oriented case management and a multidisciplinary approach, as well as intensive parental counseling and flexible outreach services, are important at the action level.
(Hospital) School as a Development-Promoting System: A Conceptual Approach to the Prevention and Intervention of School Absenteeism This article develops initial considerations for the development of a conceptual framework for the prevention and coping with school absenteeism, which understands (hospital) schools as systems that promote development. The aim of the article is to combine theoretical and regional findings into a practice-oriented framework that conceptually brings together prevention and intervention along clear lines of responsibility, cooperation logic, and needs-oriented support principles. The starting point is the classification of school absenteeism as a multifactorial phenomenon with high relevance for mental health, educational biographies, and institutional transitions. Based on a presentation of the current state of research, different forms of school absenteeism and school avoidance behaviour are differentiated and the need for early, coordinated prevention and intervention measures is highlighted. For contextualization, findings from two regional, descriptive studies from the "Märkischer Kreis" are used (teachers' perspective on massive school absenteeism; school management's perspective on organizational challenges). The combination of both studies reveals, in particular, delayed problem recognition, inconsistent definition and procedural standards, and deficits in interinstitutional cooperation. Building on this, KoopASSIST (a municipal cooperation and control instrument) and PowerBase (a psychological-pedagogical intervention approach based on the consistency theory of basic psychological needs) are two complementary approaches currently in development that combine structural control and individual support. The article concludes with implications for research and practical school development at the interfaces between schools, youth welfare services, and child and adolescent psychiatric care.
Truancy - Prevention and Intervention - An Overview of the Origins, Classification, and Preventive Approaches School absenteeism is an umbrella term for any form of absence, regardless of the reason. Absence means missing out on learning content and social interaction, thereby increasing the risk of dropping out of school, youth unemployment and the development of mental illness. In order to tackle school absenteeism, it is necessary to have a good understanding of the concept and to be able to diagnose symptoms and comorbid disorders. Numerous interventions and preventive measures have been developed. Initial data from the USA show that amongst other interventions the introduction of School Attendance Teams (SATs) in schools can lead to an improvement in school attendance rates. Schools are strategically well placed to intervene when problems arise. In line with the On the Frontline for Attendance (OTFA) concept, SATs may reduce absenteeism by applying the basic models of the Multidimensional Multi- Tiered System of Support (MD-MTSS) and the Response to Intervention (RtI) model. Continuous absenteeism tracking (RtI) allows early detection of emerging non-attendance and implementation of interventions. The severity or duration of absences determines the measures to be implemented (MD-MTSS). Three levels of severity are distinguished, which can be applied at school, class, and student level. This facilitates the allocation of preventive school-wide and individual interventions, taking into account the individual school culture and the student concerned.
This study aimed to provide initial evidence on the short-term effectiveness of a school-based universal health promotion program for adolescents, focusing on coping and self-efficacy. Forty sixth graders (M = 11,83, SD = 0,59 years; 43 % female) participated in the study to determine if these personal protective factors changed in the intervention group (IG) compared to an untreated control group. A supplementary qualitative interview (n = 2) offered deeper insights into the changes within the IG. The results indicated improvements in emotion regulation, positive self-instructions, and social support seeking during stressful social situations. However, for the first time, a negative effect occurred, i.e., in rumination. Self-efficacy also improved in the short term. The interviews supported successful application of emotion regulation strategies, effective time management techniques, and increased self-efficacy. It is recommended to expand the program by including problem-solving strategies, gender-specific elements, and a more intensive focus on reflecting on maladaptive coping. Overall, the preliminary findings suggest that the new school-based program is a promising universal prevention approach that may improve the key personal protective factors of "coping" and "self-efficacy" among sixth graders. This may contribute to strengthening essential protective factors for adolescent mental health during a critical developmental stage.
The paper presents a systematic literature review that evaluates international qualitative studies (n = 20) from the last decade on the subjective experience of first-time fatherhood. Through thematic analysis, seven thematic clusters were identified: ambivalent feelings in the transition to fatherhood, changing paternal identity and self-image, social pressure and role expectations, emotional self-regulation and coping, gaps in care and information, attachment to the child, and relationship with the partner. Finally, the findings are interwoven with psychoanalytic considerations in order to situate and understand the findings more comprehensively in the dynamic field of psycho-and sociodynamics.
This article presents the work of nexus, a psychotherapeutic and psychiatric counseling team, specializing in the areas of Islamist and right-wing extremism. Founded in Berlin in 2018, nexus has been cooperating nationwide with specialized counseling services and deradicalization programs since 2023. In this article, case reports are used to highlight the crucial intersection of youth welfare, extremism prevention and mental health. Considerations are discussed as to how psychotherapists and related professionals can contribute to such complex case constellations in order to enhance the prospects of successful distancing and exit processes.
This qualitative study investigates the psychological and social factors influencing individual deradicalization processes. The starting point were exemplary case reports from which potentially conditioning factors were extracted. These factors, which often resemble a "black box" in the deradicalization process, were thoroughly discussed in four moderated focus group discussions with N = 15 professionals from extremism prevention, exit counselling, correctional services, and constitutional protection. In collegial exchange, the experts reflected on key dynamics from their practice. The results highlight the high individuality and complexity of deradicalization trajectories, which are significantly shaped by developmental maturation, biographical experiences, and social contexts. Adolescence plays a particular role: extremist groups often compensate for deficits in identity development during this phase. Sustainable distancing processes usually require cognitive opening as well as experiences of disillusionment-such as the absence of expected gains through the extremist scene. Professional support, family involvement, and realistic future perspectives foster self-reflection and self-efficacy. Important implications arise for developmental psychologists and the work of child and adolescent psychiatrists: targeted promotion of developmental maturation and nuanced assessment of psychosocial burdens are essential to support sustainable deradicalization and reintegration processes. The study thus emphasizes the central role of developmentally informed expertise in multidisciplinary intervention approaches. Furthermore, the study points to the limited validity of existing evaluation tools and underscores the necessity for longterm, developmentally oriented interventions. The findings provide important impulses for the evidence-based advancement of deradicalization and reintegration practice.
Violent extremism is directed against societies and institutions and aims to destabilise such structures and trigger uncertainty. The expressive effect of these acts therefore also arises from the public's evaluation of them. The specific nature of the violent act also has implications for those children and adolescents directly and indirectly affected by violent extremism. Within the framework of a narrative review, the specific aspects resulting from this for the treatment of trauma related disorders in children, adolescents and their relatives are presented.
Young people spend a lot of time on social media and are confronted with fake news and propaganda from extremist groups. Extremist groups operate on the platforms that young people use and target their needs. Radicalization processes are increasingly taking place exclusively online. The article is designed as a narrative review and provides an overview of the current state of research on (online) radicalization among adolescents. It addresses the developmental psychological background to radicalization and looks at how young people are exposed to extremist content and the technological mechanisms behind it. A multi-layered approach to prevention is recommended, which considers aspects of communication, information and education to strengthen media literacy and addresses the responsibility of platform operators. It also points out the possibilities of counseling in this area.
Deficits in emotion knowledge can impact children's social-emotional interactions, which are particularly evident in children with autism spectrum disorders (ASD). However, consistent evidence regarding emotion knowledge and its individual components across ASD subtypes, as defined by ICD-10, remained limited. This study investigates emotion knowledge development - both as a whole and in seven specific components - in children with ASD, categorized by subtype, and compares them with a matched group of children without ASD using nearest neighbor matching based on gender, age, and language background. The sample includes 79 children with ASD (68 boys, 11 girls; ages 5-10): Childhood Autism (n = 33), Atypical Autism (n = 15), and Asperger's Syndrome (n = 31). Participants completed the Adaptive Test of Emotion Knowledge for Three- to Nine-year-olds (ATEM 3-9). A control group of 152 children without ASD was drawn from the ATEM 3-9 norming sample. Results reveal significant differences in emotion knowledge development across ASD subtypes. Children with Childhood Autism scored significantly lower than children without ASD, whereas children with Asperger's Syndrome or Atypical Autism showed no significant differences compared to the control group. These findings suggest that emotion knowledge deficits in ASD are subtype specific. Future research should account for these distinctions when examining emotional development in children with ASD.
Short-term Effects of a School-based Health Promotion Program on Coping and Self-efficacy in Sixth Graders. A Pilot Study This study aimed to provide initial evidence on the short-term effectiveness of a school-based universal health promotion program for adolescents, focusing on coping and self-efficacy. Forty sixth graders (M = 11,83, SD = 0,59 years; 43 % female) participated in the study to determine if these personal protective factors changed in the intervention group (IG) compared to an untreated control group. A supplementary qualitative interview (n = 2) offered deeper insights into the changes within the IG. The results indicated improvements in emotion regulation, positive self-instructions, and social support seeking during stressful social situations. However, for the first time, a negative effect occurred, i.e., in rumination. Self-efficacy also improved in the short term. The interviews supported successful application of emotion regulation strategies, effective time management techniques, and increased self-efficacy. It is recommended to expand the program by including problem-solving strategies, gender-specific elements, and a more intensive focus on reflecting on maladaptive coping. Overall, the preliminary findings suggest that the new school-based program is a promising universal prevention approach that may improve the key personal protective factors of "coping" and "selfefficacy" among sixth graders. This may contribute to strengthening essential protective factors for adolescent mental health during a critical developmental stage.
