Treatment of youth in residential care may be a challenging task for most providers because comorbid problems are common and general psychosocial functioning is low. Cognitive behavioral therapy (CBT) is found to be the most effective treatment but results in only rather small improvements. Hence, there is potential to improve treatment approaches. Acceptance and Commitment Therapy (ACT) could be one such approach. The purpose of this study was to test the effectiveness and feasibility of a brief trans diagnostic ACT group intervention for youth with comorbid problems in residential care. We also wanted to see whether increased psychological flexibility (PF) mediated potential positive outcomes, and to test the intervention under real-world conditions in residential care when delivered by less-specialized staff. With a quasi-experimental design, 69 youth (mean age 17.3 years) received Treatment-As-Usual (TAU), and 91 youth received TAU with an additional 12 h of ACT in a group setting (TAU + ACT). Follow-ups were conducted two weeks, 1 month, 6 months and 18 months after baseline. Intention-to-Treat (ITT) analyses showed statistically significant improvements 18 months after baseline, measured by the interaction of treatment and time for the primary outcomes of, anxiety [ACT * Months = -0.885 (0.445), p < 0.05, d = 0.34], depression [ACT * Months = -1.058 (0.526), p < 0.05, d = 0.39] and psychological flexibility [ACT * Months = -0.970 (0.413), p < 0.05; ACT * Months(2) = 0.053 (0.023), p < 0.05; d = 0.44] in TAU + ACT youth compared to TAU alone. Regarding secondary outcomes 6 months after baseline, the TAU + ACT group showed a significant decrease in anger, disruptive behavior, and increased self-concept, with small to medium effect sizes. We also observed that psychological flexibility mediated the decrease in the primary outcome of decreased anxiety. ACT in group format may be of help in promoting various positive outcomes for youth in residential care when added to treatment as usual. Increasing PF is a promising process variable that can be targeted to increase the effectiveness of interventions for this population.

Background: Previous research has found strong associations between adolescents' hazardous alcohol use and their perception of peer behavior, as well as own spending money and a range of antisocial behaviors. However, there is insufficient evidence of gender-specific predictors among adolescents with elevated antisocial behavior and alcohol use to design effective selective interventions. The aims of this study were to test short-term predictors of Heavy Episodic Drinking (HED) and risk-use of alcohol among 12-18-year-old females and males with elevated externalizing and delinquent behavior, and alcohol use.Methods: Eighty-five females, 77 males, and their parents, originally recruited for a parent intervention, were assessed at baseline and 6 months later with several validated instruments measuring externalizing and internalizing behavior, alcohol use, psychosocial distress, and delinquency.Results: The perception of peer drinking significantly predicted both genders' HED and risk-use, and also externalizing behavior predicted female risk-use. Rule-breaking behavior and social problems predicted both HED and risk-use among males, while rule-breaking predicted female HED and social problems predicted female risk-use. The parents' ratings of externalizing behavior predicted only their sons' risk-use. Lastly, no differences in prediction strength were found to be statistically significant differences between genders.Conclusions: Females and males shared several predictors of hazardous alcohol use, and perception of peer drinking emerged as a strong predictor. This suggests that interventions may target both genders' hazardous use of alcohol, and should address peer-resisting skills.

Two theoretically based parent training programs, delivered in real-world settings by the social services, were examined in this randomized controlled trial for effectiveness in reducing adolescents’ antisocial behavior and substance use. Two hundred and thirty-seven (237) adolescents in ages between 12 and 18 and their parents were assigned to one of two programs or to a wait-list control condition. The programs were the nine weekly group sessions program Comet 12–18 (Swedish Parent Management Training Program) and the six weekly ParentSteps (Swedish shortened version by Strengthening Families Program 10–14). Outcome measures were antisocial behavior, substance use, and delinquency, and psychosocial dysfunction. Data based on adolescents’ and parents’ ratings of the adolescents’ problem behavior at baseline and 6 months later were analyzed with repeated measures ANVOA, Logistic regression, and Kruskal–Wallis H test. The results showed that parents’ ratings of adolescents’ antisocial behaviors decreased significantly over time, but no time by group effect emerged. No program effects were found in the adolescents’ self-reported antisocial behavior, delinquency, or psychosocial functioning. A threefold risk of illicit drug use was found in both intervention groups. The results suggest that neither Comet nor ParentSteps had beneficial effects on adolescent’s antisocial or delinquent behavior, or on alcohol use. The only significant group difference found was a threefold risk of drug use in the intervention adolescents at follow-up, but for several reasons this finding should be interpreted with caution.

Background: Consistent with the theory underlying Acceptance and Commitment Therapy (ACT), a construct termed psychological inflexibility has been suggested. There are few validated measures of psychological inflexibility for children and adolescents. One such validated instrument is the Avoidance and Fusion Questionnaire for Youth (AFQ-Y). The results from a single study have not so far been replicated for youth.Objective: The aim of this study is to test psychometric characteristics for Swedish versions of the AFQ-Y17 and AFQ-Y8. The participants were recruited from an on-going study within institutional care for young people (12-20 years) with psychosocial problems.Findings: In this study of a sample of 159 Swedish adolescents (15-20 years of age) with psychosocial problems, the full 17-item scale was used, and analyses of the 8 items that constitute the short version (AFQ-Y8) were conducted later. The short version showed better psychometric properties than the full 17-item scale. Confirmatory factor analysis (CFA) was conducted to examine factor solutions. The better fit for AFQ-Y8 was indicated by three of the most common measures of model fit: the comparative fit index (CFI) value exceeded .95 (the recommended cut-off value), the root mean squared error of approximation (RMSEA) was below 08 (the recommended cut-off value), and the value of the standardized root mean squared residual (SRMR) was below the recommended .05 for the AFQ-Y8 scale, which the AFQ-Y17 scale failed to attain.Conclusions: This study supports the reliability, convergent validity and generalizability of both AFQ-Y17 and the shorter version AFQ-Y8. With regards to validity, both versions related in a theoretically consistent way with other psychological constructs. AFQ-Y8 was well represented by a single factor structure, while AFQ-Y17 showed a less good fit to a single factor structure. Overall, the AFQ-Y17 and AFQ-Y8 may be valuable clinical tools in reflecting changes in psychological inflexibility among adolescents. However, since the shorter version, AFQ-Y8, had psychometric properties that were at least as robust as the full 17-item scale, the shorter version is recommended for use among adolescents. (C) 2016 Association for Contextual Behavioral Science. Published by Elsevier Inc. All rights reserved.

Purpose: We aimed to examine the association between school grades at the age of 16 years and problem gambling at the age of 17-25 years among Swedish females and males.Methods: In a cohort design, we followed the 16-to 24-year-old participants in the representative Swedish Longitudinal Gambling Study for 2 years, 2008/2009 and 2009/2010, generating 3,816 person-years of follow-up time. The outcome, incidence of mild and moderate/severe gambling problems, was measured by the Problem Gambling Severity Index in telephone interviews. The exposure was register-linked information about final grades in compulsory school. The association between school grades and problem gambling was estimated in multinomial logistic regressions.Results: Low and average school grades were associated with increased incidence of mild and moderate/severe problem gambling compared to high grades, adjusted for sociodemographic characteristics, psychological distress, and alcohol use. Low grades, compared to high grades, were associated with a higher risk of mild gambling problems for adolescent males, whereas the incidence proportion of moderate/severe problem gambling was high for males aged 20-25 years with low grades, among whom unemployment was also very high. Furthermore, we found a strong and graded association between school grades and moderate/severe problem gambling for women in both age groups, despite a low prevalence of gambling participation among females compared to males.Conclusions: Our findings show that Swedish youth with low school achievement have an increased risk of gambling problems up to 8 years after school graduation, after control for confounding from sociodemographic characteristics, psychological distress, and alcohol use, and that this association is stronger for females than males. (C) 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license

The relationship between mental illness and violent crime is complex because of the involvement of many other confounding risk factors. In the present study, we analysed psychiatric and neurological disorders in relation to the risk of convictions for violent crime, taking into account early behavioural and socio-economic risk factors.

Depression, anxiety and stress are common problems among adolescents. Teaching young people coping strategies in school-based intervention programs is one promising approach hoped to remedy the negative consequences of distress in adolescence. The aim of the two pilot studies was to examine the effect of a brief intervention based on the principles of Acceptance and Commitment Therapy (ACT) on depressive symptomatology (Australian study, N = 66) and stress (Swedish study, N = 32) among adolescents screened for psychosocial problems in school settings. In both studies, subjects were assigned to receive the ACT-group-intervention, or a control intervention featuring individual support from the school health care. The Australian study was a planned comparison, with random allocation for girls, plus one replication of a boys group. The Swedish study used a randomized controlled design. The ACT-intervention was an 8-session manualized group program. The Australian study showed significant reductions in depressive symptoms with a large effect, and significant reductions in psychological inflexibility with a medium effect when compared to the control group who received standard care. In the Swedish study, the ACT-intervention group, when compared to the control group, reported significantly lower levels of stress with a large effect size, and marginally significant decrease of anxiety, and marginally significant increased mindfulness skills. Taken together, the ACT-intervention seems to be a promising intervention for reducing stress and depressive symptoms among young adolescents in school and should be tested in full-sized studies. Limitations of these two pilots include small samples.

We aimed to estimate the incidence of a first episode of problem gambling among Swedish 16-24 year-olds by demographic and socio-economic characteristics, and to compare the incidence between 16-24 and 25-44 year-olds, and between young women and men. Other aims were to estimate the proportions of recovery and incidence in recurrent problem gambling, and prevalence of problem gambling among 16-44 year-olds in Sweden. We selected 4,358 participants aged 16-44 from the nationally representative Swedish Longitudinal Gambling Study in 2008/2009 and 2009/2010. The primary outcome measure was a first episode of problem gambling during 12 months before the follow-up as measured by the Problem Gambling Severity Index among participants without a history of problem gambling at baseline. The incidence proportion of a first episode of problem gambling among 16-24 year-olds was 2.26% (95% confidence interval 1.52-3.36); three times lower among females (1.14; 0.42-3.07%) than males (3.32; 2.19-5.01%). Young age and household financial problems were associated with first episode problem gambling among young women. Among 25-44 year-olds, the incidence proportion of a first episode of problem gambling was 0.81% (0.41-1.56). Recovery from problem gambling was high, in particular among females. Individual transitions from problem gambling to recovery and to recurrent problem gambling, between baseline and follow-up, were common regardless of age. This study adds further evidence to research suggesting that there is a high mobility in and out of problem gambling over time on an individual level. The high incidence of first episode problem gambling among youth in Sweden stresses the importance of prevention of problem gambling at an early age.

BACKGROUND:Most studies on offending heterogeneity have been conducted with general population samples. It is not clear to what extent these can inform such outcomes for individuals with substance use disorders specifically.AIMS:The aim of this study is to compare the offending trajectories of individuals treated for substance use disorders in adolescence with a matched general population sample, and to test for gender differences in this respect.METHOD:Growth mixture models were applied to identify offending trajectories from age 15 to 33 of 1568 individuals treated for substance use disorders in adolescence, and in a matched population-based sample of 1500 individuals.RESULTS:Several parallel trajectories for men and for women were identified in both samples. The substance misuse treatment sample, however, had higher levels of offending, larger offender classes, longer careers and two additional, distinct trajectories. Although there were similarities between the men and women, the men were more heterogeneous offenders. There were two distinct offending trajectories among male substance misusers-decreasing high level and decreasing low level offending.CONCLUSIONS:Differences between substance using and general population samples indicate that results from the latter could underestimate the severity, heterogeneity, and persistence of offending trajectories if merely generalised to individuals with substance use disorders. Our results also indicated that population--based samples might be underpowered for detecting female offending heterogeneity.

BACKGROUND:This study aimed to explore the association between psychosocial health, gambling and gambling problems in a nationally representative sample of Swedish youth aged 16-24 years. Another aim was to examine whether these associations were different between young men and women.METHODS:Data were from the cross-sectional Swedish National Public Health Survey in 2004-07. With a response rate of 60.1%, the sample consisted of 19 016 youth. Using a sex-stratified multinomial logistic regression, we estimated associations between psychosocial health variables and gambling and gambling problems.RESULTS:Among males, we found that the higher the alcohol consumption, the higher the likelihood of gambling and gambling problems. Men with high alcohol consumption had an almost four times higher likelihood of gambling problems than men with no or low alcohol consumption (OR 3.94, 95% CI: 2.17-7.14). Moreover, young male victims of violence were more than twice as likely to have gambling problems than non-victims (OR 2.35, 95% CI: 1.39-3.99). Among young women, we found an inverse association between high alcohol consumption and gambling problems (OR 0.15, 95% CI: 0.05-0.44), opposite that of the young men. Furthermore, psychological distress (OR 6.15, 95% CI: 2.15-17.60) and suicidality (OR 2.88, 95% CI: 1.16-7.17) were associated with higher probabilities of gambling problems among young women.CONCLUSION:Alcohol use, violence victimization and poor mental health are associated with gambling problems among Swedish youth, however, with important sex differences. Prevention of youth gambling should consider sex differences and psychosocial health in addition to gambling.

The aim was to study the validity of 2 personality instruments, the Health-Relevant Personality Inventory (HP5i) and the Junior Temperament and Character Inventory (JTCI), among adolescents with a substance use problem. Clinical interviews were completed with 180 adolescents and followed up after 12 months. Discriminant validity was demonstrated in the lack of correlation to intelligence in both instruments' scales. Two findings were in support of convergent validity: Negative affectivity (HP5i) and harm avoidance (JTCI) were correlated to internalizing symptoms, and impulsivity (HP5i) and novelty seeking (JTCI) were correlated to externalizing symptoms. The predictive validity of JTCI was partly supported. When psychiatric symptoms at baseline were controlled for, cooperativeness predicted conduct disorder after 12 months. Summarizing, both instruments can be used in adolescent clinical samples to tailor treatment efforts, although some scales need further investigation. It is important to include personality assessment when evaluating psychiatric problems in adolescents.

The aim of the current vignette study was to examine how social workers assess adolescents with substance misuse problems, criminal behaviour and mental health difficulties, and how they make decisions about treatment interventions to reduce these problems. Earlier research has shown lack of knowledge concerning factors and processes that govern assessments and decisions in social work practice. In this anonymously administered survey, social workers in Stockholm, Sweden, were invited to assess fictitious youth issues. We found that social workers recognise the problems and needs of young people, but that they find it harder to link needs to evidence-based interventions. Also, there is a tendency to overrate alleged non-serious problems in the vignettes. We conclude that there is a need for increased knowledge about evidence-based methods and more structured procedures to broaden the basis for decisions.

Most studies on adolescent offending heterogeneity are based on general population samples, and few include individuals with substance misuse or look specifically at substance-related offending. It is also unclear how offender subtypes develop after young adulthood or how offending heterogeneity varies between genders. This study aimed to identify subgroups of offending among adolescents with misuse problems and to examine associations with offending in adulthood. The study included 1,992 females and males that consulted a clinic for adolescents with misuse problems between 1968 and 1971. Latent Class Analyses were conducted to identify subgroups based on violent and nonviolent offending before age 20. Participants were then followed until age 50 and reexamined regarding violent, nonviolent, and substance-related crimes. Associations between subgroups before age 20 and subgroups age 21-50 were examined. Before age 20, three subgroups were identified among the females and six among the males. Males were more specialized in their offending and demonstrated higher levels of offending. Results pointed to both stability and decrease of violent and nonviolent offending, and to the emergence of substance-related offending in adulthood in both genders. The connection between substance-related crimes and general delinquency in adulthood among individuals treated for substance misuse suggests that interventions should also address substance misuse for reducing the overall volume of crime. This study also highlights the importance of including females in research on offending heterogeneity.

BACKGROUND:Recent evidence suggests that factors predicting offending among individuals with no mental disorder may also predict offending among individuals with schizophrenia.AIMS:The aims of the study were (1) to explore the prevalence of risk factors for criminal offending reported at age 18 among males later diagnosed with schizophrenia, (2) to explore the associations between risk factors reported at age 18 and lifetime criminal offending, (3) to predict lifetime serious violent offending based on risk factors reported at age 18, and (4) to compare the findings with those in males with no later diagnosis of schizophrenia.METHODS:The study was a prospective, longitudinal study of a birth cohort followed up through registers after 35 years. The cohort consisted of 49,398 males conscripted into the Swedish Army in 1969-1970, of whom 377 were later diagnosed with schizophrenia.RESULTS:Among the subjects later diagnosed with schizophrenia, strong associations were found between four of the items reported at age 18 and lifetime criminal offending: (1) low marks for conduct in school, (2) contact with the police or child care authorities, (3) crowded living conditions, and (4) arrest for public drinking. Three of these four risk factors were found to double the risk of offending among males with no later diagnosis of schizophrenia.CONCLUSIONS:Criminality in individuals with schizophrenia may at least partly be understood as a phenomenon similar to criminality in individuals in the general population.

AIMSTo examine trajectories of resilience over 25 years among individuals who as adolescents received treatment for substance misuse, the clinical sample (CS) and a matched general population sample (GP).DESIGNComparison of the CS and GP over 25 years using Swedish national registers of health care and criminality.SETTINGA substance misuse clinic for adolescents in an urban area in Sweden.MEASUREMENTSResilience was defined as the absence of substance misuse, hospitalizations for physical illnesses related to substance misuse, hospitalization for mental illness and law-abiding behaviour from ages 21 to 45 years.PARTICIPANTSThe CS included 701 individuals who as adolescents had consulted a clinic for substance misuse. The GP included 731 individuals selected randomly from the Swedish population and matched for age, sex and birthplace.FINDINGSA total of 52.4% of the GP and 24.4% of the CS achieved resilience in all domains through 25 years. Among the CS, another one-third initially displayed moderate levels of resilience that rose to high levels over time, one-quarter displayed decreasing levels of resilience over time, while 9.3% showed little but improving resilience and 8.8% showed no resilience. Levels of resilience were associated with the severity of substance misuse and delinquency in adolescence.CONCLUSIONSIndividuals who had presented substance misuse problems in adolescence were less likely to achieve resilience over the subsequent 25 years than was a matched general population sample, and among them, four distinct trajectories of resilience were identified. The severity and type of problems presented in adolescence distinguished the four trajectories.

This study aimed at identifying different alcohol drinking trajectories in early to late adolescence. We also examined whether certain factors predicted membership of a specific trajectory and to what extent trajectory membership was linked to later negative consequences. Data were drawn from a longitudinal cohort study starting with 1923 adolescents including all seventh grade students in six school districts in Stockholm, Sweden 2001 (age 14), with follow-up in 2002, 2003, and 2006 (age 19). Cluster- and multinomial logistic regression analyses revealed four developmental pathways: low, gradually increasing, high, and suddenly increasing consumption. “High consumers” and “sudden increasers” reported higher levels of alcohol consumption, heavy episodic drinking, and alcohol-related problems both at age 14–16 and at age 19. The “gradual increasers” were more likely to smoke cigarettes, have easy access to alcohol, visit youth recreation centres, have friends who drink, and report a poorer health, compared to the “low consumer/abstainer group”. “High consumers” were more likely to have drinking peers than both “low consumers/abstainers” and “gradual increasers”.

Background. Adolescents who consult for substance misuse problems are at increased risk for multiple adverse outcomes from ages 21 to 50. Method. The sample included 180 adolescents who consulted a clinic for substance misuse and 251 of their parents. Adolescents and parents completed diagnostic interviews and independently completed questionnaires reporting on maltreatment of the adolescents. The adolescents completed questionnaires on substance misuse, illegal activities and relationships with others. Information was extracted from the criminal register. Twelve months later, 86% of the adolescents again completed a diagnostic interview, responded to questions about treatments they had received and completed questionnaires as before. In addition, information was extracted from health and social service files. Results. Six problem domains were defined to include externalizing and internalizing disorders, substance misuse, and violent and non-violent self-reported offending. These were generally stable during the 12-month follow-up, but some adolescents did improve, while others developed new problems. Change in the number of problem domains over the 12-month period was predicted by the number of problem domains present at first contact with the clinic and negatively by treatment during the follow-up period. Conclusion. Adolescents who consulted for substance misuse presented multiple mental health and psychosocial problems, which had been present for many years. The multiplicity of problems largely determined outcome 12 months later. Effective interventions are needed to target each problem domain. Identification and intervention with young children presenting mental health problems are needed to avoid the accumulation of problems observed in this sample of adolescents.

OBJECTIVES:The aim of this study was to examine the association between psychopathic traits and mental disorders and to study associations between psychopathic traits and familial problems across gender.DESIGN:This is a cross-sectional study.METHODS:One hundred and Eighty adolescents seeking help at a substance abuse treatment clinic (99 girls, 81 boys) and their parents (165 mothers, 90 fathers) were studied. The assessment included Psychopathy checklist: Youth version (PCL-YV) and SCID I/II or Kiddie-Sads-Present and Lifetime Version (K-SADS-PL).RESULTS:Across gender, there was a positive correlation between externalizing symptoms and PCL-YV score. Among boys, there was a positive correlation between internalizing symptoms and PCL-YV score. Further, the behavioural dimension of psychopathy was predictive of externalizing symptoms across gender. The interpersonal and affective dimension of psychopathy predicted oppositional defiant disorder (ODD)-symptoms among girls. Parent problem behaviour predicted PCL-YV score amongst girls only.CONCLUSIONS:Psychopathic traits do not only exist among adolescents who are identified because of their criminal behaviour. There were gender differences in the association between symptoms and psychopathic traits. It is suggested that different dimensions of psychopathy predisposed substance use for girls and for boys, and that ODD is particularly important in the expression of psychopathic traits among girls. This study showed transmission of antisocial behaviour between two generations among girls.

The study examined associations between antisocial behavior (ASB) before age 15 and eight adverse outcomes from age 21 to 50 among 1,623 men and 324 women who as adolescents consulted a clinic for substance misuse problems. Outcomes were documented using Swedish national registers and included death, hospitalization for physical illnesses related to substance misuse, mental illness, self-inflicted harm, substance misuse, convictions for violent and nonviolent crimes, and poverty. ASB before age 15 was associated with increased odds of all outcomes in adulthood except hospitalization for mental illness after adjusting for low family socioeconomic status, sex, Sex × ASB, and substance misuse in adulthood and with an increased number of adverse outcomes up to age 50. No gender differences were detected.