There are several major principles of youth interventions:

1. Children and young people rarely refer themselves
2. Children are rarely treated in isolation
3. There is a chance to intervene early
4. There is almost always a lot of heterogeneity
5. Development has to be taken into account

Children not referring themselves leads to problems with client motivation and problem awareness. There are three levels of youth intervention:

1. Universal (i.e. targets whole population)
2. Selective (i.e. targets youth with certain risk)
3. Indicated (i.e. targets youth already showing symptoms).

Treatment refers to targeting youth with symptoms at (sub)clinical level or those with a diagnosis. Heterogeneity in complaints exist because of three reasons:

• There is ongoing development in youth and this makes the complaints more likely to cause problems and more heterogeneous.
• There are more people involved and this makes complaints more heterogeneous.
• The DSM criteria are less clear in youth.

The question is always where one should intervene when a child presents with complaints. Efficacy refers to whether an intervention works in a controlled, laboratory setting. Effectiveness refers to whether an intervention works in clinical practice. An evidence-based intervention refers to an intervention where there is at least some evidence regarding the efficacy and effectiveness. However, there is no clear guideline for when something is evidence-based as it is a continuum. Most include at least two studies with the following:

• Careful specification of the patient population.
• Random assignment of participants to conditions.
• Use of treatment manuals that document the procedures.
• Multiple outcome measures including a measure for the disorder.
• Statistically significant differences between treatment and comparison group after treatment.
• Replication of outcome effects.

There are several ways in which a treatment can be considered well-established:

1. Superiority to placebo or other treatment.
2. Equivalence to already established treatment.

Or alternatively, when a large series of single-case designs have been used, it must demonstrate efficacy with:

3. A good use of experimental design.
4. Comparison of intervention to another treatment.

When an experiment is used, it must be conducted with treatment manuals (1), characteristics of the sample must be specified (2) and the effects must be demonstrated by at least two different teams (3).

An intervention is probably efficacious when there are at least two experiments that show that the treatment is superior to the waiting list control-group or when the treatment is well-established but has not been investigated by at least two teams. Alternatively, a treatment is probably efficacious when a small series of single-case design experiments meet well-established treatment criteria. An intervention is an experimental treatment when treatment has not been tested in trials meeting criteria for methodology.

Evidence-based practice refers to using evidence-based interventions and using available knowledge about the effectiveness and efficiency of a method in carrying out an

There are three learning paths to fear:

1. Modelling (i.e. modelling and positive reward)
   This holds that fear develops as a result of imitation and stories (i.e. imitation).
2. Classical conditioning (i.e. systematic desensitization)
   This holds that fear develops through associative learning.
3. Operant conditioning (i.e. exposure)
   This holds that fear develops through gratification and reward.

There are three intervention techniques for anxiety:

• Cognitive-behavioural therapy
• Modelling
• Exposure

The information processing theory holds that attention, interpretation and memory biases will lead to problematic cognitions. This means that an ambiguous situation (e.g. “seeing children laugh”) could be interpreted negatively (e.g. “they are laughing at me”) and this could lead to a memory bias (e.g. “I only remember people laughing at me when I wore this t-shirt”).

All treatment protocols for anxiety treatment starts psychotherapy. Next, the child is prepared for exposure by doing cognitive therapy or relaxation technique. Afterwards, there is conduct of modelling and exposure.

Cognitive-behavioural therapy is the most evidence-based prevention and treatment method for anxiety disorders. The recovery rate for anxiety disorders after using CBT is approximately 60%.

There are several principles (i.e. steps) of cognitive therapy for anxiety:

• Cognitive restructuring (e.g. going from anxious thoughts to more healthy, neutral thoughts).
• Recognize the situation-thought-feeling and registering this.
• Differentiation between feelings (e.g. fear thermometer).
• Detecting negative thoughts.
• Challenging negative thoughts.
• Formulate helping thoughts (e.g. “I can do it”).
• Learn to apply thoughts in the form of self-talk when confronting fear objects.

The goal of CBT is cognitive restructuring. Children also receive homework in CBT. The situation-thought feeling (the five G’s) is used to give insight for the client and is a tool for the therapist regarding treatment course:

1. Event
2. Thought
3. Feeling
4. Behaviour
5. Consequence

The client has to identify all and elaborate on them. Detecting the negative thoughts can be done by using questionnaires or by using cartoons. People often find it difficult to formulate helping thoughts. Therapists can help them by provide the client with this or help them formulate it (e.g. give examples).

The presence of social anxiety disorder at pre-treatment leads to slower rate of change and poorer diagnostic outcomes when using CBT. This may be as group settings are more aversive for them. They may also show behavioural inhibition from infancy, making them more resistant to change. The therapeutic relationship may also be more problematic due to their SAD. Exposure may have opposite effects as social situations are more ambiguous and more difficult to interpret. This makes it difficult to see whether one’s initial interpretation was false.

Children with SAD may thus need a longer treatment programme and a more tailored programme that helps them disconfirm their negative social expectations (e.g. equip children with social skills prior to exposure). One way in which this can be

There are several guidelines for treating children with ADHD:

1. Always start with psychoeducation.
2. Offer behavioural parent and/or teacher training.
3. Offer medication in severe cases or when the previous interventions were not effective.

Behavioural intervention cannot be supported as a front-line treatment for core ADHD symptoms. This is especially the case in studies where the outcomes are blinded. However, parenting practices and conduct problems improve after behavioural interventions and this is often the main reason for referral, meaning that behavioural interventions serve their goal. Improving parents’ behaviour towards their children may improve child behaviour and improve the quality of the parent-child relationship.

Children who receive behavioural consultation are less likely to receive medication later that year. If they do receive medication, the dosages are lower compared to children who did not receive behavioural consultation. Using ­a low-intensity behavioural intervention as a first-line treatment reduces or eliminates the need for medication in children with ADHD.

There are several reasons why it is important to reduce the need for medication:

• Parents prefer non-pharmacological interventions.
• Medication does not lead to improvement on all domains (i.e. it does not normalize functioning).
• Medication does not improve outcomes on the long-term.
• The long-term compliance is low.
• The long-term safety of medication is unclear.
• There are frequent side-effects of medication.

Adding medication secondary to initial behavioural treatment leads to better outcomes on primary outcomes than the other way around. Parents who began treatment with behavioural parent training had better attendance than those assigned to receive training after medication. The cost of starting with a low-intensity behavioural intervention is also lower. It is thus important to start with behavioural intervention.

Behaviour modification is teaches skills to parents, teachers and children to overcome some of the key functional impairments associated with ADHD. Effective treatments need to focus on peer relationships (1), parenting (2) and academic functioning (3). Combining recreational activities with educational activities increases children’s attendance.

Behavioural parent/teacher training is a mediation therapy. This means that the therapist trains the parent or teacher and this person then uses their newly learned skills on the child. This is done because interventions directly involving the child often have little effect due to self-regulation problems of children with ADHD. Using both parents may increase the consistency of the implementation of strategies and shared understanding of ADHD which may lead to better outcomes. However, the evidence for this is limited.

Barriers to parent training include situational factors (1), psychological factors (2), lack of awareness of programmes (3), unavailability of programmes (4) and issues with poor interagency collaboration (5). There are several moderators of treatment effect:

• Mild to moderate parental psychopathology may reduce treatment effectiveness.
• Parents at risk for ADHD may have more difficulty maintaining gains.
• High levels of ADHD in mothers reduces the effect.
• The presence of a conduct disorder in the child

Traditionally, a specific learning disability (SLD) referred to a discrepancy of one to two standard deviations between intellectual functioning and academic functioning. However, the amount of discrepancy was arbitrary (1), older children were favoured (2), higher IQs were favoured (3) and it was failure-based (4). Currently, the definition holds that achievement in key academic areas is substantially below the age norm and in excess of sensory deficits, linguistic processes, attention and memory. The prevalence is 2 to 10%.

Response to intervention (RTI) refers to a tiered system in which a failure to respond to an intervention is the criterium for identification of specific learning disabilities. This indicates the need for more specific and intensive intervention. First, there is screening for risk (e.g. simple tests of basic pre-reading skills) and assessment of family history of reading and language difficulties. After this, there are several tiers:

1. Tier 1 intervention (i.e. trained classroom teachers).
   This includes assessment and possible modification of the language programme in a classroom to ensure that the instruction is addressing the individual needs of all the children in the classroom.
2. Tier 2 intervention (i.e. additional one-on-one instruction and small groups).
   This includes a small-group intervention for children whose literacy difficulties are not resolved by appropriate adjustments to the classroom instructional programme.
3. Tier 3 intervention (i.e. special education classroom).
   This includes a more intensive intervention (e.g. fewer children; daily one-to-one tutoring) for children who continue to perform poorly.

In the Netherlands, there are three different but similar tiers:

1. Tier 1
   This includes a high quality classroom instruction.
2. Tier 2
   This includes additional teaching in class by teacher or additional instruction by a reading specialist, either individually or in a small group.
3. Tier 3
   This includes the help of a dyslexia specialist outside of the school but children are not yet in special education.

A child moves to the next tier if the progress in a tier is inadequate. The three-tier model is the most common model of RTI and is defined by three sequentially ordered intervention strategies. It aims at early identification of at-risk children.

All tiers depend on continuous monitoring of student progress as this determines the eligibility for a given tier. It thus does not look at an IQ­-achievement discrepancy. A diagnostic classification depends on the outcomes of different interventions. The majority of children who identified as at-risk at first scored average after one or two semesters of tutoring (i.e. tier 1). This means that most struggling readers can become average-level readers if they are provided with effective intervention.

Almost all children identified as at-risk for long-term reading difficulties in first grade had the same characteristics:

• They lacked emergent literacy skills (e.g. phonological awareness; knowledge of the alphabet).
• They were exposed to a less optimal language programme.

This means that not dyslexia but poor education was

Trauma refers to a normal response to an abnormal event. About 14% of the children exposed to a trauma develop PTSD. The probability of developing PTSD increase the longer and more severe the traumatic events are.

PTSD includes several symptoms:

• Intrusion symptoms (e.g. nightmares; flashbacks)
• Avoidance behaviour
• Negative alterations in cognitions and mood (e.g. the world is unsafe)
• Alterations in arousal and reactivity (e.g. poor concentration)

The symptoms need to last for at least a month. For late-onset PTSD, the symptoms need to have an onset of 6 months after the traumatic event. The intrusion symptoms in children are represented in pretend play (e.g. playing the traumatic experience). Regressive behaviour (e.g. going back a developmental step) is common in children with PTSD.

There are several risk factors to develop PTSD:

• Direct exposure to life threats.
• Being separated from parents during or shortly after the traumatic event.
• Serious bodily injury.
• Losing a loved one.
• Witnessing cruelties or violence.
• Experiencing the use of weapon.
• Violation of the physical integrity of a child.
• A known perpetrator.
• A negative intention of the perpetrator.

There are also several secondary sources of stress as a risk factor:

• Suffering great material losses.
• Lack of basic facilities.
• Moving houses.
• A shocking event with a long aftermath of stress.
• Pedagogical shortcomings in parents.

There are also several risk factors in children:

• Level of development.
• Temperament.
• Quality of attachment relationships.
• Guilt about the trauma.
• Previous traumatic experiences.
• Existing problems or psychopathology.
• Strong emotional reaction right after the traumatic event.

Ehler and Clarke’s cognitive model of PTSD states that persistent PTSD only occurs if individuals process the traumatic event and/or consequences in a way which produces a sense of serious, current threat. People with persistent PTSD are unable to see the trauma as a time-limited event that does not have global implications for their future. There are two key processes that lead to this sense of threat:

• Individual differences in the appraisal of trauma and its consequences.
• Individual differences in the nature of the memory for the event and its link to other autobiographical memories.

The perception of current threat is accompanied by intrusions and other re-experiencing symptoms when activated. This motivates a series of behavioural and cognitive responses that are intended to reduce perceived threat and distress in the short-term but prevent cognitive change. This maintains the disorder.

The emotional processing theory states that posttraumatic symptoms reflect the development of a problematic fear structure comprising many stimuli, responses and meaning representations. There are maladaptive responses when this is triggered.

The social cognitive theory focuses on the impact of trauma on pre-existing or developing beliefs about one’s self, others and the world. According to this theory, trauma-related feelings