A high proportion of patients in child and adolescent psychiatry with significant dissociative symptomatology after early childhood traumatization may go undiagnosed, be wrongly diagnosed and/or inappropriately treated. The diagnostics and treatment of dissociative disorders have been limited by lack of comprehensive, reliable and valid instruments and the ongoing polarization and fierce controversy regarding treatment. However, recent neurobiological findings of neurochemical, functional and structural cerebral consequences of early stressful childhood experiences point out a need for active, early and effective identification and treatment interventions. We present an update on assessment tools available in the Nordic countries, and an overview of different appropriate therapeutic intervention models for children and adolescents. A systematic overview of studies of dissociation in children and adolescent published over the last decade disclosed a total of 1019 references. The 465 papers describing aspects of assessment tools and/or treatment were studied in detail. Reliable and valid screening questionnaires and diagnostic interviews for children and adolescents now allow for effective early identification of dissociative disorders. A combination of individual psychotherapy, pharmacotherapy and family therapy are often required to handle dissociative disorders in children and adolescents. Cognitive-behavioural therapy, hypnotherapy, Eye-Movement Desensitization-Reprocessing (EMDR), psychodynamic therapy and an integrated approach are the main described psychotherapeutic approaches, but treatment of dissociation in children and adolescent does not require allegiance to any one particular treatment model. However, achievement of physical safety by providing a safe environment is a primary goal that supersedes any other therapeutic work. Assessments tools are now available, and appropriate therapeutic intervention models may hopefully contribute to reduce the risk of wrong diagnoses and inappropriate treatment of dissociative symptomatology in children and adolescents. However, controlled clinical trials of the various interventions and longitudinal outcome studies are needed.

A B S T R A C TThe aim of this project was to explore how resilience factors could be utilized in a clinical intervention for young people with stressful background experiences. Four resilience factors constituted the basis for the intervention: positive peer relations, self-efficacy, creativity, and coherence. Four main therapeutic principles were derived and elaborated with technical operationalizations: (i) focus on group work with same-age peers, and foster prosocial, supportive and accepting interactions; (ii) organize group work around activities the participants are motivated to learn more about, and assist them in reaching specified group and individual goals; (iii) facilitate playful exploration and individual symbolic expression within the chosen activity; and (iv) encourage and assist participants' attempts to make meaningful and beneficial connections between different aspects of their past, present and future lives. Nine groups underwent the intervention. As the case illustration shows, this approach gave inspiration to thinking and practice that was perceived as clinically meaningful. However, more knowledge of the interplay between positive and negative chain reactions is needed to develop adequate interventions.K E Y W O R D S coherence, creativity, positive peer relations, resilience intervention, self-efficacy I T I S S U R P R I S I N G how resilient people are despite having experienced high-risk situations such as war, disasters, loss and adversity during childhood and adolescence. Because those who cope successfully with stress and adversity rarely show up in the

Depressive symptoms were measured in a cohort of community‐based adolescents (n=163) at two time‐points, with 1 year intervening. At Time 2, participants also answered a scale about past‐year stressful life events. Depressive symptoms increased from Time 1 to Time 2, the effect being stronger for girls than for boys. Depressive symptoms were significantly correlated with concurrent measures of recent stressful life events, but this relationship disappeared after controlling for previous depressive symptoms. Rather, previous level of depressive symptoms predicted stressful life events. This demonstrates that a unidirectional model of stressful life events as the cause of depressive symptoms in adolescents is too simplistic.

The relevance of resilience research for clinical practice has not yet been established. In this intervention pilot study, the aim was to explore how group work based on enhancing the participants' creativity, self-efficacy, active coping, and sense of continuity could be utilized within a clinical context for adolescents with stressful background experiences. 31 participants and 24 parents completed pre-, post-, and 1-yr. follow-up assessments of the youths' behavior difficulties, as well as depression, positive life attitude, coping, and prosocial behavior. Apart from a drop in self-rated prosocial behavior, no significant treatment effects were found. Implications for clinical practice and research are indicated.

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