Page 121 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer
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is useful at all to make a division into age or into LPE, because reality is obviously too complex to be captured in dichotomies.
Dropout
While Moffitt (2008) previously suggested a relation between EO disruptive behavior and dropout, this had thus far not been objectified. Recently however, Kazdin
(2016) stated that the greater the impairment of children and their families, the
greater the challenge to keep them in treatment. He also argued that some factors
(e.g., current stressors in the home, socioeconomic disadvantage) tended to have
more impact on dropping out than on treatment outcomes in terms of reduction of symptoms. In this light it makes sense that individuals with EO disruptive behavior, 7 who are more likely to lack the necessary support from their social environment, feel
less inclined to complete treatment. Maybe the higher chance at dropout of the EO
group is above all associated with their long history of a diversity of often failing treatments. Presumably, their experiences thwarted their expectations of another
mental health intervention. Such a history on itself probably increases the risk of
dropout during treatment at De Fjord, regardless of the onset of the disruptive behavior. Additionally, this may also be related to levels of callous unemotional traits
of the EO group. These traits have for instance been associated with higher levels of aggression (Jambroes et al., 2016), increasing the likelihood of expulsion. The latter
was not confirmed in the present thesis (chapter 5), because the ratio between both
types of dropout were the same for both onset groups.
Finding ways to motivate the youngsters for treatment is of utmost importance. Reducing dropout is a necessity, as it is a likely indicator of effectiveness. Perhaps some of the individuals need a different approach, other than restrictive intervention in an institution that is far away from their home. An intensive, outpatient intervention as Multi Systemic Therapy (MST)(Henggeler, Melton, & Smith, 1992) or Multidimensional Family Therapy (MDFT)(Liddle et al., 2001) may be an alternative for some, although thus far there is no evidence that these approaches are effective for this specific group. Therapists and policymakers do think that at least some of the target group may better off in outpatient care. In The Netherlands, the substitution of residential facilities with outpatient care is stimulated for many years now and is an
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