Page 79 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer
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Introduction
Adolescent psychiatric inpatients with severe disruptive behaviour are likely to
drop out (i.e., premature termination of treatment). Although dropout is known to be
high within this group, research on this subject is scarce. Existing research predominantly concerns treatment on substance abuse, with few focusing on predictors of dropout (Orlando, Chan, & Morral, 2003; Schroder, Sellman, Frampton, & Deering, 2009). Just one article that described characteristics of adolescents with behavioural problems predicting completion of residential treatment was found (Van 5 den Reijen et al., 2013), in which no differences between completers and dropouts
were found. In a meta-analysis (De Haan et al., 2013) on dropout in non-residential outpatient settings, several pre-treatment client characteristics have been associated
with dropout. Many of these characteristics are dominant in patients with disruptive behaviour, that is, the presence of an externalising disorder, intensity of self-reported externalising and total problems, ethnic minority status, gender (male), lower academic functioning, higher number of diagnoses, referral source, and lower social functioning (De Haan et al., 2013). As behavioural problems substantially contribute to dropout, high dropout rates are expected in adolescents with severe disruptive behaviour treated in residential settings. Up to this date, however, little is known
about dropout and characteristics predicting dropout within this group.
In youths treated for disruptive behaviour, factors predicting dropout are unclear. Therefore, it is of interest to detect specific differentiating factors. Such knowledge is relevant for clinicians working with these youths, as it may help them to tailor interventions to their needs. Evidently, specific types of disruptive behaviour are likely to play a role. For example, the age of onset should be taken into account, as this aspect assumingly determines treatment accomplishment. Based on age of onset, Moffitt (Moffitt, 1993) developed one of the most influential theories concerning disruptive behaviour. Disruptive behaviour starting early and persisting into adulthood was called life-course-persistent disruptive behaviour (LCP), while disruptive behaviour only occurring during adolescence was labelled as adolescence-limited (AL). During adolescence, however, the LCP and AL group present similar in frequency and seriousness of offending, making both groups hard to distinguish based on their behaviour (Moffitt, 1993). Nevertheless, the underlying mechanisms leading to the
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