Page 109 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer

Compared to previous studies on dropout (De Haan et al., 2013) and in particular a sample that may be considered similar (Van den Reijen et al., 2013), the dropout percentage of 39.8% was low. In studies on dropout of treatment for reducing disruptive behavior, dropouts had more problems, both prior to treatment and at discharge (e.g., Kazdin et al., 1994). Present results indicated that dropouts also functioned worse in the period after discharge and that dropout had a unique relationship with general daily functioning at follow-up. This implicates that, in the treatment of conduct disordered youths, preventing dropout should be an important
focus. For instance, individuals with increased risk of dropout could be offered 6 interventions primarily aimed at motivational enhancement, or at enhancing the therapeutic alliance (e.g., De Haan et al., 2013), since this is likely to play a role. Also,
an important focus of treatment in conduct disordered youth should be prevention
and treatment of substance use. After all, cannabis usage prior to treatment not only predicted dropout, it also affected general daily functioning at follow-up by adding the
most variance. In this light, evidence-based treatment modalities such as Multidimensional Family Therapy (MDFT) are recommendable since it simultaneously addresses substance use, delinquency, and antisocial and aggressive behavior.
In conduct disordered youth, it may also be important to discern withdrawal and pushout, as both forms of dropout may need a different approach in order to reduce it. In present study however, no differences were found between those who had withdrawn and those who had been expelled. At least, not on the variables that were examined. This does not necessarily mean that there are no differences between these groups, and more research is indicated.
Since early-onset disruptive behavior predicted dropout (De Boer et al., 2017), and dropout was associated with poorer general daily functioning, one would think that patients with early-onset disruptive behavior would function worse compared to those with adolescent-onset behavior. Especially since other research also showed that individuals with (equivalents of) life-course persistent disruptive behavior performed worse on general daily functioning. Surprisingly we found the reverse. After controlling for cannabis usage prior to admission, male sex and discharge status, patients with early-onset disruptive behavior functioned better at follow-up. This was attributable to the stability of living conditions. Based on the information available, there is no
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