Page 111 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer

taken into account (e.g., the level of functioning in a social network, having a partner relationship).
As already mentioned, the early-onset (EO) and adolescent-onset (AO) constructs can be operationalized in different ways, leading to outcomes that may vary depending on whichever operationalization is applied (Colins & Vermeiren, 2013). It is therefore unclear to what extent the results of the present study using the retrospective EO and AO distinction can be generalized to other (prospective) onset
groups. Besides, it cannot be ruled out that some individuals in the AO group actually belonged to the EO group and vice versa (Cohn, Van Domburgh, Vermeiren, Geluk, & 6 Doreleijers, 2012; Van Domburgh, Vermeiren, et al., 2009).
During the seventeen year period, due to experience and new insights, the approach to subjects that could potentially drop out may have evolved over time. Undoubtedly, there were changes in therapists, which obviously must have affected the treatment and hence the treatment outcome as well as the attrition. Nevertheless we believe that the results of our study are useful in clinical practice, not in the least because it was a naturalistic study.
Clinical implications
The findings of present study have implications for institutions specialized in treatment of youth with disruptive behavior. It was found that patients who completed treatment functioned better at follow-up and it thus seems important to prevent dropout. In order to realize this, patients with high chance at dropout should be identified so they can participate in an intervention to foster retention. For the purpose of identifying patients with high chance at dropout, the EO and AO distinction can be used, since it was found that early-onset disruptive behavior was associated with dropout. One way to reduce the chance at dropout is probably to invest substantially in the therapeutic alliance with the identified members of the early-onset group. It has to be noted that the distinction in age of onset seems of less importance for the further course of the treatment. Once the early-onset group stays in treatment, the treatment results appear to be as good as those of the adolescent-onset group, in the short term (De Boer et al., 2017) and at eighteen months follow-up.
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