Page 116 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer

Summary and general discussion
This dissertation aimed at identifying subgroups, within an inpatient cohort of youths characterized by psychiatric disorders combined with severe disruptive behavior, based on the age of onset of their disruptive behavior. The question was, whether the distinction between life-course persistent (LCP) and adolescence-limited (AL) antisocial behavior (Moffitt, 1993; Moffitt et al., 1996), was relevant in clinical practice for predicting severity of problems and treatment outcome. After dividing the clinical sample into subgroups of early-onset (EO) disruptive behavior and adolescent- onset (AO) disruptive behavior, subgroups were compared on proximal (i.e., dropout, and psychosocial functioning at discharge) and distal outcomes (i.e., social functioning 18 months after discharge). It was hypothesized that the outcomes for individuals with EO disruptive behavior would be worse than for individuals with AO disruptive behavior. EO was expected to have a higher chance at dropout and when treated, their problems would have a higher likelihood of persistence. The incentive to differentiate within the patient population was asked for by clinicians of the orthopsychiatric facility, who felt encouraged by results from previous research conducted at their facility (Bruinsma & Boon, 2001). It was assumed that further differentiation based on age of onset of disruptive behavior, enables individualization of interventions and optimization of treatment results.
Summary of main findings
In chapter 2, the aim was to examine whether a subsample of our inpatient group could be discriminated from a non treatment control sample based on information recorded early in their lives. In most cases this information was recorded before these children came into contact with mental health care because of their behavioral problems. At two specific moments (i.e., April 2006 and March 2009), all adolescents who were then in treatment at the institution (n=49) were asked for permission to access their youth health care files. All youth health care files traced containing complete data, were examined (n=24). These files were kept from early infancy on to monitor the growth and development of children. Our analyses focused on written descriptions made by health professionals and teachers at the time that the
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