Page 12 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer

The present thesis aimed at identifying subgroups based on the age of onset of disruptive behavior within a clinical cohort of youths with both psychiatric disorders and severe disruptive behavior. The question was, whether the distinction in Life- course persistent and Adolescence-limited antisocial behavior (Moffitt, 1993; Moffitt, Caspi, Dickson, Silva, & Stanton, 1996) was relevant for clinical practice. After dividing the clinical sample into subgroups contrasting early-onset disruptive behavior (i.e., disruptive behavior prior to age 12) versus adolescent-onset disruptive behavior (i.e., disruptive behavior after age 11), subgroups were related to proximal (i.e., dropout, and psychosocial functioning at discharge) and distal outcomes (i.e., social functioning a year after discharge). It was hypothesized that the outcomes for individuals with early-onset (EO) disruptive behavior would be less satisfactory compared to individuals with adolescent-onset (AO) disruptive behavior, as they probably have a higher chance at dropout and also because their disruptive behavior has higher likelihood of being persistent. Therefore it was expected that, once they were in treatment, their problems would be enduring. In order to optimize outcome for adolescent psychiatric inpatients with severe disruptive behavior, treatment must address the needs of the individuals to whom the treatment is targeted (see e.g., Andrews & Bonta, 2010). In this light it is not only important to examine the factors that contribute to treatment success and symptom reduction, but also the factors that contribute to reducing dropout. Differentiation in subgroups, for instance based on age of onset of disruptive behavior, may benefit intervention and may eventually result in more individualized and appropriate intervention and as a consequence better treatment results (Vermeiren, 2003).
Orthopsychiatry
In the nineties of the last century, De Fjord was founded as the first center for orthopsychiatry in The Netherlands. This was the result of a need for specialized treatment of adolescents with a complex combination of problems, who for instance had been rejected or expelled by institutions for youth psychiatry because of the severity of their disruptive behavior, or could not be placed in a judicial youth institution because of the psychiatric problems. The term orthopsychiatry may be somewhat confusing, since it originally and internationally means treatment of mental
10