Page 120 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer

behavioral problems in a sample with psychiatric disorders and severe disruptive behavior is only partially useful in clinical practice. Both onset groups changed to the same extent by the end of treatment (i.e., self reported symptom reduction between admission and discharge) (chapter 4). As we have no control group, we do not know whether the improvement is due to the intensive, highly specialized, tailored treatment that was provided. The distinction in onset only seemed relevant in relation to dropout (chapter 4 and chapter 5). As explained variances were low, there were several other factors involved beside the onset of the behavioral problems. As described later in this chapter, there are limitations regarding the retrospective determination of the age of onset and these undoubtedly affected the meaningfulness of the distinction. Also, age of onset has very likely less value in our high risk sample than in a normal population, since all subjects had severe problems.
In youth with severe disruptive behavior, other differentiating factors are likely to be helpful as well, for instance callous unemotional (CU) traits (Frick, Ray, Thornton, & Kahn, 2014; Hawes, Price, & Dadds, 2014) or the related DSM specifier limited prosocial emotions. The “with Limited Prosocial Emotions (LPE)” specifier was added to the conduct disorder (CD) diagnosis of the DSM 5. Individuals with LPE are most likely to show elevated rates of CU traits (Dandreaux & Frick, 2009) and thus considered to comprise a severe antisocial subgroup of CD. It has been argued that the LPE specifier is informative regarding the effectiveness of interventions (Frick et al., 2014). Indeed, CU traits were demonstrated to be related to poor treatment outcome for both children and adolescents (Hawes et al., 2014). Furthermore, the LPE subtyping does seem to be limited to the childhood onset CD group (Frick, 2016). In this regard, subdividing the EO group into an EO group with and without LPE is considered to go beyond the distinction solely based on age of onset. However, research on the added value of the LPE specifier for clinical practice is still sparse and there are studies that question the clinical relevance and predictive value of the LPE specifier (Colins & Vermeiren, 2013; Jambroes et al., 2016). Beside, the LPE specifier was shown to explain just a limited part of the variance (Jambroes et al., 2016), as was the case with the EO versus AO distinction. Therefore, a subdivision based on this specifier will probably again be of limited value for clinical samples. Also, the question is whether it
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