Page 122 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer

ongoing process. In itself this can be regarded as a favorable development, provided that intensive home care is offered. A great advantage may be that, when the personal situation allows, individuals can stay in their own environment. This may have a positive effect on clients as well as their families. Outpatient treatment necessitates that the facility is within easy traveling distance, which in a practical sense makes it easier to apply a systemic approach, compared to inpatient facilities that likely are at a greater travel distance. Also, it increases the likelihood, for those in an outpatient facility, of organizing a gradual transition back to the home environment. Overall, residential treatment should only be indicated if intensive outpatient intervention, such as MDFT (Liddle et al., 2001) and MST (Henggeler et al., 1992), has been considered first. Considering the severity of problems and in many cases the lack of a supportive parent system, there will remain cases where residential treatment cannot be avoided.
One may wonder if it is really that harmful if someone drops out of treatment. Among children and adolescents who completed interventions aimed at reducing disruptive behavior, the effectiveness (i.e., reduction of symptoms) has clearly been demonstrated (Bennett & Gibbons, 2000; Kazdin, 2016; Kazdin et al., 1994; McCart et al., 2006; Serketich & Dumas, 1996; M. Shaw et al., 2012; Van der Pol et al., 2017). When disruptive behavior and psychiatric problems are not treated however, these problems are likely to persist or even get worse later in life (De Haan et al., 2013; Moffitt et al., 2002). With this in mind, we hypothesized that an individual completing treatment is better off than someone who prematurely drops out. To the best of our knowledge this had never been demonstrated, and thus far little to nothing was known about the course of symptoms after termination of treatment of individuals who dropped out prematurely. The present thesis (chapter 6) showed that dropout was related to poorer functioning at follow up, and therefore we concluded that it is of clinical relevance to prevent it. Thus, we do know that 18 months after (premature) discharge, a considerable part of the dropout group functioned worse than the completer group. This could be because this specific group had more problems initially. Also, we do not know whether these dropouts would have been helped with treatment. Further research is warranted to investigate whether alternative interventions are useful for this group. It could be that more outreaching interventions
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