Page 128 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer

follow-up. Therefore, in the treatment of conduct disordered youths, preventing dropout should be a main focus. This will be a challenging task, because these individuals are characterized by many risk factors associated with dropout, that likely interact with problems in multiple areas of life, negative experiences with previous youth care and overall lack of motivation. It is hypothesized that by preventing dropout, daily functioning will be improved in more individuals, additionally resulting in lower costs of care in the future. Therefore, preventing dropout will likely result in more (cost) effective care, especially since treatment that fails costs money while it probably yields nothing.
As concerns dropout prevention, the distinction in age of onset of disruptive behavior can aid to pinpoint youngsters at risk of dropout. Our study shows that both EO disruptive behavior and a history of cannabis use predicts treatment dropout. For these youngsters with high risk at dropout, practitioners should develop an intensive motivation trajectory, for instance consisting of components that appeal to the desire to change, the readiness to change, and the perceived ability to change (Nock & Kazdin, 2005).
Prevention and relapse prevention of substance use
A focus of treatment in conduct disordered youth should be prevention and treatment of substance use. In the present thesis we found that cannabis usage prior to treatment not only predicted dropout, it also affected general daily functioning at follow-up. In previous research, substance use in the year after discharge predicted aggravation of symptoms (Boon & De Boer, 2007). In this light, treatment of substance use and relapse prevention may help to reduce dropout and may also prevent worsening of symptoms. Evidence based treatment modalities that simultaneously address substance use, antisocial and aggressive behavior, and delinquency, such as Multidimensional Family Therapy (MDFT)(Henggeler et al., 1992; Van der Pol et al., 2017) and Multisystemic Therapy (MST)(Asscher et al., 2013; Liddle et al., 2001), are recommendable.
126