Page 78 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer

Abstract
Objective: To examine pre-treatment characteristics associated with dropout in 224 adolescent psychiatric inpatients (mean age 17.1 years) with severe disruptive behaviour. To date, little is known about the factors predicting dropout among adolescents treated for severe disruptive behaviour. This is surprising, as dropout is a major problem in this specific group. Method: Dropouts (n=77) and completers (n=147) were compared on known risk factors for dropout, such as severity of externalising problems and disorders, ethnic minority status, male gender, and lower academic functioning, as well as on other factors considered relevant: behavioural characteristics, including age of onset and different types of disruptive behaviour. Within dropout, withdrawal (termination against the advice of the therapist; n=40) and pushout (termination against the wish of the client; n=37) were distinguished. Results: Two characteristics significantly predicted dropout: early-onset of disruptive behaviour and cannabis usage prior to treatment. Within the dropout group no differences were found between withdrawals and pushouts. Conclusions: Predicting dropout among adolescent psychiatric inpatients with severe disruptive behaviour is difficult. The two predictors found were already present at the time of admission and are therefore considered unalterable. However, they can be used to pinpoint individuals with higher chance at dropout, who in turn can be offered tailored interventions aimed at
improving the therapeutic relationship.
Key words: Adolescent psychiatry, Antisocial behaviour, Dropout, Pushout
Key Points
Dropout is a major problem in treatment of adolescents with severe disruptive behaviour; however, little is known about the factors predicting dropout in this specific group.
Early-onset (before the age of 12) of disruptive behaviour and cannabis usage prior to treatment predict dropout in residential treatment of adolescents with severe disruptive behaviour.
For the clinician, there is a difference between withdrawal and pushout, but in the present research no differences were found between these subgroups of dropout.
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