Page 95 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer

Introduction
Because between a quarter to as much as three quarters of the outpatients terminate treatment prematurely (De Haan et al., 2013), treatment dropout can be considered a major problem in Child and Adolescent Mental Health. Not much however is known about dropout in residential psychiatric care for patients with
severe disruptive behavior, albeit a dropout percentage as high as 59.1% was found in
one study (Van den Reijen et al., 2013). Assuming that accurate treatment reduces symptoms and improves functioning, these findings suggest that a considerable
number of patients may not benefit fully from evidence based psychiatric 6 interventions. Children and adolescents with untreated behavioral problems have poor prospects. They are more likely to leave school without a qualification, to engage in delinquent activities more often, to abuse drugs and alcohol, and to become unemployed as adults, while their disorders might persist or even worsen later in life
(De Haan et al., 2013; Moffitt et al., 2002). If premature termination of treatment
entails that behavioral problems are left untreated, it may be assumed that patients
who drop out are worse off in the period after discharge. To our knowledge, no research has been conducted in which completers and dropouts were compared on
the daily functioning in the period after discharge.
Dropout can be an indication of the severity of the problems, as was indicated by Kazdin (1994), who found that children with externalizing problems who dropped out of outpatient treatment showed greater pretreatment impairment at home, school and community compared to completers. They also had greater clinical dysfunction at discharge. Previous research among residential psychiatric inpatients with severe disruptive behavior, the group followed-up in this study (De Boer, Boon, Verheij, Donker, & Vermeiren, 2017), showed that two factors are related to premature termination of treatment, i.e., early-onset disruptive behavior (i.e., exhibiting disruptive behavior prior to age 12; OR 2.9) and cannabis usage prior to the admission (OR 2.1) (De Boer et al., 2017). Therefore in the present study these variables were taken into account, because the relation between treatment adherence and general daily functioning at follow up might be confounded by them. Sex was also included in the analyses, as in previous studies sex differences were found in dropout as well as in
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