Page 96 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer

early-onset disruptive behavior (De Boer et al., 2017; De Haan et al., 2013; Odgers et al., 2008).
In residential samples with high incidence of disruptive behavior, the initiative to prematurely terminate treatment may not only lie with the patient (i.e., withdrawal), but also with the therapist (pushout). It has been argued that it is of relevance to distinguish both forms of dropout (Boon & Colijn, 2001; Van den Reijen et al., 2013), because withdrawal may be related to lack of commitment, while pushout will often be the result of incidents. Further, patients may withdraw because they feel that their treatment is completed. In some cases of pushout, the persons involved (e.g., the therapist, the referring agency, or criminal court) may deem it necessary to transfer the patient to another, more restrictive residential facility such as prison. The patient does not necessarily have to agree and may still feel the need of treatment by the expelling institution. This implies that it is of interest to distinguish between two types of dropout.
In the present study, the general daily functioning in the eighteen months following discharge was examined in a sample of former adolescent psychiatric inpatients who had been admitted to a residential institution specialized in youth with psychiatric disorders combined with severe disruptive behavior. Based on what is known about areas of life on which individuals with untreated behavioral problems function worse later in life (De Haan et al., 2013; Moffitt et al., 2002; Odgers et al., 2008; Piquero, Farrington, Nagin, & Moffitt, 2010), good general daily functioning was considered to consist of having daytime activities (education, work), not using substances (alcohol, drugs), abstaining from criminal offending, and stability of the living conditions since discharge. In order to investigate whether dropouts and completers differed in severity of dysfunction at admission and discharge, as was found by Kazdin (1994), the degree of psychological distress of dropouts and completers was compared in the first and last week of the treatment.
To control for its possible effect, early-onset disruptive behavior was included in the analyses. The concepts of early-onset disruptive behavior (i.e., disruptive behavior prior to age 12) and adolescent-onset disruptive behavior (i.e., disruptive behavior after age 11) are based on the extensive longitudinal research of Moffitt and colleagues (Moffitt, 1993; Moffitt et al., 2008; Moffitt et al., 2002; Odgers et al., 2008;
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