Unravelling heterogeneity: the use of profiles among heterogeneous groups of adolescents with severe behavioural problems

Unravelling heterogeneity: the use of profiles among heterogeneous groups of adolescents with severe behavioural problems

Unravelling heterogeneity: the use of profiles among heterogeneous groups of adolescents with severe behavioural problems

Symposium71Lisette Janssen-de Ruijter, GGzE, The Netherlands; Alexa Rutten, GGzE/Tilburg University, The Netherlands; Sanne Hillege-van Woerden, Independent, The Netherlands

Room 3FThu 10:30 - 12:00

In the heterogeneous population of adolescents with severe behavioural and psychiatric problems, it is essential to identify specific combinations of characteristics that differentiate subgroups of adolescents. The identification of these subgroups may help clinicians to tailor interventions to the specific needs of these adolescents which consequently will improve care guidance and treatment. Furthermore, more insight into these subgroups and their risk on reoffending may improve risk assessment during treatment to, eventually, reduce recidivism. In this symposium, studies will be presented on the identification of subgroups in this heterogeneous population of adolescents with severe behavioural and psychiatric problems.

Presentation 1: Predicting reoffending of male adolescents with four different risk profiles
Background
Adolescents admitted to secure residential care have an elevated risk of persistent delinquent behaviour. However, this risk may differ between subgroups in this heterogeneous population of adolescents with severe psychiatric problems and disruptive problem behaviour. Identification of subgroups based on co-occurring risk factors in multiple domains might shed a light on the complexity of persistence in delinquent behaviour and might possibly predict which adolescents persist in their delinquent behavior after treatment. In this study, a person-centred approach was used to examine the predictive validity of risk profiles on reoffending after discharge from secure psychiatric residential care.

Methods
The sample of this study comprised 238 former male patients of the Catamaran, a hospital for youth forensic psychiatry and orthopsychiatry in the Netherlands. In a Poisson regression analysis, the relation between the four previously found risk profiles (dependent variables) and frequency and severity of reoffending (independent variables) —corrected for criminal history—was examined.

Results
Results show that the risk profiles significantly predict the frequency and severity of reoffending.

Conclusion
Conclusion of this study is that exposure to an accumulation of risk factors in multiple domains increases the rate of reoffending. This argues in favour of multisystemic interventions during residential treatment by also involving the domains peers, school, and family.

Presentation 2: Though boys though decisions
Background
Working with the heterogeneous population of serious juvenile offenders asks for broad knowledge and expertise to provide the best and individualized care. Knowledge is needed on combinations of problem and risk areas within this particular population of serious juvenile offenders. Because of the heterogeneity of the population, focus in treatment differs within this diverse population and evidence-based insights are not always easily applicable in clinical practice. Therefore, a combination of scientific and practical knowledge is needed to be able to tailor treatment.

Methods
We started in the clinical field of forensic youth care in the Netherlands to detect the most important domains for treatment. Besides focus on personal offender characteristics, clinicians pointed towards the overall importance of motivation for treatment in this population. Since the population is heterogeneous, we searched for subgroups of serious juvenile offenders (N = 2010) based on different (dynamic) risk factors.

Results
Seven subgroups were identified, based on different combinations of risk factors. To translate this knowledge into practice we looked for subgroups that had the highest risk to reoffend and the factors relating to this behavior, so clinicians know what factors need focus during treatment. Finally, input from clinical practice was used in combination with literature to distill motivational techniques for the different subgroups.

Conclusion
Successively these studies result in knowledge on what are points of focus in treatment for which specific serious juvenile offender.

Presentation 3: Profiles of juveniles with different symptoms of ASD, with and without delinquent behaviour
Background
It is well known that there are multiple phenotypes of autism spectrum disorder (ASD), also among juveniles with ASD and delinquent behaviour. Specific symptoms of ASD might increase the risk of offending behaviour while on the other hand some symptoms of ASD will protect youngsters with ASD against involvement in offending behaviour. The aims of this study were as follows: 1) Identifying subgroups, with or without autistic traits, based on subscales of the Autism Quotient (AQ), and 2) Identifying subgroups with specific symptoms of ASD which are related to either an increased risk of delinquent behaviour or a lower risk.

Methods
Male juveniles from an outpatient department of child and adolescent psychiatry or admitted to a secure residential care (N = 435) were included and assessed using the AQ. Delinquent behaviour and DSM-IV diagnoses were collected. By using a Latent Class Analysis (LCA), it was investigated whether different profiles of male juveniles could be identified. Severe behavioural problems and comorbidity were added to the LCA.

Results
This study identified different profiles based on the subscales of the AQ within male juveniles. The identified profiles differed on scores on the subscales of the AQ. Different relations of the profiles were found with delinquent behaviour and comorbidity.

Conclusion
This study demonstrates distinct subgroups of male juveniles with unique needs related to their profile of ASD symptoms. More insight is needed in the relation between specific symptoms of ASD and delinquent behaviour to adjust the treatment to their unique needs.

Assessment and treatment of young and/or adolescent offenders
autism, heterogeneity, latent class analysis, reoffending
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