Effectiveness of Multisystemic Therapy for Adolescents From Families With Intellectual Disabilities
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Multisystemic therapy, Multisystemic therapy - intellectual disabilities.
- Who it may be relevant to
- Registry conditions: Behavioural Problems. Basic parameters: 10 years — 19 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Netherlands
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
The Effectiveness of Multisystemic Therapy for Adolescents With Severe Behavioural Problems From Families With Intellectual Disabilities: A Mixed-Method Study
Overview
The goal of this observational study is to determine the effectiveness of a specialisation of multisystemic therapy (MST) for adolescents with severe behavioural problems from families with an intellectual disability (ID; MST-ID). To achieve this goal, a mixed method study design is used. To this end, a quantitative and a qualitatively primary research question are formulated: * Is MST-ID superior, when compared to standard MST, in reducing rule-breaking behaviour of adolescents (quantitative)? * What are the experiences of adolescents and/or parents receiving MST-ID treatment (qualitative)? Participants will be asked to complete two screeners (questionnaires delivered as a verbal interview) with a total duration of approximately 30 minutes. Other data will be collected through Routine Outcome Monitoring questionnaires that are part of standard MST procedures. To this end, five 'time points' have been identified: T0 (start of MST\[-ID\] treatment), T1 (end of MST\[-ID\] treatment), T2 (follow-up 6 month after MST\[-ID\] treatment), T3 (follow-up 12 month after MST\[-ID\] treatment), and T4 (follow-up 18 month after MST\[-ID\] treatment). The qualitative method used to gain insight into families' experiences is determined in consultation with the families. To assess the effectiveness of MST-ID, its treatment outcomes will be compared to standard MST treatment outcomes of families with ID.
Detailed description
Background of the study:
Over the years, a large body of research has shown that adolescents with intellectual disability are 3-4 times more likely to develop severe behaviour problems than adolescents without intellectual disability. Families in which adolescents and/or one or both parent(s) have an intellectual disability (from now on, families with ID) often deal with complex problems, putting the adolescent at an increased risk of out-of-home placement. Multisystemic therapy (MST) is an intensive home-based treatment, effective in reducing severe behaviour problems and preventing the out-of-home placement of adolescents. A specialisation of MST has been developed for families with ID: MST-ID. In MST-ID, among other alterations, simplified language and visual support is used, sessions are more structured and more time is scheduled for practicing exercises, and extra attention is paid to the generalisation of what has been learned in the sessions (with the aim of attaining long-term outcomes). Pilot studies show that when compared to standard MST, MST-ID shows similar or better treatment outcomes in families with adolescents with ID. Meanwhile, MST-ID has been disseminated more widely and the target population extended by including families in which only the parent(s) have an ID.
Objective of the study:
The aim of this study is to investigate the effectiveness of MST-ID for adolescents with severe behavioural problems from families with an intellectual disability (ID), compared to standard MST. It is hypothesised that MST-ID is more effective - in terms of fewer behavioural problems, more adolescents living at home, being in school/work, no new police contacts, less parenting stress - than standard MST. Treatment outcomes are considered both quantitatively and qualitatively.
Study design:
Quantitatively, the Propensity Score (PS) method is used to balance treatment groups and, combined with Multilevel Modelling (MLM), to estimate treatment effect over time. Qualitatively, the experiences of approximately 10 adolescents and/or parents are centralised. The qualitative research methods will be decided upon in a participatory manner with respondents (examples of potential research methods are interviews, focus group discussions, or photo elicitation).
Study population:
Adolescents (10-19y) with severe behavioural problems or delinquent behaviours, and their parent(s) receiving MST(-ID) treatment. All research participants must be from families where either the adolescent and/or parent(s) has/have ID.
Intervention:
Following standard referral procedures, families were either referred to standard MST or MST-ID treatment (i.e., non-randomly). Both standard MST and MST-ID are intensive, home-based treatments with 3-5 home visits per week, targeting the severe behavioural problems of adolescents across multiple life domains. MST-ID is tailored to the needs and skill deficits of adolescents and/or parents with ID. Concretely, more attention is paid to how therapists create engagement, implement interventions, and realise support from informal supports, in a tailored, developmentally appropriate, and simplified manner (meaning in a more structured way and using accessible language, among others), when compared to standard MST.
Research questions:
Building on the objectives, the following research questions were formulated:
Primary research questions:
1. Is MST-ID superior, when compared to standard MST, in reducing rule-breaking behaviour of adolescents, according to parents? 2. Is MST-ID superior, when compared to standard MST, in reducing rule-breaking behaviour of adolescents, according to adolescents?
Secondary research questions: 3. Is MST-ID superior, when compared to standard MST, in reducing externalising and internalising behavioural problems of adolescents, according to parents? 4. Is MST-ID superior, when compared to standard MST, in reducing externalising and internalising behavioural problems of adolescents, according to adolescents? 5. Is MST-ID superior, when compared to standard MST, in reducing parenting stress? 6. Is MST-ID superior, when compared to standard MST, in preventing short and long term out-of-home placement, delinquency, truancy or joblessness, and addictions of adolescents? 7. Is MST-ID superior, when compared to standard MST, in realising improvements on family's social networks? 8. Is MST-ID superior, when compared to standard MST, in improving the instrumental outcome parenting skills? 9. Is MST-ID superior, when compared to standard MST, in improving the instrumental outcome family relations? 10. Is MST-ID superior, when compared to standard MST, in improving the instrumental outcome social support? 11. Is MST-ID superior, when compared to standard MST, in improving the instrumental outcome adolescent success in an educational or vocational setting? 12. Is MST-ID superior, when compared to standard MST, in improving the instrumental outcome adolescent involvement with pro-social peers? 13. Is MST-ID superior, when compared to standard MST, in improving the instrumental outcome change in adolescent problem behaviour? 14. What are the experiences of adolescents and/or parents receiving MST-ID treatment? 15. Do effects across subgroups of adolescents and/or parents with ID differ?
MST-ID is expected to be superior in achieving the aforementioned outcomes (#1-13) when compared to standard MST. Research questions #14-15 will be assessed exploratively, therefore no hypotheses have been formulated.
Interventions
- Behavioral Multisystemic therapy
Multisystemic Therapy (MST) is an intensive, evidence-based treatment aimed at preventing out-of-home placement of adolescents with severe behavioural problems. The intervention is home-based and focuses not only on the adolescent, but also on the various systems surrounding the adolescent, such as the family, neighbourhood, school, and friends. MST helps parents increase their parenting competencies such as parental monitoring and find (more) social support in their environment. MST also helps - Behavioral Multisystemic therapy - intellectual disabilities
Multisystemic therapy - intellectual disabilities (MST-ID) is a specialisation of standard MST (see above), tailored to the needs and skill deficits of families in which the adolescent and/or parent(s) has/have a known or suspected ID. In MST-ID, among others, simplified language and visual support are used, and extra attention is paid to the generalisation of what has been learned in the treatment sessions.
Primary outcome measures
- Rule-breaking behaviour of adolescents - parents [Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)]
- Rule-breaking behaviour of adolescents - adolescents [Time frame: Start (T0) and end (T1) of MST(-ID) treatment, an average of 4 months in between]
Secondary outcome measures (12)
- Externalising and internalising behavioural problems of adolescents - parents [Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)]
- Externalising and internalising behavioural problems of adolescents - adolescents [Time frame: Start (T0) and end (T1) of MST(-ID) treatment, an average of 4 months in between]
- Parenting stress [Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)]
- Out-of-home placement [Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)]
- Delinquency [Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)]
- School going or work [Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)]
- Addictions [Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)]
- Social network [Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)]
- IO Percentage of families with improved parenting skills [Time frame: End of MST(-ID) treatment, an average of 4 months after start of treatment]
- IO Percentage of families with improved family relations [Time frame: End of MST(-ID) treatment, an average of 4 months after start of treatment]
- IO Percentage of families with improved social support [Time frame: End of MST(-ID) treatment, an average of 4 months after start of treatment]
- IO Percentage of families with adolescent success in an educational or vocational setting [Time frame: End of MST(-ID) treatment, an average of 4 months after start of treatment]
Eligibility criteria
Referral Criteria:
- Known or suspected ID of the referred adolescent and/or their parent(s);
- Educational level of the referred adolescent and/or highest attained diploma of their parent(s) is indicative of potential ID.
Inclusion Criteria Study Sample:
- Adolescent must be 10 to 19 years old at the start of treatment;
- Adolescent presents with severe behavioural problems in at least two life areas;
- Adolescent lives with a family or there is a family the adolescent can live with, in which parent(s) have parental custody for a longer period of time;
- Parent(s) consent(s) and is/are willing to engage in treatment to prevent an out-of-home placement of the adolescent;
- Adolescent and/or parent(s) have a known or suspected intellectual disability (operationalised as an intelligence quotient \[IQ\] score of between 50-85 and additional deficits in adaptive functioning)
- Adolescent and/or parent(s) have sufficient knowledge of the Dutch language (as assessed by a clinician and/or researcher) in order to understand and answer the various (self-report) questionnaires.
Exclusion Criteria Study Participation:
- Adolescent lives independently;
- Adolescent presents with severe problematic sexual behaviours, without presenting with other severe behavioural problems;
- Adolescent presents suicidal, psychotic, or homicidal requiring specialised treatment (such as a crisis placement in a residential facility);
- Adolescent has a severe Autism Spectrum Disorder (level 2-3 according to the Diagnostic and Statistical Manual of Mental Disorders \[DSM-V\] criteria) or a severe ID (IQ score <50);
- Adolescent has internalising psychiatric problems which are the primary reason for referral, or has serious psychiatric problems (similar to #3 as well as for example eating disorder.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Case-control
Study locations
Netherlands · 4 centers
- De Viersprong — Halsteren
- Koraal — Sittard
- Stichting Prisma — Waalwijk
- Pactum — Zetten
Publications
- Emerson E, Einfeld S, Stancliffe RJ. Predictors of the persistence of conduct difficulties in children with cognitive delay. J Child Psychol Psychiatry. 2011 Nov;52(11):1184-94. doi: 10.1111/j.1469-7610.2011.02413.x. Epub 2011 Apr 19. PMID 21501168
- Blankestein A, van der Rijken R, Eeren HV, Lange A, Scholte R, Moonen X, De Vuyst K, Leunissen J, Didden R. Evaluating the effects of multisystemic therapy for adolescents with intellectual disabilities and antisocial or delinquent behaviour and their parents. J Appl Res Intellect Disabil. 2019 May;32(3):575-590. doi: 10.1111/jar.12551. Epub 2019 Jan 8. PMID 30620111
- Blankestein A, Lange A, van der Rijken R, Scholte R, Moonen X, Didden R. Brief report: Follow-up outcomes of multisystemic therapy for adolescents with an intellectual disability and the relation with parental intellectual disability. J Appl Res Intellect Disabil. 2020 May;33(3):618-624. doi: 10.1111/jar.12691. Epub 2019 Dec 28. PMID 31883357
- De Ruiter KP, Dekker MC, Douma JCH, Verhulst FC, Koot HM. Development of parent- and teacher-reported emotional and behavioural problems in young people with intellectual disabilities: Does level of intellectual disability matter? J Appl Res Intellect Disabil. 2008; 21(1): 70-80.
- Wallander JL, Dekker MC, Koot HM. Psychopathology in children and adolescents with intellectual disability: Measurement, prevalence, course, and risk. International Review of Research in Mental Retardation. 2003; 26: 93-134.
- Blankestein A, Van der Rijken R, De Vuyst K, De Bruijn J, Moonen X, Leunissen J, Didden R. Multisysteemtherapie voor jongeren met een licht verstandelijke beperking en hun ouders: Een onderzoek naar de effectiviteit van een ambulante systeemgerichte interventie. Directieve Therapie. 2016; 36(3): 204-219. Dutch.
- Dekker MC. Short Review: Psychopathology in young people with mild ID or borderline intellectual functioning: Research findings from representative (clinical) samples & future needs. Academische Werkplaats Kajak. 2019.
- Henggeler SW, Schoenwald SK, Borduin CM, Rowland MD, Cunningham PB. Multisystemic therapy for antisocial behavior in children and adolescents. 2nd ed. New York: The Guilford Press; 2009.
Identifiers
NCT: NCT06032455 · 303