title: Heterogeneity in Response during Multisystemic Therapy: Exploring Subgroups and Predictors.
abstract: Multiple studies have shown that Multisystemic Therapy (MST) is, at group level, an effective treatment for adolescents showing serious externalizing problem behavior. The current study expands previous research on MST by, first, examining whether subgroups of participants who respond differently to treatment could be identified. Second, we investigated if the different trajectories of change during MST could be predicted by individual (hostile attributions) and contextual (parental sense of parenting competence and deviant and prosocial peer involvement) pre-treatment factors. Participants were 147 adolescents (mean age = 15.91 years, 104 (71%) boys) and their parents who received MST. Pre-treatment assessment of the predictors and 5 monthly assessments of externalizing behavior during treatment took place using both adolescent and parents' self-reports. Six distinct subgroups, showing different trajectories of change in externalizing problem behavior during MST, were identified. Two of the 6 trajectories of change showed a poor treatment response, as one class did not change in externalizing problem behavior and the other class even increased. The remaining 4 trajectories displayed a positive effect of MST, by showing a decrease in externalizing behavior. Most of these trajectories could be predicted by parental sense of parenting competence. Additionally, lower involvement with prosocial peers was a predictor of the group that appeared to be resistant to MST. Adolescents do respond differently to MST, which indicates the importance of personalizing treatment. Protective factors, such as parental sense of parenting competence and prosocial peers, seem to require additional attention in the first phase of MST.
authors.affiliation: Department of Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, The Netherlands. e.c.a.mertens@uu.nl.
authors.forename: Esther C A
authors.initials: ECA
authors.lastname: Mertens
authors.affiliation: Department of Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, The Netherlands.
authors.forename: Maja
authors.initials: M
authors.lastname: Deković
authors.affiliation: Research Centre for Forensic Child and Youth Care Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Asscher
authors.affiliation: Youth Spot, Amsterdam University of Applied Sciences, Wibautstraat 5a, 1091 GH, Amsterdam, The Netherlands.
authors.forename: Willeke A
authors.initials: WA
authors.lastname: Manders
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002648:Child; D005260:Female; D006791:Hostility; D006801:Humans; D007604:Juvenile Delinquency; D008297:Male; D017063:Outcome Assessment, Health Care; D016487:Parenting / Q000523:psychology*; D010379:Peer Group; D000066553:Problem Behavior / Q000523:psychology*; D011615:Psychotherapy, Group / Q000379:methods*; D012919:Social Behavior
keywords: Externalizing problems; MST; Parental sense of competence; Prosocial peers; Trajectories