UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): a pragmatic, randomised controlled, superiority trial

Fonagy, P; Butler, S; Cottrell, D; Scott, S; Pilling, S; Eisler, I; Fuggle, P; ... Goodyer, IM; + view all (2018) Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): a pragmatic, randomised controlled, superiority trial. The Lancet Psychiatry , 5 (2) pp. 119-133. 10.1016/S2215-0366(18)30001-4. Green open access

[img]
Preview
Text
Fonagy_START paper for resubmission 161117 cleanCombined.pdf - Accepted version

Download (3MB) | Preview

Abstract

BACKGROUND: Adolescent antisocial behaviour is a major health and social problem. Multisystemic Therapy (MST) has reduced symptoms and offending rate in US trials, but non-US findings are equivocal. METHODS: We conducted an 18-month multisite pragmatic randomised controlled superiority trial in England. Adolescents (aged 11–17) with moderate to severe antisocial behaviour received either management as usual (MAU; n=342) or 3–5 months of MST followed by MAU (n=342). Primary outcome was proportion of out-of-home placements. Secondary outcomes included offending data, service and criminal justice sector costs, participant wellbeing, and substance misuse, measured at baseline, 6, 12, and 18 months. We used logistic regression for the primary outcome and mixed-effects regression models for secondary outcomes. OUTCOMES: At 18 months the treatment effect for out-of-home placement was not significant (OR 1·25, 95% CI 0·77–2·05; p=0·37). Time to first offence was also comparable but the number of offences was higher for the MST group at 18 months. There were consistent short-term symptom reductions from MST in some secondary outcomes, but no evidence of sustained superiority on most secondary outcomes. Conduct disorder diagnoses were reduced by >40% in both groups. Mean total service costs were not significantly different. INTERPRETATION: The findings do not support MST over MAU as the intervention of choice for adolescents with moderate to severe antisocial behaviour. MST achieves some early symptomatic gains on parent-rated outcomes, but not those based on independent records, which after 12 months favour MAU.

Type: Article
Title: Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): a pragmatic, randomised controlled, superiority trial
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/S2215-0366(18)30001-4
Publisher version: https://doi.org/10.1016/S2215-0366(18)30001-4
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Adolescent, Antisocial behaviour, Conduct disorder, Family treatment, Multisystemic Therapy, Randomised controlled trial, United Kingdom, Youth
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
URI: https://discovery.ucl.ac.uk/id/eprint/10037910
Downloads since deposit
121Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item