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.
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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.
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