TY - JOUR
T1 - START NOW
T2 - a cognitive behavioral skills training for adolescent girls with conduct or oppositional defiant disorder – a randomized clinical trial
AU - Stadler, Christina
AU - Freitag, Christine M.
AU - Popma, Arne
AU - Nauta-Jansen, Lucres
AU - Konrad, Kerstin
AU - Unternaehrer, Eva
AU - Ackermann, Katharina
AU - Bernhard, Anka
AU - Martinelli, Anne
AU - Oldenhof, Helena
AU - Gundlach, Malou
AU - Kohls, Gregor
AU - Prätzlich, Martin
AU - Kieser, Meinhard
AU - Limprecht, Ronald
AU - Raschle, Nora M.
AU - Vriends, Noortje
AU - Trestman, Robert L.
AU - Kirchner, Marietta
AU - Kersten, Linda
AU - Jansen, L.M.C.
N1 - Funding Information:
This study was supported by the European Commission FP7 program, Grant no. 602407 FemNAT‐CD (coordinator: C.M. Freitag). The EC was not involved in study design, data analysis or publication of the project.
Funding Information:
The authors are grateful for all female adolescents and staff from youth welfare institutions that have participated in this study. C.M.F. receives royalties for books and book chapters on ASD, ADHD, ODD, CD, and MDD. She has served as consultant for Servier in 2021. She currently receives research funding by the German Research Association (DFG), the European Commission (EC), and the German Ministry of Science and Education (BMBF). N.M.R. receives funding from the Hochschulmedizin Zurich (HMZ, STRESS), the University of Zurich Research Priority Program ‘Adaptive Brain Circuits in Development and Learning (URPP AdaBD)’ and the Swiss National Science Foundation (105314_207624). The remaining authors have declared that they have no competing or potential conflicts of interest. Furthermore, the authors want to thank Prof. Dr. Chris Kuiper and Drs. Frederique Coelman for their support on conducting this study in youth welfare institutions in The Netherlands. Open access funding provided by Universitat Basel.
Publisher Copyright:
© 2023 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
PY - 2024
Y1 - 2024
N2 - Background: Conduct disorder (CD) and oppositional defiant disorder (ODD) both convey a high risk for maladjustment later in life and are understudied in girls. Here, we aimed at confirming the efficacy of START NOW, a cognitive-behavioral, dialectical behavior therapy-oriented skills training program aiming to enhance emotion regulation skills, interpersonal and psychosocial adjustment, adapted for female adolescents with CD or ODD. Methods: A total of 127 girls were included in this prospective, cluster randomized, multi-center, parallel group, quasi-randomized, controlled phase III trial, which tested the efficacy of START NOW (n = 72) compared with standard care (treatment as usual, TAU, n = 55). All female adolescents had a clinical diagnosis of CD or ODD, were 15.6 (±1.5) years on average (range: 12–20 years), and were institutionalized in youth welfare institutions. The two primary endpoints were the change in number of CD/ODD symptoms between (1) baseline (T1) and post-treatment (T3), and (2) between T1 and 12-week follow-up (T4). Results: Both treatment groups showed reduced CD/ODD symptoms at T3 compared with T1 (95% CI: START NOW = −4.87, −2.49; TAU = −4.94, −2.30). There was no significant mean difference in CD/ODD symptom reduction from T1 to T3 between START NOW and TAU (−0.056; 95% CI = −1.860, 1.749; Hedge's g = −0.011). However, the START NOW group showed greater mean symptom reduction from T1 to T4 (−2.326; 95% CI = −4.274, −0.378; Hedge's g = −0.563). Additionally, secondary endpoint results revealed a reduction in staff reported aggression and parent-reported irritability at post assessment. Conclusions: Although START NOW did not result in greater symptom reduction from baseline to post-treatment compared with TAU, the START NOW group showed greater symptom reduction from baseline to follow-up with a medium effect size, which indicates a clinically meaningful delayed treatment effect.
AB - Background: Conduct disorder (CD) and oppositional defiant disorder (ODD) both convey a high risk for maladjustment later in life and are understudied in girls. Here, we aimed at confirming the efficacy of START NOW, a cognitive-behavioral, dialectical behavior therapy-oriented skills training program aiming to enhance emotion regulation skills, interpersonal and psychosocial adjustment, adapted for female adolescents with CD or ODD. Methods: A total of 127 girls were included in this prospective, cluster randomized, multi-center, parallel group, quasi-randomized, controlled phase III trial, which tested the efficacy of START NOW (n = 72) compared with standard care (treatment as usual, TAU, n = 55). All female adolescents had a clinical diagnosis of CD or ODD, were 15.6 (±1.5) years on average (range: 12–20 years), and were institutionalized in youth welfare institutions. The two primary endpoints were the change in number of CD/ODD symptoms between (1) baseline (T1) and post-treatment (T3), and (2) between T1 and 12-week follow-up (T4). Results: Both treatment groups showed reduced CD/ODD symptoms at T3 compared with T1 (95% CI: START NOW = −4.87, −2.49; TAU = −4.94, −2.30). There was no significant mean difference in CD/ODD symptom reduction from T1 to T3 between START NOW and TAU (−0.056; 95% CI = −1.860, 1.749; Hedge's g = −0.011). However, the START NOW group showed greater mean symptom reduction from T1 to T4 (−2.326; 95% CI = −4.274, −0.378; Hedge's g = −0.563). Additionally, secondary endpoint results revealed a reduction in staff reported aggression and parent-reported irritability at post assessment. Conclusions: Although START NOW did not result in greater symptom reduction from baseline to post-treatment compared with TAU, the START NOW group showed greater symptom reduction from baseline to follow-up with a medium effect size, which indicates a clinically meaningful delayed treatment effect.
KW - Conduct disorder
KW - aggression
KW - oppositional-defiant disorder
KW - randomized-trial
UR - https://www.scopus.com/pages/publications/85173775504
U2 - 10.1111/jcpp.13896
DO - 10.1111/jcpp.13896
M3 - Article
C2 - 37814906
SN - 0021-9630
JO - Journal of Child Psychology and Psychiatry and Allied Disciplines
JF - Journal of Child Psychology and Psychiatry and Allied Disciplines
ER -
SDG 5 Gender Equality