Do Extremely Violent Juveniles Respond Differently to Treatment?

• Date: 01 March 2018
• Author: Peter H. Van der Laan,Alithe L. Van den Akker,M. Deković,Pier J. M. Prins,Jessica J. Asscher
• DOI: 10.1177/0306624X16670951
• Published date: 01 March 2018
• Subject Matter: Articles

https://doi.org/10.1177/0306624X16670951

International Journal of

Offender Therapy and

Comparative Criminology

2018, Vol. 62(4) 958 –977

© The Author(s) 2016

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DOI: 10.1177/0306624X16670951

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Article

Do Extremely Violent

Juveniles Respond

Differently to Treatment?

Jessica J. Asscher1, M. Deković2,

Alithe L. Van den Akker1, Pier J. M. Prins1,

and Peter H. Van der Laan3,4

Abstract

This study increases knowledge on effectiveness of treatment for extremely violent (EV)

youth by investigating their response to multisystemic therapy (MST). Using data of

a randomized controlled trial on effectiveness of MST, we investigated differences in

treatment response between EV youth and not extremely violent (NEV) youth. Pre-

to post-treatment comparison indicated MST was equally effective for EV and NEV

youth, whereas treatment as usual was not effective for either group. Growth curves of

within-treatment changes indicated EV youth responded differently to MST than NEV

youth. The within-treatment change was for EV youth non-linear: Initially, they show

a deterioration; however, after one month, EV juveniles respond positively to MST,

indicating longer lasting, intensive programs may be effective in treating extreme violence.

Keywords

treatment response, multisystemic therapy (MST), extremely violent (EV) juvenile

delinquents, externalizing behavior problems, parent–adolescent relationship quality

Delinquent acts, especially extreme violence, committed by juveniles attract much

societal attention and often have an enormous impact. Extreme violence leads to large

societal costs, directly associated with involvement of the judicial system (Azur,

1University of Amsterdam, The Netherlands

2Utrecht University, The Netherlands

3Vrije Universiteit Amsterdam, The Netherlands

4Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, The Netherlands

Corresponding Author:

Jessica J. Asscher, Forensic Child and Youth Care Sciences, University of Amsterdam, P.O. Box

15776, 1001 NG Amsterdam, The Netherlands.

Email: j.j.asscher@uva.nl

670951IJOXXX10.1177/0306624X16670951International Journal of Offender Therapy and Comparative CriminologyAsscher et al.

research-article2016

Asscher et al. 959

Garrazza & Goldweber, 2011). Victimization, in addition, leads to significant costs

due to the involvement of mental health services (Delisi & Gatling, 2003; DeLisi

et al., 2010; DeLisi & Piquero, 2011). Antisocial behaviors cost American society

more than one trillion dollars each year (Anderson, 1999). Given the high economical

and psychological costs, it is important to improve treatment and prevention efforts for

extremely violent juveniles.

In the present study, we examined whether multisystemic therapy (MST) is an

effective treatment for extremely violent youth. MST is a treatment program for per-

sistent and serious juvenile delinquents (see for an overview, Henggeler, 2011). It is

based on Bronfenbrenner’s (1979) socio-ecological model, stating that the develop-

ment of all behavior, and thus also the development of antisocial behavior, is the result

of the interactions between individuals and the various systems in which they find

themselves. In line with this model, MST focuses on risk factors of juveniles and their

families within and between the different systems. This broad focus (on the various

systems, the juvenile is embedded in, rather than on, the problem behavior specifi-

cally) is more likely to be effective with complex problems such as extreme violence

than programs focusing on a single aspect of the problem, such as individual self-

regulation (Farmer, Compton, Burns, & Robertson, 2002; Le’Roy, Vera, Simon, &

Ikeda, 2000). Extreme violence is the most severe category of violent offenses, with a

long sentence threat for offenders (i.e., those juveniles who have committed murder,

or have used excessive violence in, for example, armed robberies; Farrington &

Loeber, 2000). Although all the juveniles who receive MST show persistent and seri-

ous antisocial behavior, not all of them can be considered to be extremely violent (as

those juveniles committed offenses such as robbery, theft from homes, possession of

weapons, gang membership, drug possession, and trafficking). To our knowledge,

none of the trials has identified whether MST is effective for the most severe category

of violent offenders.

MST is likely to be effective for this specific group, as it is one of the few interven-

tions that is well adjusted to the specific characteristics of the problem behavior

intended to treat, as well as to the specific risk and protective factors for the onset and

continuation of the problems of extremely violent juveniles (Farmer et al., 2002;

Tzoumakis, Lussier, & Corrado, 2014). In addition, Azur and colleagues (2011)

showed that although delinquency decreases over time, violence does not.

Consequently, interventions are needed that reduce violence. Interventions aimed at

reducing extreme violence should be based on empirically supported theories and on

those (risk) factors that have been shown to be related to the onset and/or persistence

of extreme violence. However, the literature regarding extreme violence is still lim-

ited, as much more research efforts have gone into identifying the factors that play a

role in the onset and persistence of antisocial behavior in general, or in the predictors

of persistent violence (e.g., Corrado, DeLisi, Hart, & McCuish, 2015), rather than

extreme violence per se (Dishion, French, & Patterson, 1995; Dodge & Pettit, 2003).

MST may thus be suitable for extremely violent youth, given its theoretical basis

focusing on risk factors that are linked with the development of antisocial behavior. In

addition, because MST is intensive in nature and can be flexibly adjusted to specific