An observational study in Behavioural Problems, sponsored by De Viersprong. Recruiting at 4 sites in Netherlands. Open to participants aged 10 Years to 19 Years. Per ClinicalTrials.gov, last updated 2026-04-13.
Sponsored by De Viersprong · Observational
The goal of this observational study is to determine the effectiveness of a specialisation of multisystemic therapy (MST) for adolescents with severe behavioural problems from families with an intellectual disability (ID; MST-ID).
To achieve this goal, a mixed method study design is used. To this end, a quantitative and a qualitatively primary research question are formulated:
Participants will be asked to complete two screeners (questionnaires delivered as a verbal interview) with a total duration of approximately 30 minutes. Other data will be collected through Routine Outcome Monitoring questionnaires that are part of standard MST procedures. To this end, five 'time points' have been identified: T0 (start of MST[-ID] treatment), T1 (end of MST[-ID] treatment), T2 (follow-up 6 month after MST[-ID] treatment), T3 (follow-up 12 month after MST[-ID] treatment), and T4 (follow-up 18 month after MST[-ID] treatment). The qualitative method used to gain insight into families' experiences is determined in consultation with the families.
To assess the effectiveness of MST-ID, its treatment outcomes will be compared to standard MST treatment outcomes of families with ID.
Background of the study:
Over the years, a large body of research has shown that adolescents with intellectual disability are 3-4 times more likely to develop severe behaviour problems than adolescents without intellectual disability. Families in which adolescents and/or one or both parent(s) have an intellectual disability (from now on, families with ID) often deal with complex problems, putting the adolescent at an increased risk of out-of-home placement. Multisystemic therapy (MST) is an intensive home-based treatment, effective in reducing severe behaviour problems and preventing the out-of-home placement of adolescents. A specialisation of MST has been developed for families with ID: MST-ID. In MST-ID, among other alterations, simplified language and visual support is used, sessions are more structured and more time is scheduled for practicing exercises, and extra attention is paid to the generalisation of what has been learned in the sessions (with the aim of attaining long-term outcomes). Pilot studies show that when compared to standard MST, MST-ID shows similar or better treatment outcomes in families with adolescents with ID. Meanwhile, MST-ID has been disseminated more widely and the target population extended by including families in which only the parent(s) have an ID.
Objective of the study:
The aim of this study is to investigate the effectiveness of MST-ID for adolescents with severe behavioural problems from families with an intellectual disability (ID), compared to standard MST. It is hypothesised that MST-ID is more effective - in terms of fewer behavioural problems, more adolescents living at home, being in school/work, no new police contacts, less parenting stress - than standard MST. Treatment outcomes are considered both quantitatively and qualitatively.
Study design:
Quantitatively, the Propensity Score (PS) method is used to balance treatment groups and, combined with Multilevel Modelling (MLM), to estimate treatment effect over time. Qualitatively, the experiences of approximately 10 adolescents and/or parents are centralised. The qualitative research methods will be decided upon in a participatory manner with respondents (examples of potential research methods are interviews, focus group discussions, or photo elicitation).
Study population:
Adolescents (10-19y) with severe behavioural problems or delinquent behaviours, and their parent(s) receiving MST(-ID) treatment. All research participants must be from families where either the adolescent and/or parent(s) has/have ID.
Intervention:
Following standard referral procedures, families were either referred to standard MST or MST-ID treatment (i.e., non-randomly). Both standard MST and MST-ID are intensive, home-based treatments with 3-5 home visits per week, targeting the severe behavioural problems of adolescents across multiple life domains. MST-ID is tailored to the needs and skill deficits of adolescents and/or parents with ID. Concretely, more attention is paid to how therapists create engagement, implement interventions, and realise support from informal supports, in a tailored, developmentally appropriate, and simplified manner (meaning in a more structured way and using accessible language, among others), when compared to standard MST.
Research questions:
Building on the objectives, the following research questions were formulated:
Primary research questions:
Is MST-ID superior, when compared to standard MST, in reducing rule-breaking behaviour of adolescents, according to adolescents?
Secondary research questions:
MST-ID is expected to be superior in achieving the aforementioned outcomes (#1-13) when compared to standard MST. Research questions #14-15 will be assessed exploratively, therefore no hypotheses have been formulated.
387 studies on the registry are indexed under Intellectual Disability; 105 are open to participants now.
This study's planned enrollment of 470 is above the median of 150 across 125 observational studies indexed under Intellectual Disability.
Browse Intellectual Disability studies →De Viersprong is the lead sponsor of 4 studies on the registry; 2 are open to participants now.
Compared within Intellectual Disability, this study's primary condition as ClinicalTrials.gg classifies it; the registry's first condition term is Mental Disorders. The counts are of registry records indexed under each term, refreshed daily. How we classify →
The target population consists of adolescents and their parent(s) with a known or suspected ID referred to MST-ID at one of three Dutch mental health care organisations (de Viersprong, Koraal, and Prisma) or to standard MST at one of two Dutch mental health care organisations (de Viersprong and Pactum).
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Referral Criteria:
Inclusion Criteria Study Sample:
Exclusion Criteria Study Participation:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
The American Psychiatric Association’s manual of mental health diagnoses. DSM-5 (2013, revised as DSM-5-TR in 2022) replaced DSM-IV, and some studies still name the older edition. “Meets DSM criteria for …” means diagnosed by that edition’s diagnostic criteria, usually by a clinician in an interview.
DSM diagnostic criteria
The American Psychiatric Association’s manual of mental health diagnoses. DSM-5 (2013, revised as DSM-5-TR in 2022) replaced DSM-IV, and some studies still name the older edition. “Meets DSM criteria for …” means diagnosed by that edition’s diagnostic criteria, usually by a clinician in an interview.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Families in which the adolescent and/or parent(s) has/have an ID receiving standard MST treatment
Behavioral: Multisystemic therapy
Families in which the adolescent and/or parent(s) has/have an ID receiving MST-ID treatment
Behavioral: Multisystemic therapy - intellectual disabilities
Multisystemic Therapy (MST) is an intensive, evidence-based treatment aimed at preventing out-of-home placement of adolescents with severe behavioural problems. The intervention is home-based and focuses not only on the adolescent, but also on the various systems surrounding the adolescent, such as the family, neighbourhood, school, and friends. MST helps parents increase their parenting competencies such as parental monitoring and find (more) social support in their environment. MST also helps adolescents improve their relationship with their parents, school participation, and social activities, and promotes contact with pro-social peers. These goals are achieved by working together with key figures in the family's environment. MST treatment duration is three to five months. In MST, a family can contact a therapist 24/7.
Also known as: MST
Multisystemic therapy - intellectual disabilities (MST-ID) is a specialisation of standard MST (see above), tailored to the needs and skill deficits of families in which the adolescent and/or parent(s) has/have a known or suspected ID. In MST-ID, among others, simplified language and visual support are used, and extra attention is paid to the generalisation of what has been learned in the treatment sessions.
Also known as: MST-ID
Rule-breaking behaviour of adolescents - parents
Rule-breaking behaviour of adolescents according to parents will be assessed using the Child Behavior Check List (CBCL). The CBCL consists of 118 questions rated on a 3-point scale from 0 (absent) to 2 (occurs often). Higher scores indicate that adolescents experience more problems.
Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)
Rule-breaking behaviour of adolescents - adolescents
Rule-breaking behaviour of adolescents according to parents will be assessed using the Youth Self Report (YSR). The YSR consists of 112 questions rated on a 3-point scale from 0 (absent) to 2 (occurs often). Higher scores indicate that adolescents experience more problems.
Time frame: Start (T0) and end (T1) of MST(-ID) treatment, an average of 4 months in between
Externalising and internalising behavioural problems of adolescents - parents
Externalising and internalising behavioural problems of adolescents will be assessed using the Child Behavior Check List (CBCL). The CBCL consists of 118 questions rated on a 3-point scale from 0 (absent) to 2 (occurs often). Higher scores indicate that adolescents experience more problems.
Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)
Externalising and internalising behavioural problems of adolescents - adolescents
Externalising and internalising behavioural problems of adolescents according to adolescents will be assessed using the Youth Self Report (YSR). The YSR consists of 112 questions rated on a 3-point scale from 0 (absent) to 2 (occurs often). Higher scores indicate that adolescents experience more problems.
Time frame: Start (T0) and end (T1) of MST(-ID) treatment, an average of 4 months in between
Parenting stress
Parenting stress will be assessed using the Parenting Stress Questionnaire (PSQ), which is the English version of the Dutch Opvoedingsbelasting Vragenlijst (OBVL). The PSQ consists of 34 questions rated on a 4-point scale from 1 (not true) to 4 (very true). Higher scores indicate more parenting stress.
Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)
Out-of-home placement
Out-of-home placement of adolescents will be assessed using the Social Demographic Information 3.0 questionnaire (SDI 3.0).
Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)
Delinquency
Delinquency of adolescents is operationalized as police contact and will be assessed using the SDI 3.0.
Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)
School going or work
The adolescent's school going or work is operationalised as "school going that meets the expectations of the school or public education law officer or work that meets the expectations of caregivers and the referring agent" and will be assessed using the SDI 3.0.
Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)
Addictions
Addictions of adolescents are operationalised as "adolescent drug misuse/abuse, screen or game dependency that has resulted in addiction, and/or other addictions" and will be assessed using the SDI 3.0.
Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)
Social network
Social network is operationalised as "forms of social network available to a family and number of supports (read: individuals) that are available to the family" and will be assessed using the SDI 3.0.
Time frame: Start of MST(-ID) treatment (T0) until 18-month follow up (T4)
IO Percentage of families with improved parenting skills
MST's so called "instrumental outcomes" (IOs) identify skills which are instrumental to achieving positive treatment outcomes and are reported by therapists. The first IO assesses whether or not families show improved parenting skills, answered 'yes' or 'no'.
Time frame: End of MST(-ID) treatment, an average of 4 months after start of treatment
IO Percentage of families with improved family relations
MST's so called "instrumental outcomes" (IOs) identify skills which are instrumental to achieving positive treatment outcomes and are reported by therapists. The second IO assesses whether or not families show improved family relations, answered 'yes' or 'no'.
Time frame: End of MST(-ID) treatment, an average of 4 months after start of treatment
IO Percentage of families with improved social support
MST's so called "instrumental outcomes" (IOs) identify skills which are instrumental to achieving positive treatment outcomes and are reported by therapists. The third IO assesses whether or not families show improved social support, answered 'yes' or 'no'.
Time frame: End of MST(-ID) treatment, an average of 4 months after start of treatment
IO Percentage of families with adolescent success in an educational or vocational setting
MST's so called "instrumental outcomes" (IOs) identify skills which are instrumental to achieving positive treatment outcomes and are reported by therapists. The fourth IO assesses whether or not the adolescent obtained success in an educational or vocational setting, answered 'yes' or 'no'.
Time frame: End of MST(-ID) treatment, an average of 4 months after start of treatment
IO Percentage of families with adolescent involvement with pro-social peers
MST's so called "instrumental outcomes" (IOs) identify skills which are instrumental to achieving positive treatment outcomes and are reported by therapists. The fifth IO assesses whether or not the adolescent is involved with pro-social peers, answered 'yes' or 'no'.
Time frame: End of MST(-ID) treatment, an average of 4 months after start of treatment
IO Percentage of families with change in adolescent problem behaviour
MST's so called "instrumental outcomes" (IOs) identify skills which are instrumental to achieving positive treatment outcomes and are reported by therapists. The sixth IO assesses whether or not the adolescent obtained changes in problem behaviour that were sustained for 3-4 weeks, answered 'yes' or 'no'.
Time frame: End of MST(-ID) treatment, an average of 4 months after start of treatment
Family and treatment characteristics
Characteristics of families that are gathered are previous treatment, referral stream and the following: Adolescent: age, gender identity, cultural background, prior residential placement, living situation, level of education Primary caregiver: level of education, employment status, partner, experienced financial stress, experienced living situation stress
Time frame: Start of MST(-ID) treatment (T0)
Intellectual functioning
Intellectual functioning will be assessed using the Dutch Screener for Intelligence and Learning Disabilities (SCIL). The SCIL consists of 14 questions that result in a total SCIL score that can range from 0 to 28. A total SCIL score of 19 and below indicates the presence of intellectual disabilities.
Time frame: Start of MST(-ID) treatment (T0)
Adaptive functioning
Adaptive functioning will be assessed using the Dutch Screener for Adaptive Functioning and Learning Disabilities (SCAF). The SCAF consists of 12 questions that result in a total SCAF score that can range from 0 to 13. A higher score indicates a higher level of adaptive functioning.
Time frame: Start of MST(-ID) treatment (T0)
Treatment fidelity
Treatment fidelity is measured and checked through administration of a validated questionnaire to the primary caregiver of each family (TAM-R).
Time frame: Monthly throughout MST(-ID) treatment, an average of 4 months
Subgroups of ID families
Families included in this study are divided across three subsamples: families in which only the adolescent, only the parent(s), and both the adolescent and parent(s) have ID. This This variable will be calculated based on participants' SCIL scores.
Time frame: Start of MST(-ID) treatment (T0)
Experiences of families receiving MST-ID
Experiences of families receiving MST-ID will be assessed using participatory and qualitative research methods. The aim is to recruit 10 adolescents or parents and to ask them to help identify which elements of MST-ID are most important to them, and which elements were found least and most helpful. This can lead to a better understanding of what works well and less well in MST-ID treatments. Potential qualitative research methods are focus group discussions, peer-interviewing, and photo-elicitation/photo voice.
Time frame: Through study completion, an average of 1 year
Plan to share: No
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