Multisystemic Therapy vs Management as Usual for Adolescents With Antisocial Behavior

depression, depressed teen, adolescent, young adult
depression, depressed teen, adolescent, young adult
Study participants received either management as usual or multisystemic therapy for moderate-to-severe antisocial behavior.

Multisystemic therapy is not superior to usual management of adolescents with moderate-to-severe antisocial behavior, according to research published in Lancet Psychiatry.

Researchers from the United Kingdom conducted an 18-month, multisite, pragmatic, controlled superiority trial (START; Systematic Therapy for At Risk Teens) in 11- to 17-year-olds with moderate-to-severe antisocial behavior. 

Between February 4, 2010, and September 1, 2012, 684 adolescents were randomly assigned to receive either 18 months of management as usual or 3 to 5 months of multisystemic therapy followed by management as usual (n=342 for both).

At 18 months, there was no significant difference in the proportion of adolescents in out-of-home placement between the treatment groups (13% in the multisystemic therapy group vs 11% in the management as usual group [P =.37]).

Antisocial behavior in adolescence is a widespread and serious problem, with consequences for the youths involved, their families, and society as a whole. Studies in the United States have shown that multisystemic therapy reduces antisocial behavior and criminal offenses committed by this group; however, findings from the START study do not lend support to this treatment approach.

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The authors noted several limitations. Management as usual was not homogeneous, and there was considerable between-site variation in the interventions provided. The authors plan future analysis to determine whether these factors had any effect on the outcomes. Management as usual may also have offered greater flexibility in addressing the specific needs of the individual.

As for the greater efficacy found for multisystemic therapy in the American studies, the authors suggested that this may be attributable to the greater efficacy of management as usual in the United Kingdom rather than the efficacy of the multisystemic approach in the United States.


Fonagy P, Butler S, Cottrell D, et al. Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): a pragmatic, randomised controlled, superiority trial [published online January 4, 2018]. Lancet Psychiatry. doi:10.1016/S2215-0366(18)30001-4