Trial reportThe lancet. Psychiatry2018
Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): a pragmatic, randomised controlled, superiority trial.
Trial report in The lancet. Psychiatry, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 102 citations in OpenAlex.
- Predicting criminal offence in adolescents who exhibit antisocial behaviour: a machine learning study using data from a large randomised controlled trial of multisystemic therapy.European child & adolescent psychiatry · 2025Trial
- Measuring Outcomes in Evaluations of Interventions to Prevent Youth Crime and Violence: Challenges and Potential Solutions.Journal of prevention (2022) · 2026Article
- Promoting Positive Youth Development with Adolescent Boys in UK Schools: A Theory-Driven Evaluation of the "Becoming a Man" Programme.Journal of prevention (2022) · 2026Article
- Preventing Youth Crime and Violence: Intervention and Evaluation Issues.Behavioral sciences (Basel, Switzerland) · 2026Review
- The Lifelong Impact of Bullying Behaviours on Crime Through David Farrington's Legacy.Criminal behaviour and mental health : CBMH · 2025Article
- Childhood psychosocial adjustment and midlife obesity, diabetes and hypertension: prospective study from two birth cohorts.The British journal of psychiatry : the journal of mental science · 2024Article
- Missing outcome data in randomised clinical trials of psychological interventions: a review of published trial reports in major psychiatry journals.BMC psychiatry · 2024Review
- Identification of treatment elements for adolescents with callous unemotional traits: a systematic narrative review.Child and adolescent psychiatry and mental health · 2024Review
- The Profile and Characteristics of Young People Accessing Recently Implemented Community Forensic Child and Adolescent Mental Health Services (F:CAMHS) in Northern Ireland.Journal of child & adolescent trauma · 2024Article
- Transporting an Evidence-based Youth Development Program to a New Country: A Narrative Description and Analysis of Pre-implementation Adaptation.Journal of prevention (2022) · 2023Article
- Reducing the risk of criminal exploitation using multi-systemic therapy (the RESET Study): study protocol for a feasibility study and process evaluation.Pilot and feasibility studies · 2023Article
- Evidence Base Update of Psychosocial Treatments for Adolescents with Disruptive Behavior.Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 · 2023Article
- Developing a predictive signature for two trial endpoints using the cross-validated risk scores method.Biostatistics (Oxford, England) · 2023Article
- A scoping review of system-level mechanisms to prevent children being in out-of-home care.British journal of social work · 2022Article
- Promoting Learning from Null or Negative Results in Prevention Science Trials.Prevention science : the official journal of the Society for Prevention Research · 2022Article
- Improving treatment outcomes for adolescents with borderline personality disorder through a socioecological approach.Borderline personality disorder and emotion dysregulation · 2022Article
- Antisocial cognition as a mediator of the peer influence effect and peer selection effect in antisocial adolescents.European child & adolescent psychiatry · 2022Article
- Family-based treatments for disruptive behavior problems in children and adolescents: An updated review of rigorous studies (2014-April 2020).Journal of marital and family therapy · 2022Review
- Bullying behaviours and other conduct problems: longitudinal investigation of their independent associations with risk factors and later outcomes.Social psychiatry and psychiatric epidemiology · 2021Article
- Developing and testing high-efficacy patient subgroups within a clinical trial using risk scores.Statistics in medicine · 2020Article
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Authors and funding
15 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundAdolescent antisocial behaviour is a major health and social problem. Studies in the USA have shown that multisystemic therapy reduces such behaviour and the number of criminal offences committed by this group. However, findings outside the USA are equivocal. We aimed to assess the effectiveness and cost-effectiveness of multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour.
methodsWe did an 18 month, multisite, pragmatic, randomised controlled, superiority trial in England. Eligible participants aged 11-17 years with moderate-to-severe antisocial behaviour had at least three severity criteria indicating past difficulties across several settings and one of five general inclusion criteria for antisocial behaviour. We randomly assigned families (1:1) using stochastic minimisation, stratifying for treatment centre, sex, age at enrolment to study, and age at onset of antisocial behaviour, to receive either management as usual or 3-5 months of multisystemic therapy followed by management as usual. Research assistants and investigators were masked to treatment allocation; the participants could not be masked. The primary outcome was out-of-home placement at 18 months. The primary analysis included all randomised participants for whom data were available. This trial is registered, number ISRCTN77132214. Follow-up of the trial is still ongoing.
findingsBetween Feb 4, 2010, and Sept 1, 2012, 1076 families were referred to nine multi-agency panels, 684 of whom were assigned to management as usual (n=342) or multisystemic therapy followed by management as usual (n=342). At 18 months, the proportion of participants in out-of-home placement was not significantly different between the groups (13% [43/340] in the multisystemic therapy group vs 11% [36/335] in the management-as-usual group; odds ratio 1·25, 95% CI 0·77-2·05; p=0·37).
interpretationThe findings do not support that multisystemic therapy should be used over management as usual as the intervention of choice for adolescents with moderate-to-severe antisocial behaviour.
fundingDepartment for Children, Schools and Families, Department of Health.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.