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In addition, part of the sample is scored simultaneously by trained students, in order to calculate inter-observer reliability of this categorisation. Johnson [ 16 ], proposed four patterns of violence: intimate terrorism, violent resistance, mutual violent control, and common couple violence. The therapist scores the dynamics of the domestic violence after the first three sessions on the basis of all available information. All therapists are trained to score the dynamics of the domestic violence.

In order to increase the reliability, the scoring is regularly discussed in the multidisciplinary team. In addition, a part of the sample is scored simultaneously by trained students, in order to calculate inter-observer reliability of this categorisation. Subsequently, a trained clinician administers three clinical interviews, i. In addition, the treating therapist fills in the MOAS therapist version and assesses the subtype of the offender according to Holtzworth-Munroe and Stuart and the dynamics of the domestic violence according to Johnson.

Partners fill in the CTS2 partner version. Therapists fill in the MOAS therapist version and assess compliance with treatment.

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The participant must have sufficient command of the Dutch language to fill in questionnaires. The severity of the IPV is at least moderate, operationalised by a score of at least 1 on the physical assault subscale of the Conflict Tactics Scale CTS2 , or a score of at least 1 on the injury from assault subscale of the CTS2, or a score of at least 3 on the psychological aggression subscale of the CTS2, or a score of at least 2 on the indoor aggression part of the MOAS. Patients with acute severe mental symptoms that require immediate crisis interventions will be excluded.

This is assessed at the beginning by the professional who conducts the intake interview with the patient and during treatment by the treating therapist. The secondary study outcome is the observation of the therapist about any change in indoor and outdoor aggression, determined by the difference in scores on the MOAS therapist version between t0 and t2.

Compliance with treatment, as determined by the number of treatment sessions received at t2, is a covariate predictor. Severity of borderline personality disorder problems, assessed by the SCID2; dimensional score;. Severity of antisocial personality disorder problems, assessed by the SCID2; dimensional score;. Subtype of the offender by Holtzworth-Munroe and Stuart, assessed by structured clinical assessment by the therapist; categorical score;.

Dynamics of the domestic violence by Johnson, assessed by structured clinical judgment by the therapist; categorical score. Data will be analysed in a multiple regression analysis with change in IPV as dependent variable and change in ADHD symptoms as primary predictor.

With this sample size, a beta of 0. A maximum of 10 predictors is included in this analysis. This means that the desired sample size at t0 is participants.

Impact of treatment of ADHD on intimate partner violence (ITAP), a study protocol

Covariate predictors compliance with treatment, severity of ADHD at t0, severity of borderline personality disorder problems, severity of antisocial personality disorder problems, presence of mood disorder at t0, presence of anxiety disorder at t0, presence of substance use disorder at t0, subtype of the offender by Holtzworth-Munroe and Stuart, and dynamics of the domestic violence by Johnson will be included in the analysis. The primary analysis is with completers.

Additionally, an intention to treat analysis will be carried out using the last-observation-carried-forward method. Later on, an additional and exploratory analysis will be carried out in which all time points are examined by using a multilevel-mixed model approach. The high prevalence of IPV and the severe consequences for victims and children stress the importance of focusing on adequate therapy. However, little is known about effective treatment of IPV. If this hypothesis is confirmed, this insight may contribute to the practice of diagnostics and treatment of IPV offenders.

Additionally, the ITAP study examines the presence of comorbid psychopathology and includes this information in the analysis. Furthermore, the ITAP study is expected to reveal more information about the importance of determining offender types, dynamics of the relationship and, finally, how this knowledge will influence the treatment of IPV. Although the prevalence of these classifications in IPV has been studied thoroughly, the benefits of these classifications within the treatment of IPV have never been examined.

In most studies, offender types were determined by cluster analysis and not by clinical assessment. Little is known about the reliability of these parameters, when classified by clinicians for practical use. The inter-rater reliability is presumably problematic; therefore, data from the ITAP study can also be used for establishing this reliability.

Exploring the relationship between ADHD and IPV in a longitudinal design is challenging and research in this field will have to address several practical and methodological obstacles. Firstly, as mentioned above, a randomised controlled trial would provide stronger evidence for causality; however a design in which one group of ADHD patients is not treated is considered unethical.

This observational design will not allow inferences about causality, but we hope to detect a strong association between severity of ADHD symptoms and that of IPV. Secondly, relationships of couples with IPV are usually very unstable. This may lead to problems with follow-up assessments, since change in IPV can only be measured if couples have at least regular contact. For this reason we extended the CTS2- and MOAS follow up questionnaires with questions about the actual situation: still living together, not living together anymore but frequently having contact, separated but still having contact, and contact with children, if any.

Thirdly, the drop-out rate in forensic psychiatry is generally high and even higher in ADHD patients. Fourthly, forensic patients tend to have little insight in their behaviour and problems or are inclined to trivialise it. This may result in lower scores on t0 self-reports and make it difficult to detect change. In addition, one of the intended effects of therapy is to improve self-reflection and self-understanding. Treatment with ADHD medication, for instance, often provides more insight into problematic behaviour.

In that case, a feasible decline of symptoms or improvement in behaviour is not properly reflected by the scores on the self-reports. In spite of this, the ITAP study will provide more insight into the complex matter of treatment of IPV in clinical practice and may reveal clinically important factors that contribute to more effective treatment of IPV.

The authors acknowledge De Forensische Zorgspecialisten for supporting this study financially and logistically and paying the article-processing charge. Competing interests. De Forensische Zorgspecialisten financially supports this study and the article-processing charge.

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Neither the authors nor De Forensische Zorgspecialisten will gain or lose financially from the publication of this manuscript. Therefore they declare that they have no competing interests. He is not an employee of any of these companies, and not a shareholder of any of these companies either. He has no other financial or material support, including expert evidence, patents, and royalties. NB developed the study design, coordinated the data-collection, and drafted the manuscript. JP participated in designing the study and coordinating the study, contributed to the manuscript, and revised it critically.

AS participated in designing the study and coordinating the study, contributed to the manuscript, and revised it critically. JB supervised the process of designing the study, contributed to the manuscript, and revised it critically. All authors read and approved the final manuscript. Nannet JL Buitelaar, Email: ln. Jocelyne A Posthumus, Email: ln. Agnes Scholing, Email: ln.

Jan K Buitelaar, Email: ln. National Center for Biotechnology Information , U. BMC Psychiatry. Published online Nov Author information Article notes Copyright and License information Disclaimer. Child and adolescent psychiatrist at Karakter, Nijmegen, the Netherlands. Corresponding author. Received Nov 18; Accepted Nov Discussion Research on the treatment process of IPV offenders and victims is complicated by many factors. Design Given existing evidence of effective treatment of ADHD in adults, it was considered ethically incorrect to conduct a randomised controlled trial with a condition in which ADHD is not treated.

Ethics statement The ITAP study is performed in accordance with the ethical principles laid down in the Declaration of Helsinki and subsequent amendments. Instruments DIVA 2. Subtype of the offender Holtzworth-Munroe and Stuart [ 10 , 57 ] differentiated four subtypes of offenders, i. Dynamics of the domestic violence Johnson [ 16 ], proposed four patterns of violence: intimate terrorism, violent resistance, mutual violent control, and common couple violence.

The participant must be decisionally competent and willing to give informed consent. Exclusion criteria of the ITAP study Patients with acute severe mental symptoms that require immediate crisis interventions will be excluded. Sample size Data will be analysed in a multiple regression analysis with change in IPV as dependent variable and change in ADHD symptoms as primary predictor. Discussion The high prevalence of IPV and the severe consequences for victims and children stress the importance of focusing on adequate therapy.

Acknowledgements The authors acknowledge De Forensische Zorgspecialisten for supporting this study financially and logistically and paying the article-processing charge. AS has no competing interests. References 1. Reported frequency of domestic violence: cross sectional survey of women attending general practice. BMJ Clinical research ed ; Hegarty KL, Bush R. Prevalence and associations of partner abuse in women attending general practice: a cross-sectional survey.

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Int J Law Psychiatry. Risk of intimate partner violence among young adult males with childhood ADHD. J Atten Disord. Theriault SW, Holmberg D. Impulsive, but violent? Are components of the attention deficit-hyperactivity syndrome associated with aggression in relationships? Violence Against Women. Mandell A. An investigation of the presence of adult attention deficit hyperactivity disorder behavior in a population of court mandated domestic violence perpetrators.

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Impulsivity in the general population: a national study. J Psychiatr Res. Skirrow C, Asherson P. Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. I was deemed a public enemy and a menace to society. Then she condemned me to a court-mandated week anger management course for being a domestic violence offender Get A Copy. Paperback , pages. More Details Friend Reviews. To see what your friends thought of this book, please sign up. To ask other readers questions about 52 Weeks , please sign up.

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