Den här avhandlingen handlar om flickor och unga kvinnor mellan 12 och 20 år som har vårdats på särskilda ungdomshem på grund av eget beteende. Avhandling består av två tvärsnittsstudier och en uppföljningsstudie. Huvudsyftet var att utforska flickornas och de unga kvinnornas mönster av externaliserande och internaliserande problem vid inskrivningstillfället på särskilda ungdomshem samt att undersöka om olika mönster av anpassningsproblem vid intagningen var relaterade till olika återanpassning fyra år senare. Det holistisk interaktionistiska perspektivet, livsloppteori och utvecklingspsykopatologi användes som övergripande teorier. För att utforska anpassningsproblemen vid inskrivningstillfället användes befintliga ADAD-intervjuer som utförs vid inskrivning. Uppföljningen utfördes med hjälp av telefonintervju och intervjuguiden anpassades till intervjuformen genom att använda igenkännande ADAD-frågor och ”positiva” frågor. I linje med det holistisk interaktionistiska perspektivet användes personorienterade metoder för att utforska mönster av anpassningsproblem. I uppföljningsstudien kombinerades en personorienterad och en variabel-orienterade metod.

I Studie 1 identifierades psykometriskt lämpliga skalor utifrån dimensionsanalyser av de ungdomsrapporterade svaren i ADAD. Totalt identifierades 11 index med god konstruktvaliditet och god intern konsistens för fem olika problemområden.

I Studie 2 utforskades mönster av externaliserande och internaliserande problem var för sig utifrån de index som utformades i studie 1. Den valda externaliserande klusterlösning bestod av nio kluster varav två inkluderade multiproblem. För de internaliserande problem valdes sjuklusterlösningen, två multiproblemkluster återfanns även i denna klusterlösning. Externaliserande och internaliserande syndrom tenderade att förekomma tillsammans hos samma individer i klustren med Låga problem enbart. Men också bland flickor och unga kvinnor med aggressivt beteende, då de tenderade att ha internaliserande problem som ångest, depression, somatiska problem och parasuiciadal problem. Detta skulle kunna tyda på "komorbiditet", d.v.s "samsjuklighet", mellan aggressiva externaliserande syndrom och internaliserande syndrom.

I studie 3 undersöktes om olika mönster av anpassningsproblem vid intagning till särskilda ungdomshem var relaterade till social återanpassning fyra år senare. Resultatet visade att unga kvinnor i Missbrukssyndromet och Multipla-problemsyndrom 1 (Droger och egendom/drogbrott) rapporterade allvarliga fortsatta problem med narkotikamissbruk fyra år efter intagning. Allvarligast problem hade Multipla problemsyndrom 1 som injicerade droger samt också i hög utsträckning blivit återintagna i tvångsvård. Sammanfattningsvis har denna avhandling både teoretisk och praktisk betydelse dels då resultaten ger information om flickornas och de unga kvinnornas hela problembild utifrån ADAD, något som bör beaktas vid val av behandlingshem, vård och planering. Av vikt är också studie 3, där resultaten definieras utifrån viktiga livsomständigheter, t.ex. familje- och sociala relationer samt brottslighet, alkohol- och drogmissbruk och återfall i tvångsvård fyra år efter intagning till särskilda ungdomshem. Denna studie indikerar vilka syndrom som har de största utvecklingspotentialen gällande vård och resurser. Slutligen skulle studie 1 kunna vägleda framtida bedömningsmetoder, d.v.s. användning av de ungdomsrapporterade svaren i ADAD som visade sig vara vetenskapligt användbara. 

This thesis is about girls and young women between the ages of 12 and 20 who have been placed in special youth homes because of their own behaviour. The thesis is based on two cross-sectional studies and a follow-up study. The main focus was to examine the girls' and young women's patterns of externalizing and internalizing problems at the time of admission to special juvenile homes, and to examine whether different patterns of adjustment problems at admission were related to different readjustments four years later.

The holistic interactionist perspective, life course theory and developmental psychopathology were used as general theories. To examine adjustment problems at admission, existing ADAD interviews conducted at admission were used. The follow-up was conducted using a telephone interview and the questionnaire was adapted to the interview format by using recognizable ADAD questions and "positive" questions. In line with the holistic interactionist perspective, person-oriented methods were used to explore patterns of adjustment problems. In the follow-up study, a person-oriented and a variable-oriented approach were combined.

In Study 1, psychometrically appropriate scales were identified from dimensional analyses of adolescents' reported responses in the ADAD. A total of 11 indices with good construct validity and internal consistency were identified for five different problem areas.

In Study 2, patterns of externalizing and internalizing problems were examined separately based on the indices designed in Study 1. The selected externalizing cluster solution consisted of nine clusters, two of which contained multiple problems. For internalizing problems, a solution with seven clusters was selected; two clusters with multiple problems were also present in this cluster solution.

Externalizing and internalizing syndromes tended to co-occur in the same individuals in the low-problem clusters. Also among girls and young women with aggressive behaviour, as they also tended to have internalising problems such as anxiety, depression, somatic problems and parasuicial problems. This could indicate comorbidity between aggressive externalizing syndromes and internalizing syndromes.

Study 3 investigated whether different patterns of adjustment problems at admission to special juvenile homes were related to social reintegration four years later. Results showed that young women in substance use disorder and multi-problem syndrome 1 (drugs and property/drug offences) reported serious continued problems with drug use four years after admission. The most serious problems were experienced by offenders with Multiple Problem Syndrome 1 who injected drugs and who were also highly likely to have been re-admitted to compulsory care.

In conclusion, this thesis has both theoretical and practical significance, as the findings provide information on the whole problem picture of girls and young women on the basis of ADAD, which should be taken into account when choosing a treatment home, care and planning. Also of importance is study 3, where the results are defined in terms of important life conditions, such as family and social relationships, as well as delinquency, alcohol and drug abuse and reoffending four years after admission to special youth care. This study shows which syndromes have the greatest potential for development in terms of care and resources. Finally, Study 1 may guide future assessment methods, i.e., the use of responses reported by youth in the ADAD that have been shown to be scientifically useful.

Aim: This cross-sectional study investigates the psychometric properties of the Swedish edition of the Adolescent Drug Abuse Diagnosis (ADAD), and specifically examines the internal consistency and construct validity of five life domains reported by female adolescents in special residential care in Sweden (N= 780;M-age= 16 years old).

Methods: Principal component analysis and entropy-based analysis were used to test construct validity.

Conclusion: Results indicate that ADAD may be able to reliably distinguish between areas that are important targets for intervention.

This study examined the adjustment of a sample of adolescent girls and young women (N = 228) who were in compulsory care in Sweden between 1999 and 2000. Using person-oriented analyses, participants’ responses to the Adolescent Drug Abuse Diagnosis Instrument (Friedman & Utada, 1989; ADAD) at intake yielded five externalizing problem configurations. The main analyses focused on examining whether problem configuration at intake was important to participants’ adjustment at a four-year follow-up. Overall, results indicated that problem configuration can be important to later adjustment (less life satisfaction, more drug use, and problems controlling violent behavior), particularly if the problem configuration involves multiple problems at elevated levels and/or drug use. The implications of the study results are discussed in light of efforts to improve the tailoring of care and treatment for diverse youth who experience multiple problems.

The purpose of this series of three cross-sectional studies was to identify typical syndromes of self-reported externalizing and internalizing problems, and examine their overlap, among adolescent girls and young women in Swedish special residential homes for young people (N = 713). The associations with some family background factors were also investigated. Data came from a research register at the Swedish National Board of Institutional Care and concerned structured interviews with all girls admitted to these homes from 1997 to 2001. An advanced clustering procedure was applied and significant syndrome structures were retrieved in both the externalizing and internalizing area. Among the nine externalizing syndromes were a low-problem syndrome and two multiple-problem syndromes, one combining aggressive behavior, alcohol use/abuse and criminality, and the other combining drug abuse with property/drug offenses. Among the seven internalizing syndromes were a low-problem syndrome, an anxiety/depression syndrome and a generalized internalizing syndrome with particularly high rates of physical and sexual abuse. Results supported the theoretical assumption, made within a holistic-interactionistic paradigm, that adjustment problems would co-occur in a limited number of syndromes. When the overlap between externalizing and internalizing syndromes was considered, good adjustment was generalized between the two areas, whereas there appeared to be an increased risk of having an internalizing syndrome among girls with externalizing syndromes related to aggressive behavior. It is of great importance to consider the full problem pattern of girls with externalizing adjustment problems, including internalizing problems and histories of physical and sexual abuse, when considering subgroups in need of different treatment regimes.