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Background In Europe, the number of females exhibiting oppositional defiant disorder ODD and conduct disorder CD is growing. Many of these females live in youth welfare institutions. Consequently, there is a great need for evidence-based interventions within youth welfare settings. A recently developed approach targeting the specific needs of girls with ODD and CD in residential care is START NOW. The aim of this group-based behavioural skills training programme is to specifically enhance emotional regulation capacities to enable females with CD or ODD to appropriately deal with daily-life demands. It is intended to enhance psychosocial adjustment and well-being as well as reduce oppositional and aggressive behaviour. We present the study protocol version 4. Once the first cycle is completed, each institution will run a second cycle with the opposite condition. Children and adolescents with conduct problems, including aggression, represent a highly heterogeneous group. The heterogeneity is reflected not only by a great variety of symptoms ranging from impulsive, hot-tempered quarrels or stealing to acts of cruelty to animals or people but also by the extent of co-morbidity e. In that sense, youth with ODD or CD represent a highly vulnerable group with a significant risk and cost, not only to themselves but also to their immediate surroundings and ultimately to society as a whole. Sequelae such as school failure, substance abuse, delinquency, child prostitution, and early pregnancy often associated with poor parenting skills pose serious problems on an individual as well as a societal level. Patients with ODD and patients with CD are characterised predominantly by impulsive-aggressive behaviour that is often associated with high emotional vulnerability exemplified by hypervigilant behaviour in response to neutral stimuli. In addition, patterns of thought that include automatic appraisals and distortions of attribution are often found. On top of that, adolescents with conduct problems frequently experience interpersonal difficulties, which are oftentimes associated with high levels of psychological distress. As for a specific sub-group of adolescents with CD that can be best described as callous-unemotional with associated features, such as a lack of emotional responsivity, lack of empathy, extreme patterns of thought e. In its original format, START NOW is a manualised, group-based skills training programme designed for use within correctional institutions. START NOW is an integrative evidence-informed intervention based on several therapeutic approaches. These therapeutic elements were chosen because of research findings as well as suitability for the target population i. More specifically, the programme combines aspects of cognitive behavioural therapy CBT , motivational interviewing MI , dialectical behaviour therapy DBT and trauma-sensitive care. The subsequent sections outline the different elements that comprise START NOW in more detail and elaborate on their relevance with regard to the target population. Cognitive behavioural therapy CBT represents the theoretical underpinning of the intervention. The programme integrates functional analysis to help group members break down behaviour patterns and understand their own behaviour in the context of its antecedents and consequences. In addition, CBT serves to help patients understand how their own conceptualisation of events is connected to their mood and behaviour. Furthermore, it facilitates recognition and coping with pote
