Early Prevention of CD

8/9/2019 Early Prevention of CD

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Early Intervention of Child Conduct Problems and Prevention of Antisocial BehaviorJackie Lund

School Psychology Program, The University of IowaOctober, 2000

Why is early intervention important?Early starting patterns of conduct problems areremarkably stable.

There has been a detectable increase in conductproblems shown by children over the past twenty-some years.There are few effective treatments for stablepatterns of conduct problems.

Antisocial children often fail at school and arefrequently disliked by peers and rejected by parents.

– By the middle elementary grades, theaggressive child’s negative reputation andpeer group and peer rejection may be wellestablished.

– Even if the child learns appropriate and

effective social skills during the middleelementary grades, this pattern of rejectionmay make it difficult for the child to use theseskills to change his/her image.

Thus, intervening at a young age can help childrendevelop effective social skills early and reduce theiraggressive behaviors before these behaviors andreputations develop into permanent patterns.

Three Promising Early Intervention/PreventionPrograms

1. First Step to Success2. Fast Track3. The Incredible Years Training Series

First Step to Success An early intervention program designed to achievesecondary prevention goals.

– It targets individual children whosebehavioral histories and family backgroundshave placed them at-risk for antisocialbehavior and potential school failure.

– These children are already experiencingproblems in their behavioral adjustments asthey begin schooling and require intensiveintervention to offset their exposure to anarray of risk factors.

The 3 modular components (designed to be used inconcert with each other)

1. Proactive, universal screening of all kindergartenpopulations2. Consultant-based school interventions involvingthe target child, peers, and teachers3. Parent training in caregiver skills for supportingand improving the child’s school adjustment-performance

RationaleFirst Step is based on a risk-factors exposure model(which is developmental in nature).

The three modules are based on extensive researchon school and home intervention procedures withaggressive, antisocial youth and over a decade ofwork related to the universal, proactive earlyscreening of at-risk children to provide earlydetection.

First Step’s Primary Goals1. To teach the at-risk child to get along with others(teachers and peers) and to engage in assignedschoolwork in an appropriate, successful manner.2. To divert at-risk children who are showing clearsigns of antisocial behavior from a path leading to ahost of destructive outcomes.

How does the school intervention module work? An adapted version of the CLASS Program is used.

– A consultant-based intervention forremediating behavior problems of disruptive,aggressive children in the primary grades

– Requires 30 program days for successfulcompletion. Each program day has a built incriterion that has to be met beforeproceeding to the next day of the interventionprogram.

It is applied to only one child at a time in a

kindergarten classroom.The child’s behavior is monitored using a red andgreen card worn around the consultant or teacher’sneck.

– After a specified amount of time, (e.g., 30sec.) the child is awarded one point. If thechild’s behavior is appropriate at that timethe point goes on the green side; if not, itgoes on the red side. To receive the pre-specified reward, 80% of the points (e.g.,during the 20 min. period) need to be on thegreen side. The card is gradually faded out.

How does the home-based component work?It consists of six lessons designed to enable parentsto build child competencies and skills in six areasthat affect school adjustment and performance.The target skills are: Communication and sharingschool, Cooperation, Limits-setting, Problem-solving,Friendship-making, and Developing confidence.The program contains lessons, instructionalguidelines, and parent-child activities and games fordirectly teaching these skills.It requires six weeks for implementation and beginsafter the child has completed program day 10 of the



CLASS program.



Is the First Step Program Successful?The First Step to Success program has been evaluatedusing pre/post and waitlist/control group designs. Inaddition, efforts have been implemented to assess socialvalidity and consumer satisfaction.Studies indicate that it produces robust treatment effectsfor the majority of at-risk children to whom it is applied andparticipants generally report high levels of satisfaction with

the program.

Fast Track A multisite, multicomponent preventive intervention foryoung children at high risk for long-term antisocialbehavior.Components include: a universal-level classroom program,social skills training, academic tutoring, parent training,and home visits

Goal of Fast TrackTo improve competencies and reduce problem behaviorsin a high-risk group of children selected in kindergarten.

RationaleFast Track is based on a model of the development ofantisocial behavior derived from developmental theory andlongitudinal research.

– Developmentally, antisocial behavior is multipledetermined (e.g., child factors, parenting practices,negative school experiences).

– Consequently, preventive interventions must becomprehensive and target multiple risk andprotective factors.

– Additionally, risk is cumulative, and thus theprogram is designed to extend from Grade 1-10.

How does Fast Track Work?For the universal (school-based) component, Grade 1classroom teachers deliver an adapted version of thePATHS curriculum.

– Two to three lessons are taught per week.

– Lessons cover four domains of skills: skills foremotional understanding and communication,friendship skills, self-control skills, and socialproblem-solving skills.

Children whose rated behavior problems (by teachers andparents) fall in the top 10% of the class make up the “highrisk” sample.

–In addition to the PATHS curriculum, these familiesare offered parent groups, child social skills traininggroups and academic tutoring during a weekly 2-hrenrichment program held on Saturdays or weekdayevenings. Home visits and telephone calls are alsoimplemented between group sessions.

What is the evidence that the program works?Studies have shown that, compared to control conditions,at the end of Grade 1, there were moderate positive effectson children’s social, emotional, and academic skills; peerinteractions and social status; and conduct problems and

special-education use. Additionally, parents reported less physical discipline andgreater parenting satisfaction/ease of parenting andengaged in more appropriate/consistent discipline,warmth/positive involvement, and involvement with theschool.The creators of the program state that these findings areconsistent with the developmental model on which the

intervention is based, which suggests that changes inchild, family, and school-based risk factors are necessaryin order to significantly reduce and prevent child antisocialbehavior.

The Incredible Years Training SeriesDesigned to prevent, reduce, and treat conduct problemsamong children ages 2 to 10 and to increase their socialcompetence.Consists of Parent Training Programs, a Teacher TrainingProgram, and a Child Training Program

Series GoalsLong range goals:

–

1) to develop comprehensive treatment programsfor young children with early onset conductproblems.

– 2) the development of cost-effective, community-based, universal prevention programs that allfamilies and teachers of young children can use topromote social competence and to prevent childrenfrom developing conduct problems in the first place.

Short-term goals:

– 1) Reduce conduct problems in children

– 2) Promote social, emotional, and academic

competence in children – 3) Promote parental competence and strengthen

families

– 4) Promote teacher competence and strengthenschool-home connections

RationaleGerald Patterson’s theoretical work on childhoodaggression strongly influenced the development of theIncredible Years parent and teacher training programs.Incredible Years Child Training Program--Dina Dinosaur

Social Skills and Problem-Solving CurriculumThe units covered include: Making friends and learning

school rules, Understanding and detecting feelings,Detective Wally teaches problem-solving steps (whichincludes a unit on anger management), Molly Mannersteaches how to be friendly, Molly explains how to talk withfriends, and Dina Dinosaur teaches how to do your best inschool.Instructional approaches include: videotape modeling,fantasy play and instruction (using near life-sized humanpuppets and a variety of animal puppets), role-playing,activities (e.g., plays, games), feedback and reinforcement,and fostering skills maintenance and generalization.



For treatment of children with conduct problems, theprogram is offered to groups of five or six children in 2-hour sessions held once a week for 22 weeks.

As a classroomwide curriculum to promote social andemotional competence in all children (preschool throughgrade three), it is implemented two to three times a weekin 20- to 30-minute circle time discussions accompanied by20-minute practice activities during the day.

Parent Training ProgramsMultiple parent programs are offered, including: the earlychildhood BASIC program (ages 2-7), School-age BASICprogram (ages 5-12), ADVANCE program (ages 4-10), andSupporting your child’s education program (ages 5-10).The parent programs are designed as group discussionswith 12-14 parents per group and 1 group leader (2leaders if resources permit).

Approximately 60% of each session is group discussion,problem solving, and support; 25% videotape modeling;and 15% teaching.The following instructional approaches are used: videotape

modeling, role-playing and rehearsal, weekly homeworkactivities, weekly evaluations, phone calls and makeupsessions, and buddy calls.

Teacher Training ProgramsThe collaborative training methods and processes usedwith teacher training groups are similar to those used withparent groups.Teachers come together in groups of 15-25 to discuss aseries of videotaped vignettes.It takes six full-day workshops to complete the componentsof the training.Is there evidence that the Incredible Years Training Series

is effective?There have been multiple studies on the effectiveness ofthis program.

--The BASIC program appears highly effective inreducing child conduct problems by promoting socialcompetence, reducing parents’ violent methods ofdiscipline and improving their child management skills.--The ADVANCE program has been shown to be ahighly productive treatment for promoting parents’ useof effective problem-solving and communication skills,reducing maternal depression, and increasingchildren’s social and problem-solving skills.

Improvements in child conduct problems andparenting interactions have been sustained up to 4years after intervention.

--Teacher-trained classrooms, when compared tocontrol classrooms, have been found to have significantlyfewer students misbehaving, off task, disruptive, oraggressive.--Teachers and parents from the combined interventionconditions report a significantly higher level ofcollaboration, stronger home-school connections andchildren with fewer behavior problems.

--The child training program has been found to result insignificantly improved social skills and positive conflictmanagement strategies with peers.--The combined parent and child training was moreeffective than parent training alone.

ConclusionsEarly intervention seems to be a best practice in thetreatment of child conduct problems.The three programs reviewed here all seem to hold a greatdeal of promise.To effectively address a child’s conduct problems, it seemsbeneficial, if not necessary, to go beyond the child

him/herself and also address the relevantpeople/environments in his/her life (e.g., parents, teachers,peers).

References:

Conduct Problems Prevention Research Group (1999).Initial impact of the Fast Track prevention trial for conductproblems: II. Classroom effects. Journal of Consulting andClinical Psychology, 67, 648-657.

Conduct Problems Prevention Research Group (1999).Initial impact of the Fast Track prevention trial for conduct

problems: I. The high-risk sample. Journal of Consultingand Clinical Psychology, 67, 631-647.

Walker, H., Severson, H.H., Feil, E.G., Stiller, B., &Golly, A. (1998). First Step to Success: Intervening at thepoint of school entry to prevent antisocial behaviorpatterns. Psychology in the Schools, 35, 259-269,www.incredibleyears.com www.ncjrs.org/html/ojjdp/2000_6_3/contents.html www.sorpriswest.comwww.strengtheningfamilies.org/html/model_programs_1997/mfp_pg30.html

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