Current Research into Interdisciplinary Approaches in Preventing AntiSocial Behaviour in Children

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Current Research into Interdisciplinary
Approaches in Preventing AntiSocial Behaviour in
Children

• Linda L. Baker, Ph.D., C.Psych.
• Executive Director
• Centre for Children and Families in the Justice
  System

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Antisocial Behaviour (AB)

• Stable over time
• Identifiable trajectory
• probabilistic models
• longitudinal studies -- ages at which building
  blocks for AB put in place
• Persistent violations of socially appropriate
  norms and the rights of others

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Antisocial Behaviour

• Multiply determined
• Risk operates at many levels
• Child
• His/her close interpersonal relations
• Proximal social settings
• Social macro-system
• Salience of risk developmental stage

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Why Prevention?

• Victimization
• Personal suffering of these individuals and
  others
• Highly resistant to intervention
• Financial costs

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No area riper for an experimental design
(Robins, 1992)

• Population at risk is known
• Instruments exist to measure problem
• Multiple informants possible
• Large window of opportunity to evaluate
  occurrence
• Hypothetical causal agents identified

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To inform practice and policy, we need answer to
following question

• What preventive interventions implemented at what
  point in time will positively change the
  developmental course of an individual

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Types of Preventive Interventions

• Universal (entire population)
• Targeted (at risk population)
• Selective (risk due to socio-familial
  environmental factors)
• Indicated (risk due to personal factor)

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Optimal Preventive Strategy

• 1st step effective universal programs to promote
  all childrens competencies
• 2nd step targeted programs for children with
  multiple risk factors (focus on children, their
  families, or their communities)
• Offord, Chmura Kraemer, Kazdin, Jensen,
  Harrington, 1998

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Why Inter-disciplinary?

• Concern of individuals from many disciplines
• Helpful because of multiple determinants
• developmental perspective
• Reduce gaps and increase potential for
  integrated, multi-domain, multi-component
  interventions
• Potential for increased impact

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Review of Preventive Experiments

• 20 studies wide variability
• Cannot definitively identify best prevention
  strategies
• Between waves of studies bimodal to multimodal
• Randomized efficacy trials
• Successes represent promising practice
• LeMarquand, Tremblay Vitaro, 2001
• Tremblay, LeMarquand Vitaro, 1999

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From 50 to 20 Eligibility Criteria

• Non-referred children
• Before individual fulfills criteria
• Children under 12 at onset of research
• Minimum follow-up 1 year
• Random assignment or quasi experimental designs

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20 Preventive Experiments

• 2 Universal
• School based, 6 yrs, 2-6 duration, 4-6 follow-up
• 18 Targeted
• 11 focused on children under 6
• 8 selective (s) (socio-familial risks)
• 3 indicated (i) (child personal risks)

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Components of Intervention

• Child-focused (e.g., SCT, meds, academic skills)
• Family parent-focused (e.g., PMT, FFT, PE)
• Peer-based (e.g., peer mediation, conflict
  resolution)
• Community (e.g., decrease drug trade, gun control
  policy)

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Key for next slides

• Study, age of participants at onset, duration of
  intervention, length of follow-up, effect size
• Effect sizes .2 small .5 medium .8 large
• (Cohen, 1977)

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Prenatal to Toddler Under 2

• Day care Parent skills 4 s
• Houston Parent-Child Proj, 1, 2, 5-8, ExBeh
  ES.45
• Infant Health Dev. Prog, birth, 3, 5, ExBeh
  ES.05
• Yale Child Welfare Proj, birth, 2.5, 10, ExBeh
  ES.8
• Mailman Center Prog, birth, 8 mons, 5-8, ExBeh
  ES.09
• Parent skills Maternal life issues 1 s
• Elmira Home Visitation, prenatal, 2yrs, 13, na

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Prenatal - Preschool

• Day care parent skills 1 s
• Syracuse Program, prenatal, 5.5, 10, Del ES.49

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Elmira Home Visitation Program(Olds et al, 1997
1998)

• Home visitation with high risk families
• Nurse visitors
• Eligibility criteria lt19/ unmarried/ low SES
• Randomized efficacy trial
• Goals 1)alter pregnancy outcomes, (b) child
  health and development (c) parental life course
• Follow-up 13 years

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Elmira contd Intervention

• T1 info support for health and development
• T2 T1 plus free transportation
• T3 9 visits during pregnancy
• T4
• Maternal life issues (education, employment)
• Information on pre neonatal maternal health
• Child care skills
• 9 visits during pregnancy
• 23 home visits birth to 2

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Elmira contd Outcome

• Mothers
• improved health
• Reduced rates of child abuse/neglect
• Reduced welfare dependence
• Fewer emerge visits (56) and injuries
• Fewer pregnancies
• Fewer alcohol drug problems
• Fewer smoking (75 reduction in preterm births)
• Less criminal involvement

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Elmira contd Outcome

• Children followed until age 15
• No difference in self, parent, teacher reported
  ext. behav.
• Fewer arrests for youth
• For particularly high risk families
• Lower incidence of smoking, alcohol use,
  runaways, criminal convictions and probation
  violations

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Efficacy to Effectiveness TrialsDugan et al.,
2004

• Rigorous experiment
• Home visitation intervention had no effect on
  child maltreatment (CM)
• Confirmed partner violence, substance abuse,
  parental depression as robust risks for CM
• Risks that mattered most, home visitors felt
  least equipped to manage focused on other
  issues
• Retool intervention to target proximal risk

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Preschoolers 3 to 5 years

• Academic skills parent skills 2 i
• High/Scope Perry Preschool, 3-4, 1-2, 22, Del
  ES.35
• High/Scope Curriculum, 3-4, 1-2, 18, Del ES.22
• Parent skills teacher training 1 s
• Webster-Stratton, 4.7, 4 mons, 1, Adv beh ES.25
  
• ExBeh ES.01
• Parent skills 1 i
• PCI Training , 3.9, 3 mons, 1, Ext Beh ES.45

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Preschool Elementary School 3 to 11 years

• Day Care Academic skills Parent skills 1 s
• Abecedarian Project, 4.4, 5, 13, Del ES.03

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High Scope Perry Preschool Study(Schweinhart et
al., 1993)

• Random assignment
• N123 58 I (25 girls) 65 C (26 girls)
• Eligibility lower IQ children of low SES
• Intervention
• ½ day program 30 wks/yr for 2 yrs
• 1 ½ hr home visit/wk by teacher with mother
  child
• Enhanced cognitive development through daily
  high/scope preschool
• Parenting skills through teacher home visits

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High Scope contd Outcome

• Fewer officially recorded lifetime arrests (ES
  .54)
• Higher IQ
• Greater school achievement
• More high school graduands
• Higher home owners
• Fewer received social services

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High/Scope Perry Preschool Hypothesized Causal
Model

• Learning achieved in preschool with parental
  support
• Increases motivation early in school
• Leading to completion of higher level of school
• Ultimately resulting in reduce crime and higher
  earnings

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What have we learned? Parents

• Interventions with parents are promising
• 2 focused on pregnant women, 4 focused on parents
  of infants, 5 targeted parents of preschoolers
• Different durations
• Begin during pregnancy, intervene for longer,
  focus on higher risk families
• Need to be part of multi-component interventions
• Parent management training component needs to be
  incorporated
• Greater description of intervention content
  needed
• Future consider interventions with future
  parents (before expecting)

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What have we learned? Day care

• Part of intervention in 6 of 11 studies
• Typically paired with parent skills component
• Primarily infants and toddlers
• Effect of day care alone not known
• When parents face challenges in fostering childs
  development
• Impact likely related to quality of the day care
  program (e.g., Syracuse)

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What have we learned? Academic Skills

• 3 of 11 studies
• Enhancing cognitive development at age 3-4 is
  promising direction
• Further research needed to understand how
  preschool impacts AB
• Appears parent component is critical
• Teachers need to be targets or allies
• Likely need to combine neighborhood-level risk
  factors

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What have we learned? Community

• Impact of community interventions on individual
  development not measured
• Community indicators (e.g., youth crime rates)
  used to assess community interventions
• Better Beginnings, Better Futures Project,
  (Peters Russell, 1996)
• Focused on 0-8 year-olds in 11 low SES
  neighborhoods
• Over 4 years, each community implementing some of
  the following strategies home visiting,
  enrichment of child care facilities, family
  parent programs, class enrichment, community
  programs

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Multi-Component Interventions

• New generation of preventive interventions
• E.g., Fast Track Program, Metropolitan Area Child
  Study
• Children at risk for CD identified in K
• 6 year, 7 component intervention
• Parent training, home visiting, parent-child
  relationship enhancement, academic tutoring,
  social-cognitive skills training, emotional
  regulation training, and interpersonal skills
  training
• Results towards end of decade

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What are promising preventive interventions?

• Interdisciplinary, multi-component programs
• Integrated across multiple contexts/domains
• Over longer periods of time
• From the earliest stage/age during important
  developmental transitions
• With children families experiencing high-risk
  families

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• 1 good study better than many poor studies
• Randomized efficacy trials necessary, not
  sufficient
• No basis for successful targeted efficacy trial
  to universal intervention
• Wide dissemination should follow effectiveness
  trials
• Statistical significance not enough
• Sufficient dose of best intervention
• Full descriptions of intervention content
• Greater info about contextual variables
  participants
• Learn from successes and from what didnt work
• Target our advocacy

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Well-designed well-implemented studies with
relatively long follow-ups

• Theory/hypothesis driven interventions with
  defined targets
• Full description of intervention and
  skills/resources to implement
• Assessment of degree to which program implemented
• Assessment of variables that effect
  implementation

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• Assessment of the moderating effects of
  contextual variables
• Appropriate, consistent outcome measures from
  multiple sources
• Randomized effectiveness evaluations
  (replications in community)

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• Community involvement and capacity (e.g.,
  resources for programs, technical supports,
  knowledge transfer, and evaluation)

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Future Considerations

• Matching preventive intervention to subgroups
  (e.g., cognitive deficits, poor peer relations)
• Gender responsive preventive interventions
• Follow up children as parents
• Costs/benefits of selection criteria and
  intervention target being the same (e.g., low SES
  selection with parenting intervention target)