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Fast track randomized controlled trial to prevent externalizing psychiatric disorders: findings from grades 3 to 9
1Members of the Conduct Problems Prevention Research Group for this report include Karen L. Bierman, Ph.D., Department of Psychology, Pennsylvania State University; John D. Coie, Ph.D., Department of Psychology, Duke University; Kenneth A. Dodge, Ph.D., Center for Child and Family Policy, Duke University; E. Michael Foster, Ph.D., School of Public Health, University of North Carolina; Mark T. Greenberg, Ph.D., Department of Human Development and Family Studies, Pennsylvania State University; John E. Lochman, Ph.D., Department of Psychology, University of Alabama; Robert J. McMahon, Ph.D., Department of Psychology, University of Washington; and Ellen E. Pinderhughes, Ph.D., Department of Child Development, Tufts University.
Objective:
This study tests the efficacy of the Fast Track Program in preventing antisocial behavior and psychiatric disorders among groups varying in initial risk.
Method:
Schools within four sites (Durham, NC; Nashville, TN; Seattle, WA; and rural central Pennsylvania) were selected as high-risk institutions based on neighborhood crime and poverty levels. After screening 9,594 kindergarteners in these schools, 891 highest risk and moderate-risk children (69% male and 51% African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention (begun in 1991 with three yearly cohorts) included parent behavior-management training, child social-cognitive skills training, reading tutoring, home visiting, mentoring, and a universal classroom curriculum. Outcomes included criterion counts and psychiatric diagnoses after grades 3, 6, and 9 for conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, any externalizing disorder, and self-reported antisocial behavior. Grade 9 outcomes were assessed between 2000 and 2003, depending upon cohort.
Results:
Significant interaction effects between intervention and initial risk level were found at each age but most strongly after grade 9. Assignment to intervention had a significant positive effect in lowering criterion count scores and diagnoses for conduct disorder, attention-deficit/hyperactivity disorder, and any externalizing disorder, and lowering antisocial behavior scores, but only among those at highest risk initially.
Conclusions:
Prevention of serious antisocial behavior can be efficacious across sex, ethnicity, and urban/rural residence, but screening is essential.
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