PROSPER delivery of universal preventive interventions with young adolescents: long-term effects on emerging adult substance misuse and associated risk behaviors.

BACKGROUND: Substance misuse and associated health-risking behaviors are prevalent in emerging adulthood. There is a knowledge gap concerning the post-high school effects of community-based delivery systems for universal preventive interventions implemented during young adolescence. This study reports effects of the PROSPER delivery system through age 19, 7.5 years past baseline. METHODS: A cohort sequential design included 28 public school districts randomly assigned to the PROSPER partnership delivery system or usual-programming conditions. PROSPER community teams implemented a family-focused intervention in 6th grade and a school-based intervention in 7th grade. Outcomes for the age 19, post-high school report included lifetime, current, and frequency of substance misuse, as well as antisocial and health-risking sexual behaviors. Intent-to-treat, multi-level analyses of covariance of point-in-time outcomes were conducted, along with analyses of risk-related moderation of intervention effects. RESULTS: Results showed emerging adults from PROSPER communities reported significantly lower substance misuse across a range of types of substances, with relative reduction rates of up to 41.0%. No significant findings were observed for associated antisocial and health-risking sexual behavior indices; or for lifetime rates of sexually transmitted infections. Risk-related moderation effects were non-significant, suggesting generally comparable outcomes across higher- and lower-risk subgroups of emerging adults. CONCLUSIONS: The PROSPER delivery system for brief universal preventive interventions has potential for public health impact by reducing long-term substance misuse, with positive results extending beyond high school.

Evaluation and community prevention coalitions: validation of an integrated Web-based/technical assistance consultant model

Community coalitions (CCs) have labored with some difficulty to demonstrate empirical evidence of effectiveness in preventing a wide range of adolescent problem behaviors. Training and technical assistance (TA) have been identified as important elements in promoting improved functioning of CCs. A reliable, valid, and inexpensive method to assess functioning of CCs has been developed and is tested in this article in the context of Pennsylvania's Communities That Care (CTC) model. A CC Web-based questionnaire was developed and administered to more than 79 communities (867 participants) and the validity and reliability were assessed through multiple means, including the use of a companion TA implementation feedback questionnaire completed by TAs assigned to each of the sites. Results indicated adequate to good psychometric properties on internal reliability of the Web-based questionnaire, moderate construct validity across different reports of functioning, and relative stability throughout the course of 1 year. Implications for a variety of community prevention coalitions interested in a relatively low-cost, user friendly, and suitable methodology for evaluating coalition functioning are discussed. In addition, areas of application for future research including linking coalition functioning with the quality and nature of technical assistance, levels of risk and protective factors, and large data sets of youth risk factor and problem behavior data are highlighted. (AU)

Structure and validity of people in my life: A self-report measure of attachment in late childhood.

No self-report measure of attachment is well validated for middle-childhood. This study examined the validity and factor structure of the People in My Life (PIML) measure in 320 urban, fifth and sixth graders. Validity analyses consisted of correlational analyses between PIML subscales and the Child Behavior Checklist, Delinquency Rating Scale for Self and Others, Heath Resources Inventory, and Reynolds Child Depression Scale. Validity correlations were consistent with a-priori hypotheses. Confirmatory factor analyses consisted of comparison of model fit indices between seven models. Two models fit the data well and both models were consistent with the traditionally used PIML scoring protocol. Moreover, both models were consistent with the Inventory of Parent and Peer Attachment (IPPA), on which the PIML is modeled, as well as the theoretical underpinnings of attachment in childhood. The PIML and IPPA provide instruments for obtaining a continuous self-report measure of attachment from middle-childhood through adulthood.

Correlates of clinic referral for early conduct problems: variable- and person-oriented approaches.

The current study utilized both variable- and person-oriented analyses to examine correlates of early disruptive behavior problems. Participants included 80 preschool boys referred to a child psychiatry clinic and diagnosed with oppositional defiant disorder (with or without attention-deficit hyperactivity disorder) and 80 case-matched normal comparison boys. The study examined four domains of correlates: vulnerable child characteristics, poor parenting practices, insecure attachment, and adverse family ecology. Results indicated that the combination of these factors provided relatively high sensitivity (81%) and specificity (85%), clearly differentiating referred from comparison boys. A dramatic increase in clinic status occurred when three or more factors were present, and specific combinations of factors were differentially predictive of conduct problems. However, no correlates were found to be either necessary or sufficient for clinic status. By maintaining the integrity of individual cases, person-oriented analyses were able to answer different questions than more traditional variable-oriented analyses. Discussion focuses on the value of person-oriented analyses for understanding heterogeneous clinical groups.

Stress and coping in hearing mothers of children with hearing loss: factors affecting mother and child adjustment.

The present study examines maternal and child adjustment as a result of the application of a stress and coping model (Folkman, Schaefer, & Lazarus 1979) to factors associated with having a school-aged child with a hearing loss. Thirty-six hearing mothers of children with hearing loss participated in the study. Information was gathered through parent and teacher questionnaires and home interviews and observations. Results indicated that (a) social support emerged as an important predictor of maternal adjustment as well as a buffer between current life stress and maternal adjustment, and (b) maternal problem-solving skill emerged as a significant predictor of child adjustment and as a mediating factor between child's age and teacher rating of child adjustment. The discussion focuses on possible explanations for these findings, the utility of a competency-based rather than psychopathology-based perspective in understanding parent and child outcomes, and implications for intervention strategies.

A two-year longitudinal study of neuropsychological and cognitive performance in relation to behavioral problems and competencies in elementary school children.

Despite interest in early neuropsychological status as a possible contributor to children's behavioral development, prospective longitudinal investigations of neuropsychological measures in relation to later behavioral outcomes in childhood are few. A 2-year longitudinal study in a nonselected childhood sample is reported. The study tested the influence of early neuropsychological performance (verbal fluency, mental inhibitory control, and visual spatial ability) on later childhood behavioral problems and social competency. Regular education children (n = 235) were assessed at three time points 1 year apart. To control for autocorrelation of outcome measures, Time 1 behavior was partialed while testing the effects of Time 1 neuropsychological scores on Time 3 outcome. To control for autocorrelation of neuropsychological scores, Time 2 scores were partialed while testing the predictive effect of Time 1 scores on Time 3 outcome. Both sets of regression models suggested modest but statistically significant effects for inhibitory control and verbal fluency, but not IQ, reading, or visual spatial ability, on behavioral outcome. Study results are consistent with a modest causal effect of selected neuropsychological skills on later behavioral adjustment. The findings support theories that implicate subtle neuropsychological dysfunction in the development of behavioral problems in childhood.

Predicting developmental outcomes at school entry using a multiple-risk model: four American communities. The Conduct Problems Prevention Research Group.

The contributions of different risk factors in predicting children's psychological and academic outcomes at the end of 1st grade were examined. Using a regression model, levels of ecobehavioral risk were assessed in the following order: specific demographics, broad demographics, family psychosocial status, mother's depressive symptoms, and neighborhood quality. Participants were 337 families from 4 American communities. Predictor variables were assessed in kindergarten, and teacher, parent, and child outcomes (behavioral and academic) were assessed at the end of 1st grade. Results indicated that (a) each level of analysis contributed to prediction of most outcomes, (b) 18%-29% of the variance was predicted in outcomes, (c) a common set of predictors predicted numerous outcomes, (d) ethnicity showed little unique prediction, and (e) the quality of the neighborhood showed small but unique prediction to externalizing problems.

Attachment in boys with early onset conduct problems.

Few studies have examined the association between attachment and psychopathology in samples of clinically diagnosed children or the relation between attachment variables and the continuity of clinical symptoms. Clinic-referred preschool boys (n = 80) with early onset conduct problems (as indicated by diagnoses of Oppositional Defiant Disorder) were compared with a case-matched group of 80 nonproblem boys to determine whether observed attachment behaviors could: (a) differentiate the groups, (b) explain concurrent variation in problem severity within the clinic group, and (c) predict the outcomes of clinic boys 1 and 2 years later. Over half of the clinic boys with early onset conduct problems (54%) exhibited an insecure attachment strategy during reunion, as opposed to 18% of comparison group boys. All insecure patterns were overrepresented in the clinic group. Clinic boys were more likely than comparison boys to engage in provocative behavior when separated from their mothers. Contrary to our hypothesis, attachment variables showed little ability to explain concurrent or future variation in the problem severity or diagnostic status of clinic boys. We conclude that observable attachment behaviors exhibited during the preschool years are related to the initial identification of early onset conduct problems but may have little value by themselves in predicting the subsequent course and severity of problems in the 2 years following clinic referral.

Fathers and preschool behavior problems.

Fathers have seldom been the focus of research investigating the causes and correlates of early behavior problems. Two studies examined fathers of preschool boys with and without clinic-referred behavior problems. Six domains of risk were examined: life stress, social support, psychological symptoms, parenting attitudes, positive involvement, and harsh discipline. Clinic fathers differed from fathers of matched comparison boys with respect to all of these except social support, but only harsh discipline contributed uniquely to clinic status. These domains correctly classified 81% of the boys. Within the clinic group, teacher-rated problem severity 1 year later was predicted by fathers' life stress, psychological symptoms, and positive involvement, indicating that different factors may account for initial clinic status versus stability of problems. Mothers' self-report data better predicted clinic group membership, whereas fathers' data better predicted Year 2 outcomes for clinic boys.

Fathering and early onset conduct problems: positive and negative parenting, father-son attachment, and the marital context.

Research literature linking negative and positive aspects of the father-child relationship with early onset conduct problems is reviewed. Evidence from the Preschool Families Project, a longitudinal study of clinic-referred preschool boys at risk for conduct disorder, is presented, including previously unpublished data on father-child attachment. Both negative (e.g., harsh, angry, and physically punitive) and positive (involvement, warmth, and secure attachment) dimensions of fathering, as well as aspects of the marital relationship, appear to be associated with the emergence of early onset conduct problems.

Observed family interaction during clinical interviews: a comparison of families containing preschool boys with and without disruptive behavior.

The clinical intake interview is an opportunity to observe family interactions and formulate hypotheses about their influence on presenting problems. In this study family interactions were assessed during an unstructured segment of a clinical intake. Families with disruptive preschool boys were compared with those having nonproblem boys. Mother's and fathers' reports of marital satisfaction, parenting involvement, and child behavior problems were examined in relation to observed behavior during intake. Patterns of family interaction emerged which were consistent with previous research and with family systems theory. Clinic boys oriented more toward mothers than fathers and interacted more negatively with their fathers than did comparison boys. Implications for integrating the assessment of family interactions into clinical practice and research with behavior problem children are discussed.

Clinic referral for oppositional defiant disorder: relative significance of attachment and behavioral variables.

Attachment classifications have been found to distinguish clinic-referred, oppositional preschool boys from controls, but there has been no previous effort to examine the relative contribution of attachment when behaviors from a social learning perspective are also considered. The present study examined the contribution of attachment and behavioral variables to the prediction of clinic referral for oppositional defiant disorder in a sample of preschool boys. We hypothesized that the attachment measures would offer better discrimination of clinic and control group boys at this age. This hypothesis was confirmed when the attachment measures were compared with the parent-child behaviors most strongly associated with social learning conceptualizations of disruptive problems (maternal commands and criticism, and child noncompliance), but rejected in a more stringent test in which the attachment measures were compared with the behavioral variables distinguishing the groups in this particular sample.

The relations between emotional understanding, intellectual functioning, and disruptive behavior problems in elementary-school-aged children.

This study examined individual differences in children's emotional understanding and behavioral adjustment. Participants included 220 first- and second-grade children (75% regular education, 25% special education) who were individually interviewed using the Kusche Affective Interview--Revised. Dependent measures of emotional understanding and experience included the ability to provide personal examples of 10 different emotions and the cues used for recognition of five emotions in oneself and other persons. Children were also administered the WISC-R Vocabulary, Block Design, and Coding subtests. One parent independently completed an Achenbach Child Behavior Checklist for each child. Results indicated that children who were rated as higher in behavior problems showed deficits in emotional understanding. Intellectual functioning was negatively associated with behavior problems and attenuated the effects of behavior problems on emotional understanding. Implications of the current findings for prevention and treatment programs for children with behavior problems are discussed.

Developmental approach to the psychology of craniofacial anomalies.

This article outlines a developmental perspective on psychosocial maladjustment and its implications for the psychological study and treatment of individuals with craniofacial anomalies. A developmental theory of attachment is described and used to formulate hypotheses about the developing parent-child relationship during the first 5 years of life and its influence on the child's subsequent social and emotional growth. Preliminary research involving infants with clefts and other craniofacial anomalies is reviewed with respect to hypothesized points of vulnerability in the attachment process. Two major points are made: (1) developmental theory provides a framework for the early identification of children in this population with elevated risk of subsequent psychosocial problems, and (2) among the multiple child and family variables associated with elevated risk, a craniofacial anomaly is unlikely to produce maladjustment in the absence of one or more other risk conditions such as family adversity, insecure attachment, or compromised child characteristics.

Parent and peer attachment in early adolescent depression.

Insecure attachment relations have been theorized to play a significant role in the development of depressogenic modes of adaptation and to thus form a vulnerability factor for the emergence of depressive disorder in children. This study examined security of parent and peer attachment among four groups of early adolescents: clinically depressed, nondepressed psychiatric controls, nonpsychiatric controls, and adolescents with resolved depression. Depressed adolescents reported significantly less secure parent attachment than either of the control groups, and less secure peer attachment than the nonpsychiatric control group. Attachment security of adolescents with resolved depression was on a par with the nonpsychiatric control group. Among all psychiatric patients, security of attachment to parents was negatively correlated with severity of depression according to interview and self-report ratings. Less secure attachment to parents, but generally not to peers, was also related to more maladaptive attributional styles, presence of separation anxiety disorder, and history of suicidal ideation.

Minor parenting stresses with young children.

The importance of major life stress and minor daily hassles associated with parenting was studied in 74 mothers and their 5-year-old children. Of interest were the relative and absolute contributions of the stress factors to indices of parental, child, and family functioning. Mothers completed questionnaires regarding stressors, aspects of parenting and individual psychological status, social support, family functioning, and child behavioral status. Mother-child pairs were also observed in interactions in a laboratory setting. Analyses indicated that life stress and parenting daily hassles significantly predicted aspects of child, parent, and family status. Hassles, however, proved to be a more powerful stress construct. Further analyses indicated that mothers' social support moderated the influence of hassles on indices of maternal behavior. The results are discussed in relation to the potential for minor parenting stresses to influence microsocial processes within parent-child relationships and contribute to dysfunction in children and families.

Stress and coping among parents of handicapped children: a multidimensional approach.

The relations of child characteristics, family social network, parent belief systems, and coping styles to parent outcome were examined with parents of 48 young handicapped children. Child characteristics predicted mothers' and fathers' parenting stress and fathers' psychological distress. Parental belief systems predicted all three parent outcomes for mothers and fathers. Coping styles predicted psychological distress and fathers' family adjustment. Social network predicted family adjustment and fathers' psychological distress. Psychological distress was low in mothers who had either a positive belief system or a noncritical family network. Findings support the value of a multidimensional examination of family characteristics that mediate the impact of a child's handicap.

Longitudinal predictors of developmental status and social interaction in premature and full-term infants at age two.

This investigation involved the longitudinal assessment of 30 mother-preterm and 40 mother-full-term dyads from birth to 2 years of age. Measures of maternal attitudes, maternal perception of the infant, and parental functioning were obtained at 1 and 8 months of infant age. Mother-infant interactions were observed at 4, 8, 12, and 24 months. Infant cognitive, motor, and language development was assessed at 4, 12, and 24 months. Results indicated that by age 2 years, no group differences were apparent on any child development, mother-child interaction, or maternal attitudinal measures; the lone exception was that preterms were significantly poorer in motor skills. This similarity in functioning at age 2 years was in marked contrast to earlier findings of major group differences at 12 months. Correlational and regression analyses indicated that the developmental and social interaction outcomes were predicted by different factors in the two groups; moreover, whereas 40%-60% of the variance in preterm infants' social and cognitive outcomes could be accounted for, only 15%-30% was accounted for in the full-term group. These results are discussed in terms of compensatory mechanisms that may characterize the parenting of high-risk infants, and of the applicability of transactional models of development.