Description and Immediate Impacts of a Preventive Intervention for Conduct Problems

A population-based randomized intervention trial for the prevention of conduct problems (i.e., oppositional defiant disorder and conduct disorder) is described. The LIFT (Linking the Interests of Families and Teachers) intervention was designed for all first- and fifth-grade elementary school boys and girls and their families living in at-risk neighborhoods characterized by high rates of juvenile delinquency. The 10-week intervention strategy was carefully targeted at proximal and malleable antecedents in three social domains that were identified by a developmental model of conduct problems. From 12 elementary schools, 671 first and fifth graders and their families participated either in the theory-based universal preventive intervention or in a control condition. The intervention consisted of parent training, a classroom-based social skills program, a playground behavioral program, and systematic communication between teachers and parents. A multiple measure assessment strategy was used to evaluate participant satisfaction and participation, fidelity of implementation, and the immediate impacts of the program on targeted antecedents.     

Development of a Family-based Program to Reduce Risk and Promote Resilience Among Families Affected by Maternal Depression: Theoretical Basis and Program Description

Depression is a family matter. It not only diminishes the quality-of-life of the depressed person, but also strains the resources of the family unit and increases the children's risk of developing significant problems that start early and persist into adulthood. Although treatment of a parent's depression is critical, many families also need professional intervention to reduce children's risk. This article reviews the evidence on needs of these families and shows that the theoretical and clinical evidence exists to support the design of interventions for families affected by maternal depression. A preventive intervention developed from this foundation is described, the Keeping Families Strong (KFS) program, that is designed to promote resilience and reduce the risk for psychological disorders in children of parents with depression. The pilot study on the KFS program, conducted in adult mental health outpatient settings, is described. Families participate in 10 meetings 90 min each, with a group for parents and for children (10 years and older) conducted concurrently. The program structure and content are described, the challenges of implementing a family preventive intervention in actual clinical settings are discussed, and a case example is provided, as well as preliminary outcome data on ten families. In sum, we provide a strong rationale for the potential of preventive interventions for families affected by maternal depression.     

Information-processing biases in young adults from bereaved and divorced families

Parental loss or divorce is associated with increased risk for affective disorders, potentially because of dysfunctional information processing. This study evaluated attentional biases to threat or loss-related cues in young adults from divorced, parental-loss, or intact families. Participants from intact families showed avoidance of supraliminal threat and loss cues, whereas those from divorced families showed vigilance toward loss cues. Those from bereaved families showed no pattern of bias. Abuse and poor family relationships were associated independently with vigilance toward negative cues. After controlling for abuse, group differences in threat bias were no longer apparent. Results suggest that parental death or divorce may increase risk of affective disorder owing to the loss of a "protective bias" away from negative stimuli.     

Targeting preventive interventions: Enhancing risk estimates through theory

Incorporation of mediational screening procedures within targeted preventive interventions must be grounded in a substantial theoretical and epidemiological knowledge base. Essential information includes an etiological model of the disorder(s) to be prevented and epidemiological confirmation that risk factors used for the selection of intervention recipients have been prospectively confirmed. Targeting these recipients using a combination of indicated and selective criteria is expected to increase the base rate at which the disorder(s) to be prevented occurs in the intervention population and thus the power of the evaluation design used to confirm reductions in proximal and distal indices of disorder(s). Caution is urged, however, to consider the potential iatrogenic effects of overly focused targeting and the potential reductions in intervention effectiveness resulting from application to homogeneous vs. heterogeneous populations. Mediational screening's heuristic contribution to theory is discussed.     

Long-term effects from a randomized trial of two public health preventive interventions for parental depression.

This article presents long-term effects of a randomized trial evaluating 2 standardized, manual-based prevention strategies for families with parental mood disorder: informational lectures and a brief, clinician-based approach including child assessment and a family meeting. A sample of 105 families, in which at least 1 parent suffered from a mood disorder and at least 1 nondepressed child was within the 8- to 15-year age range, was recruited. Parents and children were assessed separately at baseline and every 9 to 12 months thereafter on behavioral functioning, psychopathology, and response to intervention. Both interventions produced sustained effects through the 6th assessment point, approximately 4.5 years after enrollment, with relatively small sample loss of families (<14%). Clinician-based families had significantly more gains in parental child-related behaviors and attitudes and in child-reported understanding of parental disorder. Child and parent family functioning increased for both groups and internalizing symptoms decreased for both groups, with no significant group differences. These findings demonstrate that brief, family-centered preventive interventions for parental depression may contribute to long-term, sustained improvements in family functioning.     

The Comorbidity of Conduct Problems and Depression in Childhood and Adolescence

An extensive body of research documents the high prevalence of comorbidity among child and adolescent disorders in general and between conduct problems and depression in particular. These problems co-occur at significantly higher rates than would be expected by chance and their comorbidity may have significant implications for nosology, treatment, and prognosis. Four main hypotheses have been put forth to account for these high rates of comorbidity. First, comorbidity may be a result of shortcomings associated with referral or informant biases. Second, comorbidity may be an artifact of overlapping definitional criteria. Third, one disorder may cause the other disorder by influencing the developmental trajectory and placing an individual at increased risk for further difficulties. Finally, comorbidity between two disorders may be explained by shared underlying causal or risk factors. The purpose of this review is to explore these possibilities, concentrating primarily on the common risk factors of parent psychopathology, emotion regulation, and cognitive biases that may underlie the co-occurrence of these two disorders. Based on our review, we propose a model for the development of comorbidity between these two disorders.     

The role of parent depressive symptoms in positive and negative parenting in a preventive intervention

This study examined the role of parent depressive symptoms as a mediator of change in behaviorally observed positive and negative parenting in a preventive intervention program. The purpose of the program was to prevent child problem behaviors in families with a parent who has current or a history of major depressive disorder. One hundred eighty parents and one of their 9- to 15-year-old children served as participants and were randomly assigned to a family group cognitive-behavioral (FGCB) intervention or a written information (WI) comparison condition. At two months after baseline, parents in the FGCB condition had fewer depressive symptoms than those in the WI condition, and these symptoms served as a mediator for changes in negative, but not positive, parenting at 6 months after baseline. The findings indicate that parent depressive symptoms are important to consider in family interventions with a parent who has current or a history of depression. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

A Child Trauma Treatment Pilot Study

We examined outcomes of a promising 21-session trauma treatment model for children aged 3 to 17 and their caregivers. All children in treatment had experienced at least one traumatic event. The treatment intervention was rooted in theories of trauma and attachment and combines parent training with cognitive behavioral therapy to form a comprehensive trauma treatment program. We report on 27 families who completed the program. Results reflect significant reductions in conduct disorder, problems in social relations, and caregiver depression at an average of a one-year post-treatment follow-up. Results from our preliminary study offer support for further evaluation of the model.     

Change in caregiver depression as a function of the Strong African American Families Program.

A randomized prevention trial contrasted families who participated in the Strong African American Families Program (SAAF), a preventive intervention for rural African American parents and their 11-year-olds, with control families. This article focuses on the program's effect on primary caregivers' depressive symptoms. Among the 167 caregivers with elevated scores on the Center for Epidemiologic Studies-Depression Scale, SAAF participation was associated with reduced depressive symptoms, enhanced parenting, and perceived improvements in youth behavior. Change in parenting (consistent discipline, youth monitoring, and open communication) but not change in youth intrapersonal competencies significantly mediated intervention effects on caregivers' depression. Results support the link between reduced depressive symptoms and stronger family relationships, particularly the importance of enhanced parenting efficacy in alleviating depressive symptoms.     

Sustained Effects of Incredible Years as a Preventive Intervention in Preschool Children with Conduct Problems

The present study evaluated preventive effects of the Incredible Years program for parents of preschool children who were at risk for a chronic pattern of conduct problems, in the Netherlands. In a matched control design, 72 parents of children with conduct problems received the Incredible Years program. These families (intervention group) were compared with 72 families who received care as usual (control group). Two years after termination of the intervention, it appeared that observed and selfrated parenting skills were significantly improved in the intervention group. Likewise, in this group, observed child conduct problems showed sustained intervention effects. The decrease in observed critical parenting mediated the decrease in observed child conduct problems over time. In addition, it appeared that parental influence increased over time.     

If It's Offered,Will They Come? Influences on Parents' Participation in a Community-Based Conduct Problems Prevention Program

This study examined influences on the rate and quality of parent participation in the Fast Track Program, a multi-system, longitudinal preventive intervention for children who are at risk for conduct problems. A theoretical model of the relations among family coordinator characteristics, parent characteristics, the therapeutic engagement between family coordinator and parent, and rate and quality of parent participation was the basis for this study. Family coordinators are the Fast Track program personnel who conduct group-based parent-training sessions and home visits. Participants in this study included 12 family coordinators (42% were African American, 58% European American) and 87parents (55% were African American, 45% European American). The level of therapeutic engagement between the parent and the family coordinator was positively associated with the rate of parent attendance at group training sessions. The extent of family coordinator-parent racial and socioeconomic similarity and the extent of the family coordinator's relevant life experiences were highly associated with the level of therapeutic engagement. The quality, but not the rate, of participation was lower for African American parents. Implications of these findings for preventive intervention with this population are discussed.     

Feasibility,Acceptability, and Preliminary Outcomes of the Fortalezas Familiares Intervention for Latino Families Facing Maternal Depression

This pilot study examined the feasibility, acceptability, and preliminary outcomes of a linguistically and culturally adapted intervention for immigrant Latina mothers with depression and their families. Fortalezas Familiares (Family Strengths) is a community‐based, 12‐week, multifamily group intervention that aims to increase communication about family processes leading up to and affected by the mother's depression, build child coping and efficacy, enhance parenting competence and skills, and promote cultural and social assets within the family. In terms of feasibility, of 16 families who enrolled and participated in the intervention, 13 families attended more than 90% of meetings and completed the intervention. Posttests reported positive changes following the intervention, including improved psychological functioning, increased family and marital support, and enhanced family functioning, as reported by mothers and other caregivers. Mothers also reported decreased conduct and hyperactivity problems among their children. Children reported positive changes in their psychological functioning and coping, parenting warmth and acceptance, and overall family functioning. Postintervention focus groups and surveys measuring acceptability revealed families' satisfaction with the intervention and suggested areas of improvement. We discuss similarities and differences in outcomes between the adapted intervention, Fortalezas Familiares, and the original intervention, Keeping Families Strong, and propose future areas of intervention adaptation and development.     

Developing a family-based depression prevention program in urban community mental health clinics: a qualitative investigation

Extensive research documents that children of depressed mothers are at a significantly higher risk for developing a variety of socioemotional difficulties than children of nondepressed mothers. Yet, little prevention research has been conducted for this population, and low-income, minority, and urban families are rarely included. To address this deficit, we are developing the Protecting Families Program (PFP), a family-based multicomponent depression prevention program for mothers in treatment at urban community mental health agencies and their school-aged children. To inform intervention development and begin relationship building with the agencies, patient and staff focus groups were conducted in the participating agencies. Eighteen mothers with depression participated, and eight major themes were identified: (1) depression symptoms, (2) generational legacy, (3) parenting difficulties, (4) child problems, (5) social support, (6) stressful life events, (7) therapy and other helpful activities, and (8) desired treatment. In the focus groups with 10 mental health providers, the five major themes identified were parenting difficulties, lack of social support, life stress, current mental health practices, and intervention development. The findings support the multicomponent design of PFP, which focuses on increasing knowledge of depression, enhancing social support, and improving parenting skills. The study helped clarify many of the challenges of conducting research in a community mental health system.     

Participation and Attrition in a Coping Skills Intervention for Adolescent Girls with Inflammatory Bowel Disease

The current study examined factors associated with adolescent and parent participation in a coping skills intervention for adolescent girls with inflammatory bowel disease (IBD) and examined factors associated with attrition related to intermittent missing data. Thirty-one adolescent girls with IBD and their parents enrolled in the intervention. Psychosocial and disease factors related to participation in the 6-week web component of the coping skills intervention were examined as were baseline group differences between those who provided post-treatment data and those who did not. Adolescents experiencing more difficulties related to their disease and psychosocial functioning participated less in the web component of the treatment intervention. Families who attrited had higher baseline levels of parental catastrophic thoughts, parenting stress, and adolescent depression. Families experiencing greater levels of psychological and disease-related difficulties may be at risk for low participation and eventual dropout from pediatric IBD psychological treatment interventions.     

Parent–Child Interaction Therapy: One- and Two-Year Follow-Up of Standard and Abbreviated Treatments for Oppositional Preschoolers

The long-term effect of two parent training programs for conduct problem preschoolers is reported. Families of 54 behaviorally disturbed preschool-aged children were randomly assigned to 1 of 3 treatment conditions: standard Parent-Child Interaction Therapy (STD), an abbreviated form of PCIT (ABB), and a no-treatment waitlist control group (WL). Of the families who completed treatment (STD and ABB), data were collected on 97% and 94% of families at 1- and 2-year follow-up, respectively. Follow-up assessment of parent report and independent observations indicated that treatment gains were largely maintained for both treatment conditions with little difference between the two treatments. The findings suggest that an abbreviated form of PCIT has long-term benefits for families with young children displaying early conduct problems.     

Family structure and family processes in Mexican-American families

Despite increases in single-parent families among Mexican Americans, few studies have examined the association of family structure and family adjustment. Utilizing a diverse sample of 738 Mexican-American families (21.7% single parent), the current study examined differences across family structure on early adolescent outcomes, family functioning, and parent-child relationship variables. Results revealed that early adolescents in single-parent families reported greater school misconduct, conduct disorder/oppositional deviant disorder, and major depressive disorder symptoms, and greater parent-child conflict than their counterparts in 2-parent families. Single-parent mothers reported greater economic hardship, depression, and family stress. Family stress and parent-child conflict emerged as significant mediators of the association between family structure and early adolescent outcomes, suggesting important processes linking Mexican-American single-parent families and adolescent adjustment.     

Prevention,the appropriate target of infant psychotherapy

The aim of this paper is to evaluate the case for preventive interventions in infancy aimed at the reduction of childhood psychopathology. The paper considers the terminology of prevention and the case for prevention in infancy. It is argued that increased knowledge concerning the developmental pathways involved in many psychological disorders opens the door to prevention initiatives. An overview of recent prevention trials is provided and the implications from treatment evaluation studies are explored. The case for prevention of conduct disorders is taken as an illustration of the potential for interventions in infancy. A developmental model of conduct disorder implicates a vicious cycle of parent–child interactions, a process that may arguably be preempted by early intervention. Three modalities are considered in detail: (a) early parent training; (b) the enhancement of attachment security; and (c) the facilitation of the development of reflective function. Studies in each of these areas are reviewed. The paper concludes that increased emphasis on the prevention aspect of infant mental health interventions is justified and desirable. © 1998 Michigan Association for Infant Mental Health     

Suicidal Ideation, Depression, and Conduct Disorder in a Sample of Adolescent and Young Adult Twins

The co-occurrence of suicidal ideation, depression, and conduct disturbance is likely explained in part by correlated genetic and environmental risk factors. Little is known about the specific nature of these associations. Structured interviews on 2,814 twins from the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) and Young Adult Follow-Up (YAFU) yielded data on symptoms of depression, conduct disorder, and adolescent and young adult suicidal ideation. Univariate analyses revealed that the familial aggregation for each trait was explained by a combination of additive genetic and shared environmental effects. Suicidal ideation in adolescence was explained in part by genetic influences, but predominantly accounted for by environmental factors. A mixture of genetic and shared environmental influences explained ideation occurring in young adulthood. Multivariate analyses revealed that there are genetic and shared environmental effects common to suicidal ideation, depression, and conduct disorder. The association between adolescent suicidal ideation and CD was attributable to the same genetic and environmental risk factors for depression. These findings underscore that prevention and intervention strategies should reflect the different underlying mechanisms involving depression and conduct disorder to assist in identifying adolescents at suicidal risk.     

Coherence and specificity of information-processing biases in depression and social phobia

Research has not resolved whether depression is associated with a distinct information-processing bias, whether the content of the information-processing bias in depression is specific to themes of loss and sadness, or whether biases are consistent across the tasks most commonly used to assess attention and memory processing. In the present study, participants diagnosed with major depression, social phobia, or no Axis I disorder, completed several information-processing tasks assessing attention and memory for sad, socially threatening, physically threatening, and positive stimuli. As predicted, depressed participants exhibited specific biases for stimuli connoting sadness; social phobic participants did not evidence such specificity for threat stimuli. It is important to note that the different measures of bias in memory and attention were not systematically intercorrelated. Implications for the study of cognitive bias in depression, and for cognitive theory more broadly, are discussed.     

The Implementation of the Fast Track Program: An Example of a Large-Scale Prevention Science Efficacy Trial

In 1990, the Fast Track Project was initiated to evaluate the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders in four demographically diverse American communities (Conduct Problems Prevention Research Group [CPPRG], 1992). Representing a prevention science approach toward community-based preventive intervention, the Fast Track intervention design was based upon the available data base elucidating the epidemiology of risk for conduct disorder and suggesting key causal developmental influences (R. P. Weissberg & M. T. Greenberg, 1998). Critical questions about this approach to prevention center around the extent to which such a science-based program can be effective at (1) engaging community members and stakeholders, (2) maintaining intervention fidelity while responding appropriately to the local norms and needs of communities that vary widely in their demographic and cultural/ethnic composition, and (3) maintaining community engagement in the long-term to support effective and sustainable intervention dissemination. This paper discusses these issues, providing examples from the Fast Track project to illustrate the process of program implementation and the evidence available regarding the success of this science-based program at engaging communities in sustainable and effective ways as partners in prevention programming.