Approaches to Prevention

Approaches to prevention may be universal, selected, or indicated. Universal programs address an entire population of children, such as those in classrooms, schools, or neighborhoods, and usually address a community-level risk factor such as neighborhood poverty rather than a delinquency outcome. Selected programs, on the other hand, target high-risk children who may have already shown some antisocial behavior. Indicated programs are for those children who have been identified as showing clear signs of delinquent or antisocial behavior.

A program can address a specific population at one of three levels of prevention. Primary prevention addresses the disease or disorder, such as antisocial behavior. One example of primary prevention would be to decrease low-weight births by eliminating maternal smoking. Secondary prevention detects early signs of a disorder, such as ADHD or academic underachievement, and curtails or cures the problem. Tertiary prevention addresses the disabilities or damages caused by a disorder, for example, treatment of academic difficulties resulting from chronic depression.

Family- and Parent-Focused Components

Effective family- and parent-focused programs have used one of three strategies: parent management training, functional family therapy, or family preservation.¹

Parent management training. This method attempts to influence child behavior by teaching parents better parenting strategies. Parents of children with behavioral problems tend to be inconsistent and punitive in establishing and enforcing rules, which often causes children to use aversive behavior such as whining to manipulate their environment.² Parent management training offers parents individual or group training at a school or clinic where they learn to:

• Communicate clear expectations about behavior to their children.
  
  
• Identify positive and negative behaviors.
  
  
• Recognize antecedents of problem behaviors.
  
  
• Provide positive consequences for positive behavior.
  
  
• Impose noncoercive negative consequences for inappropriate and noncompliant behavior.

Parents are given homework assignments to practice the skills they learn in class, and they receive feedback from the therapist. Parent management training programs also promote positive, shared family experiences by "prescribing" joint parent-child playtime or shared family recreational activities.³

Although evaluations of parent management training programs demonstrate substantial changes in parent and child behavior, followup studies show that 25–40 percent of children whose parents participated in these programs continue to have clinically significant behavior problems.⁴ Families are less likely to benefit from these programs if the parents have limited economic and personal resources, psychiatric problems, little social support, or serious marital conflict.⁵ Also, if the training focuses solely within the home, the lessons may not be generalized to other environments such as the school.

Functional family therapy. This approach⁶ increases communication and mutual problem solving by specifying clear rules and consequences for breaking them; developing clear and contingent parent-child contracts that link good child behavior to specified rewards; using social reinforcement such as praise; instituting a token economy (the exchange of privileges for good behavior); and relying on cognitively based interventions. The functional family therapy approach has been found to improve family communication and lower recidivism of youth.⁷

Family preservation. This multisystemic crisis intervention is intended to prevent placement of a child outside the home as a result of abuse, neglect, or delinquency. Family preservation's intense, short-term services (10–20 hours per week for 4–6 weeks) entail a low caseload—caseworkers usually handle fewer than five families—and include parent management training, didactic training in life skills, home and budget management, assertiveness training, and coordination of community services.

Evaluations have shown that although they decrease the number of children placed outside the home, family preservation methods fail to improve the situation of the family (Feldman, 1991; Miller, 1995). The individualization of services is an advantage over "packaged" services, but the reliability of these programs is difficult to track (Miller, 1995). Also, given the well-publicized instances of the failure of social services to prevent the abuse and death of children remaining in the home, this approach may not always be the most effective.

Child-Focused Components

Social competence training. Children who lack social and cognitive skills tend to be aggressive (Huesmann et al., 1992). They fail to pay attention to social cues (Dodge, Bates, and Pettit, 1990), have poorer problem-solving abilities (Rubin and Krasnor, 1986), and exhibit less empathy than their peers. Social competence training helps youth learn positive social behaviors (e.g., conversational skills, academic achievement, and behavioral control strategies) and to improve social-cognitive processes (e.g., problem solving and self-control). These programs, often school-based, focus on the consequences of physical aggression or coercion and are neither used to treat serious conduct problems nor focused on covert antisocial behavior such as stealing or vandalism. Some examples of social competence training programs follow:

• The Interpersonal Cognitive Problem-Solving curriculum uses games ranging from simple word concepts to strategies for finding solutions to interpersonal problems, and for thinking consequentially and learning to empathize. Children in this program become less aggressive, more socially appropriate, and better able to solve problems.⁸
  
  
• Kazdin's social competence training program⁹ treats antisocial psychiatric inpatients and outpatients using the methods described above. Participants often made long-standing therapeutic gains at home and in school but continued to exhibit deviant behavior after the training.
  
  
• The Brainpower program seeks to reduce the number of times that African American boys with high teacher/peer ratings for aggressiveness attribute hostile intentions to other people in ambiguous scenarios (situations in which the motivation of the participants is unclear) (Hudley, 1994). After completing 12 weeks of cognitive retraining, late-elementary school children were less likely to attribute hostile intentions to others than they were before the program.
  
  
• Under the Positive Adolescents Choices Training (PACT) program, African American middle school students were trained to give and accept feedback, resist peer pressure, solve problems, and negotiate effectively (Hammond and Yung, 1991, 1992; Brewer et al., 1995). Suspensions and expulsions decreased among students in the intervention group and increased among students in the control group. Unfortunately, this study encountered a number of problems. Intervention and control groups may not have been comparable at baseline, teachers were not blind to the assignment of students to the two groups, and the authors did not present the statistical significance of their results (Brewer et al., 1995).
  
  
• Lochman's school-based anger coping (AC) program helped aggressive and disruptive boys understand the physiology of aggression, especially anger, and taught them coping strategies such as self-talk (e.g., calming oneself down by telling oneself, "Maybe he didn't mean that. If I start a fight, I'll get put in detention.").¹⁰ Three years later, the intervention group reported less substance abuse and greater self-esteem and social problem-solving skills. However, neither self-reported delinquency rates nor observations of classroom behavior indicated a difference between intervention and control groups. Researchers concluded that the program's long-term effects could be enhanced by adding parent training (Lochman, 1992).

Academic skills enhancement. Poor school achievement, poor attendance, and school suspensions contribute to antisocial behavior (American Psychological Association, Commission on Violence and Youth, 1993). A review of the effects of well-designed programs on the academic and behavioral outcomes of at-risk youth found that these programs have a positive impact on academic functioning (Maguin and Loeber, 1996; Moffitt, 1990). The most effective are law-related moral education programs, which educate youth about the role of law in society (Arbuthnot and Gordon, 1986; Gottfredson and Gottfredson, 1992). Many academic programs, however, target elementary or high school students who have already developed academic and behavioral problems. This may be the reason that programs offering reading instruction and tutoring are less effective than law-related education. Basic skills programs may be more effective with younger children (Kellam et al., 1998).

Medication. ADHD, a common risk factor for conduct disorder, is commonly and effectively treated through psychostimulant medication (Abikoff and Klein, 1992; Spencer et al., 1996), which can reduce symptoms of inattentiveness, motor overactivity, and impulsiveness. The medication can also improve poor peer interactions (Gadow et al., 1990; Pelham et al., 1993) and improve short-term academic functioning for youth with ADHD (Greenhill, 1995).

The effect of medication on conduct disorder is not yet known, largely because of the great overlap between children with ADHD and conduct disorder. However, improvements in the behavior of children diagnosed with both ADHD and conduct disorder who are treated with stimulant medications indicate that medication may be useful in the treatment of conduct disorder alone (Hinshaw, 1991; Spencer et al., 1996).

Abikoff and Klein (1992) note the following limitations of using stimulant medication as a single intervention in treating ADHD:

• Medication wears off by the end of the day, creating management problems at home.
  
  
• Treatment gains are short-lived and limited to the length of the medication's effects.
  
  
• Not all children respond positively to medication.
  
  
• Some families are unwilling to use medication.

Other interventions. Other youth-focused interventions include individual psychotherapy and behavioral anger control programs; however, there is little evidence documenting the effectiveness of these interventions for preventing antisocial behavior (Tolan and Guerra, 1994).

Classroom-Focused Components

Classroom contingency training. These interventions may be classroom or individually based, but they take place within the classroom as opposed to the entire school. Classroom contingency training applies the techniques of parent management training to the classroom by establishing clear routines and expectations about attendance, behavior, and classroom procedures (Hawkins, Doueck, and Lishner, 1988). Teachers are trained to provide targeted and contingent encouragement and praise. Research has found that disruptive behavior and vandalism costs decreased in intervention schools while they increased in control schools.¹¹

Academic skills enhancement. Hawkins, Doueck, and Lishner (1988) combined classroom contingency training with academic skills enhancement. The program also included teacher training and supervision, proactive classroom discipline, use of student learning partners, and clear learning objectives. At the end of the academic year, students exposed to the intervention were more positive, and school disciplinary problems were fewer among children who received classroom contingency training than among those who did not. There were no effects on delinquency, however.

Token economy. In a Baltimore, MD, program, children in grades 7 to 9 with a history of suspensions were assigned to small classes of 10 to 15 students (Safer, 1996). In a token economy, they received points for good behavior that could be used for privileges, including a shortened school day. The program also attempted to develop a home-based token economy with parents. Youth in the intervention group had fewer expulsions or suspensions, but there were no differences in attendance or standardized achievement scores. The program may have had longer-term effects, however. After students in the intervention group completed the program, they were more likely to enter high school and have better attendance and classroom behavior while there than those in the control group.

Peer Group-Focused Components

Peer mediation. Peer mediation programs (Hawkins, Catalano, and Brewer, 1995) train youth to act as mediators in school settings by listening, communicating, identifying points of agreement, and arriving at nonviolent solutions to conflicts (Brewer et al., 1995). Most evaluations of these programs have not been properly designed, and few have shown positive effects (Lam, 1989).

Conflict resolution. School-based conflict resolution programs are popular and widely used in middle and high schools. These psychoeducational programs increase students' knowledge of the causes and consequences of violence, improve students' self-control, and help students develop social problem-solving skills. Evaluations of some new programs that suggest promise have emerged recently.

The Resolving Conflict Creatively Program (RCCP) attempts to alter social processes in elementary school children by changing classroom contexts, training staff and students in conflict resolution, and promoting peer mediation (Aber et al., 1998). Over the course of a school year, children in classrooms where materials were presented showed lower levels of aggressive fantasies and other social cognitive processes usually associated with aggressive behavior. Another program for elementary school children (Stevahn et al., 1996) compared promoting cooperative learning in the classroom with didactic training in conflict resolution in curriculums that are integrated into academic programming. Children exposed to both components showed the most learning and retention of conflict resolution strategies. Moving beyond children's responses to paper-and-pencil measures is very much a concern in this field, so that research needs to be evaluated in terms of behavioral changes that would indicate an impact on serious and violent juvenile offending. One well-documented program that has shown behavioral effects is the Second Step Curriculum (Grossman et al., 1997); direct observations showed decreases in physically negative behavior that were maintained 6 months later. Preliminary results from RCCP also suggest that the program has a positive impact on teacher ratings of children's aggressive and prosocial behavior (Aber, Brown, and Henrich, 1999).

Webster (1993) is skeptical about the effectiveness of conflict resolution programs for a number of reasons. First, these standardized programs assume that all students are similar, when in fact youth begin exhibiting antisocial behavior at different points and in response to different risk factors. These programs are likely to intervene too late in the development of youth whose social skills deficits originate in childhood. Second, social skills deficits, which these programs try to remedy, may not be at the root of interpersonal violence, so addressing the deficits will not necessarily reduce the violence. Third, these programs may not be sufficient because many other factors contribute to youth violence.

2 Patterson, Reid, and Dishion, 1992; Wasserman et al., 1996.

3 Barkley, 1987; Eyberg and Boggs, 1989; Forehand and McMahon, 1981; Hawkins et al., 1992; Webster-Stratton, 1984.

4 Forehand, Furey, and McMahon, 1984; Webster-Stratton, 1991.

5 Forehand, Furey, and McMahon, 1984; Strain, Young, and Horowitz, 1981; Wahler, 1980; Wahler and Dumas, 1984.

6 Alexander et al., 1976; Alexander and Parsons, 1973; Barton et al., 1985; Klein, Alexander, and Parsons, 1977.

7 Alexander et al., 1976; Alexander and Parsons, 1973; Klein, Alexander, and Parsons, 1977.

8 Shure and Spivack, 1980, 1982, 1988; Spivack and Shure, 1989.

9 Kazdin et al., 1989; Kazdin et al., 1987b.

10 Lochman, 1992; Lochman et al., 1984; Lochman and Curry, 1986.

11 Mayer and Butterworth, 1979; Mayer et al., 1983; Sulzer-Azaroff and Mayer, 1994.

Prevention of Serious and Violent Juvenile Offending	Juvenile Justice Bulletin • April 2000