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Conduct Problems Prevention ResearchGroup
ABSTRACT
The impact of the Fast Track intervention on externalizing disorders across childhood was
examined. Eight hundred-ninety-one early-starting children (69% male; 51% African
American) were randomly assigned by matched sets of schools to intervention or control
conditions. The 10- year intervention addressed parent behavior-management, child social
cognitive skills, reading, home visiting, mentoring, and classroom curricula. Outcomes
included psychiatric diagnoses after grades 3, 6, 9, and 12 for conduct disorder, oppositional
defiant disorder, attention deficit hyperactivity disorder, and any externalizing disorder.
Significant interaction effects between intervention and initial risk level indicated that
intervention prevented the lifetime prevalence of all diagnoses, but only among those at
highest initial risk, suggesting that targeted intervention can prevent externalizing disorders
to promote the raising of healthy children.
Dynamic Cascade Model of Antisocial Behavioral Development
A toddler with biologically based difficulties in impulse control and behavioral
regulation is likely to encounter parents who have difficulty with behavior
management of that child, especially if those parents live in a disadvantaged social-
ecological context and are able to spend relatively less time on the child’s skill
development. The child’s difficult temperament may grow into conduct problems at
home, which keep the child from learning necessary social-cognitive and cognitive
skills. Not surprisingly, when the high-risk child enters school, he or she is likely to
experience social rejection from peers, failure in academic tasks, and conflict with
frustrated teachers. These failure experiences lead the child toward a defensive style
of processing information about the social world and disengagement from the
mainstream groups in life, including classroom peers, school institutional activities,
and parents. Parents may withdraw from interaction with their child to relieve conflict
and tension. As the child grows into adolescence, there is nobody to monitor and
supervise the child, and so he or she may gravitate toward deviant peer groups and
accelerate antisocial behavior into serious violence.
Although it embraces the likelihood that genetic vulnerabilities ignite the chain of
development, it also posits the crucial role that the environment plays in interaction
and transaction with the child.
The Fast Track Intervention and Randomized Controlled Trial
This model implies that strategic preventive intervention might yield positive impacts
on even (or mostly) the highest risk, early-starting child. CPPRG (1992) suggested
that prevention should start as soon as high-risk children can be identified in school. It
should be multifaceted because risks can arise from family, peer, school, and
community domains. It should be sustained across development because, again,
although early risks elicit later risks, new risks can also arise de nouveau.
Models of Prevention Across Development
The first question concerns the criterion used to define an “early starter,” specifically,
the relation between continuous measures of early risk and ultimate CD outcome. If
the relation is linear, then identification of a cutoff for selection into preventive
intervention will be arbitrary. If the relation is nonlinear and accelerating, then a cutoff
for selection might be defined by the point of steepest slope. In Fast Track, risk was
assessed through parent and teacher ratings during kindergarten, which were
combined into a continuous risk score to which a dichotomous cutoff score was
applied to select children for eligibility into the prevention program evaluation.
Identifying an optimal cutoff score depends on the slope of the riskoutcome curve as
well as interactions between risk and intervention efficacy. The first goal of the current
study was to map the risk-outcome curve in the population.
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