Artikelen Orthopedagogiek Theorieën en Modellen
Dishion et al. (1999). When interventions harm: Peer groups and problem behaviour.
Introduction:
Intervention philosophy, ideology, and strategies vary widely, but science can contribute to the understanding
of which intervention strategies help, which are benign, and which actually have negative effects on youth. An
important contribution would be to cull iatrogenic interventions from the social policy armamentarium in the
effort to improve the outcomes for children and families in communities. In this article, we tested the
hypothesis that high-risk young adolescents potentially escalate their problem behaviour in the context of
interventions delivered in peer groups.
Peer influences:
Longitudinal studies on the development of adolescent problem behaviour provide compelling evidence that
such behaviour is embedded within the peer group. Contrary to earlier assumptions about beneficial effects of
friendships on children's social development, adolescence is also a time when such relationships can
undermine healthy development. In a study where Oregon Youth boys were videotaped with their friends,
topics were coded as either rule-breaking or normative, reactions as either laugh (or another positive affect or
gesture) or pause, and trained observers, codified the boys' topics and reactions from the videotapes. Two
analytic frameworks were used and the following for each framework was found:
1. Matching law: the relative rate of reinforcement (i.e., positive affect) was found to be highly
associated with the rate and duration of the boys' deviant discussions
2. Sequential analyses: revealed that delinquent dyads react positively primarily to deviant talk, whereas
nondelinquent dyads ignore deviant talk in favour of normative discussions
From these findings a new term was created, namely “deviancy training” which is defined as the process of
contingent positive reactions to rule-breaking discussions. It was found that deviancy training at 13/14 years
old could predict an increased probability for initiation of addictive substances, an increased self-reported
delinquency and an increased self-reported and police-reported violent behaviour at the age of 15/16.
More recently Patterson et al. examined the impact of the deviancy-training process on young-adult
adjustment, as defined by sexual promiscuity, substance abuse, relationship problems, and adult convictions.
Findings suggest that adolescent friendships based on deviance provide a context in which problem behaviour
escalates from adolescence through adulthood. The process seems to be functional where deviant talk and
behaviour elicits positive social reactions, compared with prosocial or normative behaviour.
Data such as these suggest a variety of implications for interventions targeting high-risk youth. One
interpretation might be that the powerful influence of peers could be harnessed in a positive direction, leading
to reductions in problem behaviour. The second interpretation is that high-risk peers will support one another's
deviant behaviour, so group affiliations should be avoided during retraining periods
The adolescent transitions program study:
The Adolescent Transitions Program (ATP) study was designed to test a theoretical model of adolescent
problem behaviour. Two developmental processes (parent and peer influences) were systematically targeted in
the intervention trial. The parent component emphasizes parenting skills shown to be effective in reducing
problem behaviour and increasing peer support for prosocial behaviour. The teen component emphasizes
prosocial goals and self-regulation, using peer reinforcement as one means to promote completion of home
exercises, as well as compliance with session activities. In the study the youth was assigned to one of the four
intervention conditions:
1. parent focus only
2. teen focus only
3. both parent and teen focus
4. attention placebo group, referred to as self-directed change, which included free access to videotapes
and written materials
, There was hypothesized that the optimal intervention would be the combined condition, involving both the
parent and teen focus curriculums. Many of the short-term effects were quite positive as both teen and parent
focus participants showed more curriculum-specific knowledge following the intervention and both teen and
parent focus participants showed more curriculum-specific knowledge following the intervention.
Unfortunately, a long-term analysis revealed that negative effects were associated with the teen focus
curriculum. Three months after random assignment, an increase in tobacco use among the teen focus
participants was noticed and teacher reports of externalizing behaviour were found to be reliably higher for the
teen focus groups. These undermine the short-term positive gains of the parent focus intervention, and the
combined parent and teen focus intervention programs did not reduce risk for substance use and delinquency,
as hypothesized. Also, teachers reported higher levels of delinquent behaviour in youth randomly assigned to
teen focus, compared with controls; these levels persisted over the three-year follow-up period. Additional
analyses revealed that older (i.e., post-pubertal) youth, with the highest initial level of problem behaviour,
were most susceptible to the iatrogenic effect
The Cambridge-Somerville Youth Study Evaluation:
The Cambridge-Somerville Youth Study (CSYS) used a comprehensive approach to crime prevention, based on
knowledge that high-risk children lacked affectionate guidance. Two analyses indicated that the iatrogenic
effects came from the treatment program. First, boys who received the most attention over the longest period
of time were the most likely to have iatrogenic effects. A dose-response analysis showed those in treatment
longer, and those who received more intense treatment, were most likely to have turned out worse than their
matched controls. Second, the iatrogenic results occurred only in the cooperative families. Among those, 27
pairs of treatment boys turned out better, but 52 pairs turned out worse. Among the pairs in which the
treatment family was uncooperative, the control and treatment boys were equally likely to turn out badly.
Discussion:
A series of studies were reviewed addressing the hypothesis that peers can contribute to escalating trends in
problem behaviour among young adolescents. Developmental research suggests peer deviancy training is
associated with subsequent increases in substance use, delinquency, and violence, as well as adjustment
difficulties in adulthood. ATP studies showed statistically reliable three-year negative effects on the youth
report of smoking and teacher report of delinquent behaviour. The CSYS study showed that pervasive, 30-year
negative effects were associated with repeated experiences in summer camps in the early adolescent years. In
short, aggregating peers, under some circumstances, can produce short- and long-term iatrogenic effects on
problem behaviour. In early adolescence, youth with moderate levels of delinquency, and who had deviant
friends, were those who escalated to more serious forms of antisocial behaviour. Poulin et al. found that boys
with the poorest relationships and highest delinquency were most vulnerable to deviancy training, with respect
to increasing delinquent behaviour. Two possible processes might explain the converging evidence from
intervention and developmental research on the influence of peers on social development:
1. youth being actively reinforced through laughter, social attention, and interest for deviant behaviour
are likely to increase such behaviour.
2. high-risk adolescents derive meaning and values from the deviancy training process that provides the
cognitive basis for motivation to commit delinquent acts in the future
Both processes suggest that repetition of contact within the peer-group intervention would create the
iatrogenic effect observed in these two intervention studies, especially among those youth likely to engage in
deviant talk and behaviour primarily in the company of peers.
Based on the studies reviewed, there is reason to be cautious and to avoid aggregating young high-risk
adolescents into intervention groups: Some conditions might further exacerbate the iatrogenic effect. The age
of the child is certainly relevant, as younger and older children may be less affected by the processes described
above. However, peer-training groups which include a mix of prosocial and aggressive youth, may be a desired
strategy. Clearly, more research is needed to understand the processes that account for the iatrogenic effects
of interventions targeting high-risk youth, because not all interventions using peer groups with difficult children
have had iatrogenic effects.
