family intervention effects on co-occurring behavior and...

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LATENTTRANSITIONANALYSIS

Emotionalandbehavioraldifficultiesarecommonconcernsthatparentshaveabouttheiryoungchil-dren.Alargebodyofresearchhasindicatedthatemotionaldifficulties,includinganxietyanddepres-sion,andbehavioralproblems,includingaggressionandoppositionality,tendtoberelativelystableacrosschildhood(Briggs-Gowan,Carter,Bosson-Heenan,Guyer,&Horwitz,2006).Forinstance,studieshaveconsistentlydocumentedthedevelopmentalconti-nuityofconductproblemsfromearlychildhoodtoantisocialbehaviorinmiddlechildhoodandado-lescence(Brook,Whiteman,&Finch,1992;Brook,Whiteman,Gordon,&Cohen,1986;Campbell,Shaw,&Gilliom,2000;Caspi,Moffitt,Newman,&Silva,1998;Hawkins,Lishner,Catalano,&Howard,1986;Lyons-Ruth,Zeneah,&Benoit,1996;Shaw,Gilliom,Ingolsby,&Nagin,2003;Vicary&Lerner,1983).Sim-ilarly,modestcontinuityhasbeenfoundforinternal-izingsymptoms,inthatyouthexhibitingproblemswithanxietyanddepressioninearlychildhoodarelikelytocontinuetoexhibitthoseproblemsintomiddlechildhoodandadolescence(Briggs-Gowanetal.,2006;Briggs-Gowan,Carter,Irwin,Wachtel,&

Family Intervention Effects on Co-occurring Behavior and

Emotional Problems in Early Childhood: A Latent Transition Analysis Approach

ARIN CoNNEll, BERNADETTE MARIE BUlloCk, ThoMAS J. DIShIoN, DANIEl ShAW, MElVIN WIlSoN, FRANCES GARDNER

AbstrAct

This study used latent transition analysis (lTA) to examine changes in early emotional and behavioral problems in children age 2 to 4 years relative to participation in a family-centered intervention. A sample of 731 economically disadvantaged families were recruited from among participants in a national food supplement and nutrition program. Families with toddlers between age 2 and 3 were randomized either to the Family Check-Up (FCU) or to a nonintervention control group. The FCU’s linked interventions were tailored and adapted to each family’s needs. Assessment occurred at age 2, 3, and 4. The FCU followed age 2 and age 3 assessments. on the basis of mothers’ reports relevant to the Child Behavior Checklist, latent class analyses were used to study children’s transitions across the following four groups from age 2 to age 4: (a) externalizing only, (b) internalizing only, (c) comor-bid internalizing and externalizing, and (d) normative. lTA results revealed that participation in the FCU decreased the likelihood of transitions into the comorbid and internalizing-only class at age 4, relative to the normative no-elevation class. These results are discussed with respect to changes in

Cicchetti,2004;Warren,Huston,Egeland,&Sroufe,1997).

Earlyemotionalandbehavioraldifficultiesmayalsopredicttheemergenceofproblemsinotherimpor-tantdomainsoffunctioning,includingacademicandsocialdifficulties,intoadolescence.Forinstance,lon-gitudinalstudieswithchildrenasyoungasage3years(e.g.,Caspietal.,1998;Shaw&Gross,inpress)haverevealedassociationsbetweenearlybehaviorprob-lemsandlong-termprofilesofrisk,includingsub-stancedependenceinadolescenceandyoungadult-hood.Researchhasdocumentedsimilarlong-termoutcomesassociatedwithinternalizingproblems,includingimpairmentsinsocial,academic,andpro-fessionalfunctioning(e.g.,Fombonne,Wostear,Coo-per,Harrington,&Rutter,2001;Lewinsohn,Rohde,Seeley,Klein,&Gotlib,2003).

Emotionalandbehavioraldifficultiestendtoco-occurinchildhoodatahigherratethanwouldbeexpectedbychance(Angold,Costello,&Erkanli,1999;Lewinsohn,Rohde,&Seeley,1995).Childrenwhoexhibitco-occurringemotionalandbehavioraldifficultiestendtoshowmoresevereimpairment

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CONNELL,BULLOCK,DISHION,SHAW,WILSON,GARDNER

thandothosewithemotionalorbehavioralproblemsalone(Nottelmann&Jensen,1999).Further,evidencesuggeststhatchildrenwithco-occurringemotionalandbehavioraldisturbancesarethemostatriskforseveralseriousadjustmentproblemsinadolescence,includinghigh-risksexualbehavior(Dishion,2000),drugabuse(Rhode,Lewinsohn,&Seeley,1995),aca-demicfailure,suicide,andotherseriousoutcomes(Asarnow&Carlson,1988;Capaldi,1992;Patterson&Stoolmiller,1991;Rhodeetal.,1995).Notsurpris-ingly,youthcomorbidmoodandbehavioralproblemsarealsothemostcostlytosocietyintermsofuseofmentalhealthandjuvenilejusticeresources(Miller,2004).

Early InterventionInlightoftheprevalenceandseriousadverseconse-quencesofearlyemotionalandbehaviorproblems,itiscriticaltoimproveourunderstandingoftheetiol-ogy,developmentalcourse,andpreventionandtreat-mentofco-occurringdisorders.Earlyinterventionmaybeparticularlybeneficial.Awealthofresearchhasdocumentedpositivelongitudinalassociationsbetweenharsh,punitiveparentinginearlychildhoodandlaterchildproblembehavior(Campbell,Pierce,Moore,Marakovitz,&Newby,1996;ShawVondra,Hommerding,Keenan,&Dunn,1994;Shaw,Owens,Vondra,Keenan,&Winslow,1996;Shaw,Gilliom,Ingoldsby,&Nagin,2003),aswellasassociationsbetweenthelackofparentalwarmth,involvement,responsivity,andpositivitywithlaterinternalizingandexternalizingproblems(e.g.,Gardner,1987,1994;Shaw,Winslow,Owens,&Hood,1998;Sup-plee,Unikel,&Shaw,2007).Numerousstudieshavealsodocumentedthelinkbetweenparentalmentalhealthandchildbehaviorproblems,withmaternaldepressionreceivingwidesupportasariskfactorfortheearlydevelopmentofchildhoodinternalizingandexternalizingsymptoms(seeConnell&Goodman,2002).

The toddleryears representa timeofmarkedchangeforchildrenintermsofcognitive,emotional,andphysicalmaturation,requiringparentstoprovidepositivebehavioralsupportandscaffolddevelopmen-tallyappropriatebehaviors(Gardner,Sonuga-Barke,&Sayal,1999).Duringtoddlerhood,thefocusoftheparent–childrelationshipchangesfromemotionalresponsivityandsensitivitytotheinfant’sneedstomonitoringahighlyactivetoddler(Shaw,Bell,&Gilliom,2000).Formanyparents,thistransitionisassociatedwithadecreaseinparentalpleasureinchil-drearingfromthefirsttosecondyears(Fagot&Kava-nagh,1993),andfamilies’adaptationtothisdevel-opmentaltransitionformsthebasisforsubsequentdevelopmentalstages(Shawetal.,2000).Intervening

duringthistransitionalperiodcouldbeinstrumen-taltopreventingthelaterdevelopmentofadolescentproblembehaviorssuchasdelinquency,deviantpeerassociation,andinternalizingdisorders.

Giventhecentralityoffamilyprocessestotheearlydevelopmentofconductproblemsandsymptomsofanxietyanddepression,family interventionsarelikelytobecriticaltopreventingthedevelopmentofproblemsacrossearlychildhood.Alongthisline,anumberofparentinginterventionshavebeenfoundtobeeffectiveforreducingearlyconductproblems(e.g.,Brinkmeyer&Eyberg,2003;Oldsetal.,1997;Webster-Stratton,1990).Lessresearchhasfocusedonfamilyinterventionsforinternalizingdifficulties,althoughseveralsuchinterventionshavebeenshowntoreduceemotionaldistressinyouth(e.g.,Asarnow,Scott,&Mintz,2002;Brentetal.,1997;Diamond,Reis,Diamond,Siqueland,&Isaacs,2002).

Todate,fewstudieshaveexaminedtheimpactofparentinginterventionsonco-occurringemotionalandbehavioraldifficulties.Unfortunately,youthwithco-occurringinternalizingandexternalizingdisordersaremorefrequentlyexcludedfromefficacytrials,comparedwithchildrenwithasinglediagno-sis.Theseverityofco-occurringinternalizingandexternalizingproblemsinchildhooddoesnotsug-gestthatparentsandchildreninthesefamilieswillbeunresponsivetointerventions.Severalstudiessupportthehypothesisthatchildrenwithcomorbidemotionalandbehavioralproblemsandtheirfami-liesareresponsivetointerventionsthatarecarefullytailoredtomeettheirneeds(e.g.,Connell,Dishion,Yasui,&Kavanagh,inpress;Dishion&Stormshak,2007).Beauchaine,Webster-Stratton,andReid(2005)reportedthatacrosssixrandomizedinterventiontri-alsofaparent-traininginterventionforfamilieswith3-to8-year-oldchildrenwithearlyconductproblems,childrenwithco-occurringanxietyanddepressiondemonstratedgreaterreductionsinearlyexternaliz-ingproblemsfrompre-toposttreatmentandbeyondto1-yearfollow-upthandidthosewithsingledis-orders.Similarly,Beauchaine,Gartner,andHagen(2000)reportedmorepositivetreatmentoutcomesfol-lowinginpatienttreatmentfor4-to12-year-oldboyswithconductdisorder/ADHDdiagnosesiftheyalsohadcomorbiddepression/anxietydisorderdiagnoses,relativetoboyswithouttheco-occurringdisorders.OurstudyexaminedtheimpactoftheFamilyCheck-Upinterventionontheprogressionofco-occurringemotionalandbehaviorproblemsinyoungchildrenfromage2to4years.

Previous research on the Family check-UpTheFCUisabriefinterventionthatincludesabroadassessmentoffamilycontextandparentingpractices



(seeDishion&Stormshak,2007).Unlikemanypar-entinginterventionsduringwhichparentsreceiveallinterventioncomponentsinastructuredsequence,theFCUapproachisanadaptiveandtailoredfamilyintervention(seeCollins,Murphy,&Bierman,2004).Anadaptiveinterventionframeworkrecognizesthatindividualfamiliesmayhavedifferingneedsandinterventiontargetsandmayvaryintheextenttowhichtheyrequireservices.Thecorefeatureofanadaptiveinterventionisthatspecifictargetsanddosesaredeterminedforeachfamilybasedonapriori,the-oreticallyderived,andempiricallyvalidateddecisionrules.Advantagesofthisapproachincludedecreasedlikelihoodofnegativeinterventioneffects,elimina-tionoftreatmentcomponentsthatareinappropri-ateforagivenfamily,decreasedwasteofresources,potentiallyincreasedcompliancewithtreatment,andincreasedinterventioneffectiveness(Collinsetal.,2004).Interventionscientistsarethusempoweredtocosteffectivelyaddresspublichealthproblemsbyusingaframeworkthatmoredirectlymeetstheneedsoffamilies.Moreover,adaptiveinterventionsmaybeparticularlyattractivetohigh-riskfamiliesforwhomextendedattendanceandengagementmaybediffi-cultinlightofchallengingfamilyorsocialcircum-stances.

TheFCUwasdirectlyinspiredbythemotivationalinterviewing(MI)frameworkofMillerandRollnick(2002).TheMIapproachisintendedtomotivatepar-entstoengagewithtreatmentservicesandtoencour-agebehaviorchangeinfamiliesofhigh-riskyouth.TheFCUisthefirststepinamenuofempiricallysup-portedandfamily-centeredinterventionsdesignedtostrengthenparentingskillsandpromotepositivebehaviors(Dishion&Kavanagh,2003).Incontrasttothestandardclinicalmodel,theFCUisrootedinahealthmaintenancemodel,whichemphasizesperiodiccontactwithfamiliesduringthecourseofkeydevelopmentaltransitions.OurstudyfocusedprimarilyontheFCUforfamilieswithyoungchil-drenwhowereengagedintheWomen,InfantsandChildrenNutritionProgram(WIC)servicesystemandwhodemonstratedriskforcomorbidemotionalandbehavioralproblems.

PreviousresearchhasexaminedtheimpactoftheFCUonproblembehaviorinearlyadolescence,whenofferedinapublicschoolsetting.Usinganintentiontotreatdesign,Dishion,Kavanagh,Schneiger,Nel-son,andKaufman(2002)foundthatproactivepar-entengagementreducedsubstanceuseamonghigh-riskadolescentsandpreventedsubstanceuseamongtypicallydevelopingyouth.Significantreductionsintheseproblembehaviorsresultedfromanaverageofsixdirectcontactmeetingswithparentsduringthecourseofthreeyears.Complieraveragecausaleffect

analysessupportedtheproposalthatparticipationintheFCUandlinkedservicesasneededresultedinsignificant,long-termreductionsinsubstanceuseandantisocialbehavior,includingdecreasedsubstanceusediagnosesandfewerarrestsbytheendofhighschool(Connelletal.,inpress).Shawandcolleagues(2006)appliedtheFamilyCheck-Uptoasampleof120high-riskfamiliesoftoddlersinvolvedintheWICprogram.EngagementintheFCUresultedinreductionsinsub-sequentchildproblembehaviorandimprovementinparentinvolvementatchildage3and4,respectively(Gardner,Shaw,Dishion,Burton,&Supplee,inpress;Shaw,Dishion,Supplee,Gardner,&Arnds,2006).

the current study Thisstudyexamineddatafrom731familiespartici-patinginWICservicesystemswhowererecruitedwhenthechildrenwereapproximately2yearsold.Thesechildrenhadbeendeemedat-riskforshow-ingearly-startingpathwaysofbehaviorproblemsonthebasisofsociodemographicrisk(i.e.,lowincomeandparentaleducation),familyrisk(e.g..,maternaldepression,parentaldrugabuse,teenparent),andchildrisk(e.g.,highlevelsofconductproblems).HalfofthefamilieswererandomlyassignedtoreceivetheFCU.Analysesfocusedontheage4follow-upreportsofchildconductandinternalizingproblems,collectedtwoyearsafterinitialcontactwithfamilies.Fami-liesinthisstudy,whichwerefertoastheEarlyStepsMultisitestudy(ES-M),wererecruitedfromthreegeographicallyandculturallyuniqueregions:met-ropolitanPittsburgh,Pennsylvania,suburbanEugene,Oregon,andruralCharlottesville,Virginia.Thesam-plereflectsculturaldiversityinthatitincludesahighpercentageofAfricanAmerican,EuropeanAmeri-can,andLatinofamilies.InadditiontoreceivingtheFCU,familiesintheinterventiongroupwereprovid-edadaptive,tailoredservicesfollowingtheFamilyCheck-Up,asneeded.

Thisstudy’sanalysesextendtwoearlierreportsontheES-MsamplethatdescribedreductionsinchildconductproblemsandinternalizingsymptomsasaresultofparticipationintheFCU.Dishionandcol-leagues(2007)usedLGMprocedurestoseparatelyexamineinternalizingandexternalizingproblemsfromage2to4.Theyfoundthattreatment-relatedreductionsinexternalizingtrajectoriesmediatedincreasesinpositiveparentingbehavior.Similarly,Shaw and colleagues (2007) found that reducedmaternaldepressivesymptomsfromchildage2to3mediatedimprovementsinbothinternalizingandexternalizingproblemsfromage2to4.

AlthoughthesestudiesprovideimportantevidencefortheeffectivenessoftheFCUintervention,LGManalyseshavelimitations.Forexample,analysesof



growthdonotaccountforwithin-childdifferencesinprofilesofinternalizingandexternalizingsymp-toms.Itislikelythatsomechildreninthissampleexhibitedelevationssolelyineitherinternalizingorexternalizingdomains,whileothersdemonstratedco-occurringsymptoms.ItisalsopossiblethattheFCUinterventionmaybedifferentiallyeffectiveforyouthwithdifferentsymptomprofiles,exertingstrongesteffectsforyouthwithco-occurringproblems.Suchapossibilitymaybestbeexaminedusingaperson-centeredanalyticapproach(seeConnell,Dishion,&Deater-Deckard,2006).

Inourstudy,weusedlatenttransitionanalysis(LTA)toidentifyclustersofyouthexhibitingdistinctprofilesofinternalizingandexternalizingsymptomsfromage2to4.ThisstrategyenabledustoexaminewhetherparticipationintheFCUaffectedthetransi-tionbetweensymptomclassesacrossage2to4.LTA,whichwasoriginallydescribedbyGraham,Collins,Wugalter,Chung,andHansen(1991),isparticularlysuitedtoexaminingchangesingroupmembershipovertime(i.e.,comorbid,internalizing-only,orexter-nalizing-onlyclassesofyouth).Ittreatssymptomclus-teringasanunobserved,latentunderlyingnominalclassification.Thatis,groupsofchildrenwithdistinctsymptomprofilesarenotdirectlyobserved,butareinsteadidentifiedbyusingaclassificationmodel,whichprovidesthebasisforstudyingtransitionsfromonegrouptoanotherovertime.Assuch,LTAprovidesameansofdealingwithmeasurementerrorandreducingbiasinestimatesofstabilityandchangeovertime(seeNylund,Muthén,Nishina,Bellmore,&Graham,2007;Pickles&Hill,2006).InlightofShawandcolleagues’(2007)resultsformaternaldepres-sion,weincludedmaternaldepressionasacovari-ateinthecurrentanalyses,examiningtheeffectofmaternalsymptomsonsymptomclassesatchildage2and4.AlthoughDishionandcolleagues(2007)alsoexaminedpositiveparentingbehaviors,becauseLTAiscomputationallyintensiveandperformsbestwithlargesamplesizes(SeeCollins,Hyatt,&Graham,2000),andparentingdatawereavailableonlyforasmallersubsetoffamilies,wedecidednottoincludetheparentingdatainthisreport.

Methods

study ParticipantsParticipantsincluded731mother–childdyadsrecruit-edbetween2002and2003fromWICprogramsinthemetropolitanareasofPittsburgh,Pennsylvania,Eugene,Oregon,andCharlottesville,Virginia(Dish-ion,Shaw,Connell,Gardner,Weaver,&Wilson,2007).FamilieswereapproachedatWICsitesandinvitedtoparticipateiftheyhadasonordaughterbetweenage

2years0monthsand2years11months.Recruitedfamilieswerescreenedtoensurethattheymetthestudycriteriaofhavingsocioeconomic,family,and/orchildriskfactorsforfuturebehaviorproblems.Riskcriteriaforrecruitmentweredefinedasatoraboveonestandarddeviationabovenormativeaveragesrele-vanttothefollowingthreedomains:(a)childbehavior(conductproblems,high-conflictrelationshipswithadults),(b)familyproblems(maternaldepression,dailyparentingchallenges,substanceuseproblems,teenparentstatus),and(c)sociodemographicrisk(loweducationachievementandlowfamilyincomeusingtheWICcriterion).Twoormoreofthethreeriskfac-torswererequiredforinclusioninthesample.

AsshowninFigure1andpartitionedbysiteinTable1,ofthe1666parentswhowereapproachedatWICsitesacrossthethreestudysitesandhadchil-drenintheappropriateagerange,879familiesmettheeligibilityrequirements(52%inPittsburgh,57%inEugene,49%inCharlottesville)and731(83.2%)agreedtoparticipate(88%inPittsburgh,84%inEugene,76%inCharlottesville).Thechildreninthesamplehadameanageof29.9months(SD=3.2)atthetimeoftheage2assessment.

Ofthe731families(49%female),272(37%)wererecruitedinPittsburgh,271(37%)inEugene,and188(26%)inCharlottesville.MoreparticipantswererecruitedinPittsburghandinEugenebecauseofthelargerpopulationofeligiblefamiliesintheseregions

Study Candidates ScreenedN = 1666

Study Candidates QualifiedN = 879

Study Candidates Participated

N = 731

Participants in Age 2Assessment Assigned to

Control ConditionN = 364


Treatment ConditionN = 367









Figure 1.Participantflowchart.



relativetoCharlottesville.Acrosssites,thechildrenwerereportedtobelongtothefollowingracialgroups:27.9%AfricanAmerican,50.1%EuropeanAmerican,13.0%biracial,and8.9%otherraces(e.g.,AmericanIndian,NativeHawaiian).Intermsofethnicity,13.4%ofthesamplereportedbeingHispanicAmerican.Duringthe2002–2003screeningperiod,morethantwo-thirdsofthosefamiliesenrolledintheprojecthadanannualincomeoflessthan$20,000,andtheaveragenumberoffamilymembersperhouseholdwas4.5(SD=1.63).Forty-onepercentofthepopulationhadahighschooldiplomaorGEDequivalency,andanadditional32%hadonetotwoyearsofpost–highschooltraining.

Retention.Ofthe731familieswhoinitiallypar-ticipated,659(89.9%)wereavailableattheone-yearfollow-upand619(84.7%)participatedatthetwo-yearfollow-upwhenchildrenwerebetweenage4and4years11months.Atage3and4,selectiveattritionanalysesrevealednosignificantdifferencesrelevanttoprojectsite,children’srace,ethnicity,gender,lev-elsofmaternaldepression,orchildren’sexternal-izingbehaviors(parentreported).Furthermore,nodifferenceswerefoundinthenumberofparticipantswhowerenotretainedinthecontrolversusintheinterventiongroupsatbothage3(n=40andn=32,respectively)andage4(n=58andn=53,respec-tively).

MeasuresDemographics questionnaire.Ademographicsques-tionnairewasadministeredtothemothersduringtheage2andage4visits.Thismeasureincludedques-

tionsaboutfamilystructure,parentaleducationandincome,parentalcriminalhistory,andareasoffamil-ialstress.

Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2000).TheCBCLisawell-establishedandwidelyused99-itemquestionnairethatassessesparen-talreportsofbehavioralandemotionalproblemsinyoungchildrenfromage1.5to5years.Motherscom-pletedtheCBCLatthechildage2andage4visits.TheCBCLhastwobroad-bandfactors,InternalizingandExternalizing.TheInternalizingscalecomprisesfoursubscales,includingEmotionalReactivity,AnxietyandDepression,SomaticProblems,andSocialWith-drawal.TheExternalizingscalecomprisestwosub-scales,AggressionandAttentionProblems.Foruseinthelatentclassanalyses(LCAs)andLTAs,scoresonthesesixsubscalesweredichotomizedtoreflectyouthbeingratedinthenormativerangeonagivenscale(t-score<60)versusintheborderlineorclinicalrange(t-score≥=60).

Center for Epidemiological Studies on Depres-sion scale (CES-D).TheCES-D(Radloff,1977)isawell-establishedandwidelyused20-itemmeasureofdepressivesymptomatologythatwasadminis-teredtomothersatthechildage2andage4homeassessments.Mothersreportedhowfrequentlytheyhadexperiencedlisteddepressivesymptomsduringthepastweekonascalerangingfrom0(lessthan1day)to3(5–7days).Itemsweresummedtocreateanoveralldepressivesymptomsscore.Forthecur-rentsample,internalconsistencieswere.76and.75attheage2andage4assessments,respectively.Aver-agelevelsofself-reporteddepressivesymptomsweremoderatelyelevatedatage2(M=16.75,SD=10.66),andage4assessments(M=14.99,SD=10.88),withscoresgreaterthan16reflectiveofclinicallysignifi-cantsymptomlevels(Radloff,1977).

Child gender.Childgenderwascodedas0=“male”and1=“female.”

Child ethnicity.Youth-reportedethnicitywascodedas0=“Caucasian”and1=“ethnicminority.”

Intervention status.Randomassignmentwascodedas0=“control”and1=“intervention.”

Assessment protocol.Parents(i.e.,mothersand,ifavailable,alternativecaregiverssuchasfathersorgrandmothers)whoagreedtoparticipateinthestudywerescheduledfora2.5-hourhomevisit.Eachassess-mentbeganbyintroducingthechildrentoanassort-mentofage-appropriatetoysandhavingthemplayfor15minuteswhilethemotherscompletedquestion-naires.Afterthefreeplay(15minutes),eachprimarycaregiverandchildparticipatedinseveraltasks:(a)aclean-up(5minutes),(b)childdelayofgratification(5minutes),(c)fourteachingtasks(3minuteseach,withthefinaltaskbeingcompletedbyalternatecaregiver



andchild),(d)asecondfreeplay(4minutes),(e)asecondclean-uptask(4minutes),(f)thepresentationoftwoinhibition-inducingtoys(2minuteseach),and(g)amealpreparationandlunchtask(20minutes).Theexacthomevisitandobservationprotocolwasrepeatedatage3and4forboththecontrolandtheinterventiongroup.Familiesreceived$100,$120,and$140forparticipatingintheage2,3,and4homevis-its,respectively.

Computer-generatedrandomizationtoFCUandcontrolgroupswasconductedbyastaffmemberwhohadnotbeeninvolvedinrecruitment.Randomizationwasbalancedbygendertoensureanequalnumberofmalesandfemalesinthecontrolandinterventiongroups.Toensureexaminerblindnesstotheinter-ventioncondition,asealedenveloperevealingthefamily’sassignmentwasopenedandsharedwiththefamilyaftertheassessmentwascompleted.Examin-erswhocarriedoutfollow-upassessmentswereneverinformedofthefamily’srandomlyassignedcondi-tion.

Forpurposesofthisstudy,onlymaternalreportsofchildproblembehaviorwereusedfromtheage2and4assessments,andmaternalreportsofdepressionwereusedfromtheage3assessment.

Intervention protocol.TheFCU.Familiesrandom-lyassignedtotheinterventionconditionwerethenscheduledtomeetwithaparentconsultantfortwoormoresessions,dependingonthefamily’spreference.Typically,thethreemeetingsincludeaninitialcontactsession,anassessmentsession,andafeedbacksession(Dishion&Kavanagh,2003).Tooptimizetheinternalvalidityofthestudy(i.e.,preventdifferentialdropoutforexperimentalandcontrolconditions),theassess-mentswerecompletedbeforerandomassignmentresultswererevealedtoeithertheresearchstafforthefamily.Thus,forpurposesofresearch,thesequenceofcontactswasasfollows:assessment(baseline),ran-domization,initialinterview,feedbacksession,andfollow-upsessionsbasedontheneedsofindividualfamilies.Eachfamilywasgivena$25giftcertificateattheendofthefeedbacksessionforcompletingtheFCU.

Essentialobjectivesofthefeedbacksessionweretoexplorethecaregivers’willingnesstochangeprob-lematicparentingpractices,supportexistingpar-entingstrengths,andidentifyservicesappropriatetothefamilyneeds.Duringthissessiontheparentwasofferedfollow-upsessionsfocusedonparentingpractices,otherfamilymanagementconcerns(e.g.,coparenting),andcontextualissues(e.g.,childcareresources,maritaladjustment,housing,vocationaltraining).

ParentconsultantswhofacilitatedtheFCUandfollow-upparentingsessionswereacombinationof

Ph.D.-andmaster’s-levelclinicians,allwithpreviousexperienceinimplementingfamily-basedinterven-tions.Parentconsultantswereinitiallytrainedfor2.5–3monthsusingacombinationofstrategies,includ-ingdidacticinstructionandroleplaying,followedbyongoingvideotapedsupervisionofinterventionactivity.Beforeworkingwithstudyfamilies,parentconsultantswerecertifiedbyleadparentconsultantsateachsite,whohadpreviouslybeencertifiedbyDr.Dishion.Certificationwasestablishedbyreviewingvideotapesoffeedbackandfollow-upinterventionsessionstoevaluatewhetherparentconsultantswerecompetentinallcriticalcomponentsoftheinterven-tionasdescribedlaterinthisarticle.Thisprocessisrepeatedyearlytoreducedriftfromtheinterventionmodel,consistentwiththemethodsofForgatch,Pat-terson,andDeGarmo(2005),whofoundthatdirectobservationsoftherapistfidelitytoparentmanage-menttrainingpredictedchangeinparentingpracticesandchildbehavior.Inaddition,cross-sitecaseconfer-enceswereconvenedweeklyusingvideoconferenc-ingtofurtherenhancefidelity.Finally,annualpar-entconsultantmeetingswereheldtoupdatetraining,discusspossiblechangesintheinterventionmodel,andaddressspecialinterventionissuesreflectedbytheneedsoffamiliesacrosssites.

Ofthefamiliesassignedtothetreatmentcondition,77.9%participatedintheinitialparentconsultantmeetingandfeedbacksessionsatchildage2,65.4%atage3,and65.3%atage4(seeTable1).Ofthosefamilieswhometwithaparentconsultant,theaver-agenumberofsessionsperfamilywas3.32(SD=2.84)atchildage2and2.83(SD=2.70)atage3,includingtheinitialparentconsultantmeetingandfeedbackastwoofthosesessions.

Analysis strategy.ThecentralanalysesusedanLTAframeworktoexaminechangesinlatentclassmem-bershipovertime,relativetoparticipationintheinter-ventionprogram.LTAisanadvancedautoregressivemodelinwhichclassmembershipateachtimepointisnotdirectlyobserved,butrepresentsacategoricallatentvariableidentifiedwithameasurementmodel.LTAincludesbothameasurementcomponentandastructuralcomponent.Forthemeasurementcompo-nent,itemprobabilitiesareclass-specificparameters



thatdescribethelikelihoodofanindividualinagivenclasstoendorseeachitem.Twostructuralcompo-nentsincludeclassprobabilities,whichdescribethesizeofeachlatentclassateachtimepoint,andtransi-tionprobabilities,whichareconditionalprobabilitiesdescribingtheprobabilityofbeinginagivenstateattime=t,conditionalonthestateattime=t−1(andonthestatusofcovariates,ifpresent).

Inthisstudy,wefollowedthegeneralguidelinesputforthbyNylundandcolleagues(2007),proceedingthroughtheLTAprocessinseveralsteps.First,sepa-rateLCAswereusedtoexaminetheoptimalnumberoflatentclassesateachstudywave.Second,anLTAwithoutcovariatesexaminedtransitionsacrosslatent

classesfromage2to4.Finally,covariateswereaddedtotheLTAmodeltoexaminetheeffectoftreatment,childgender,ethnicity,maternaldepressivesymp-tomsonlatentclassmembershipatage2and4,andtransitionprobabilitiesovertime.DetailedstatisticalpresentationsofthegeneralLTAframeworkareavail-ableinNylundandcolleagues(2007),HumphreysandJanson(2000),andReboussin,Reboussin,Liang,andAnthony(1998).

resultsDescriptivestatisticsforCBCLsubscalesareshowninTable2.Correlationsforallvariablesfromage2to4areshowninTable3.Itisimportanttonotethatnosignificantassociationswerefoundbetweentreat-mentgroupandchildgenderorethnicity,levelsofmaternaldepressivesymptoms,oranytypeofchildproblembehavioratage2,suggestingthatrandomiza-tionwassuccessful.Modesttomoderateassociationswereconsistentlyfoundbetweenmaternaldepressionandfactorsofchildproblembehaviorconcurrentlyandovertime,andamongdifferentfactorsofchildproblembehavior.

Latent class Analyses at Age 2 and 4WefirstexaminedseparateLCAsatage2and4todeterminetheoptimalnumberofclassesneededtobestcharacterizedataateachage.Mixturemodeling(ofwhichLCAisaspecificform)isanactiveareaofmethodsresearchregardingtheoptimalapproachtodeterminingthenumberof latentclasses(e.g.Nylund,Asparouhov,&Muthén,2006).Fitindices

were obtained for uncondi-tionalmodelswith1–6classesateachage.Modelswithdif-ferentnumbersoflatentclassesarenotnested,soMuthénandMuthén (2000) have recom-mended the following threecriteriaforselectingtheopti-malnumberoflatentclassesinfactormixturemodels:(a)theBayesianinformationcriteria(BIC)andasample-sizeadjust-edversionoftheBIC(AdjBIC),withlowerscoresrepresentingbetter-fittingmodels; (b) thequalityofclassificationacrossmodels,representedbyentro-py,withhigherentropyvaluesindicatingbetterclassificationofindividualsintotheirmostlikelytrajectoryclass; (c) thebootstrappedlikelihoodratiotest(BLRT),whichprovidesa

Figure 2.LCAresultsatage2.

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Internalizing, 12.8%Externalizing, 30.4%Comorbid, 9.9%Normative, 46.9%

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0.80.75

0.70.65

0.60.55

0.50.45

0.40.35

0.30.25

0.20.15

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statisticalcomparisonofthefitofagivenmodelwithamodelofonefewerclasses;and(4)thetheoreticalrelevanceandusefulnessoflatenttrajectoryclasses.RecentsimulationstudiesbyNylundandcolleagues(2006)supportedtheuseofAdjBICandBLRTforselectionoftheoptimalnumberofclassesinLCAmodels,withtheBLRTprovidingparticularlycon-sistentcorrectresults.Inlightofthesefindings,weplacedprimaryweightontheBLRTandtheAdjBICvaluesinselectingthenumberofclasses.Allanalyseswereconductedusing100randomizedstartvaluesrunfor10iterationseach,withthebest-fitting25ran-domizedstartvaluesruntomodelconvergence.

AsshowninTable4,boththeAdjBICandtheBLRTsupportedafour-classsolutionatage2.Atage4,theBLRTsupportedafour-classsolutionandtheAdjBICsupportedathree-classsolution.Wechosethefour-classsolutiontorepresentoptimalfitinlightofNylundandcolleagues’(2006)recommenda-tions,andconsistencyofthefour-classsolutionwith

hypothesesandtheories,aswellastheconsistencyofthefour-classsolutionatage4withthefour-classsolutionatage2.Theresultingfourclassesatage2and4aredepictedinFigures2and3.Mostyouthateachageareinaclasswithlowprobabilityofbeingintheborderline/clinicalrangeonanyscale.Becauseoftherelativesizeandlowlikelihoodofproblems,welabelthisclassnormativethroughouttheremainderofthisarticle.Asecondclassshowedrelativelyele-vatedprobabilitiesofsignificantproblemsonthetwoExternalizingsubscales,alongwiththeWithdrawalscale.Werefertothisclassasexternalizing.AthirdclassshowedrelativelyelevatedlikelihoodsofbeingintheclinicalrangeonthefourInternalizingscales,sowerefertothisclassasinternalizing.Finally,afourthclassshowedelevationsonallsixsubscales,sothisclassislabeledcomorbid.

Thesefourclassesmatchwellwiththefourclassesthatwouldbeexpectedonthebasisoftheoryandpastresearch, lending increasedconfidencethattheyreflectmeaningfulclustersofyouth.Itisworthemphasizingthatthesizesoftheclassesweresome-whatdifferentatage2thanatage4,particularlyfortheexternalizingclass,whichdecreasedinsizeovertime(30.4%atage2and18.3%atage4),andthenor-mativeclass,whichincreasedinsizeovertime(46.9%atage2and62.7%atage4).

Latent transition Analyses from Age 2 to 4LTAswereconductednext,whichpermittedtheexaminationoftransitionsacrossclassesfromage2toage4.WefirstexaminedanunconditionalLTAmodel.ClassproportionsfromthismodelareshowninTable5.AswasfoundintheLCAmodels,theexternalizingclassdecreasedinsizeacrossage2andage4,whilethenormativeclassgrewsubstantiallyovertime.Conversely,theinternalizingandcomorbidclasseswererelativelystableinsizeacrossage2and

age4,showingaslightdecline.Latent transition probabilities

fromthisunconditionalmodelareshown inTable6.As shown, thenormativegroupwashighlystableovertime,with90.8%ofyouthinthisgroupatage2remaininginthisgroupatage4.Nearly25%oftheage2 internalizingclass transitionedintotheage4comorbidclass,whilenoyouthinthisgrouptransitionedintotheage4externalizingclass,and42.7%transitionedintothenor-mativeclass.Veryfewyouthintheage2externalizingclasstransitionedintoeithertheage4internalizingorcomorbidclasses,withnearly50%of

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Figure 3.LCAresultsatage4.

Age 2 Age 4

GenderEthnicity

Maternal Depression,Child Age 4

Maternal Depression,Child Age 2

Intervention

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Figure 4.ConditionalLTAmodel.



thosetransitioningoutofthisclasstransitioningintothenormativeclassatage4.Only9.5%oftheage2comorbidclasstransitionedintothenormativeclass,whilenearly33%transitionedintotheage4internal-izingclass.

Next,weaddedthreetime-invariantcovariates,

includinginterventionstatus,childgender,andchildethnicity,andonetime-varyingcovariate,maternaldepressivesymptoms,tothemodel.TheconditionalLTAmodelisdepictedinFigure4.Asafirststep,weexaminedwhethertoallowinterventiontopredictage2classmembership.Effectssuchasthesewouldbeproblematicbecauseinterventionwasnotdelivereduntilaftertheage2assessment,soage2interven-tioneffectswouldref lectproblemswithrandomization.However,noneoftheseeffectswassignificant,sowefollowedamoreparsimoniousapproachofpermit-tinginterventioneffectsonlyforage4classes.Theadditionofcovariateschangedthelatenttransitionprobabilitiessome-what,asshowninTable7,andappearedtoslightlyincreasethecross-timestabil-ityofeachoftheclasses.CovariateeffectsonclassmembershipareshowninTable8.Mostnotably,interventionpredictedasignificantlyreducedlikelihoodofbeinginthecomorbidclassatage4,andatrend-level(p<.06)effectonthelikelihoodofmembershipintheinternalizingclassat

age4,relativetothenormativeclass.Thatis,youthwhoreceivedinterventionwerelesslikelytobeineitherof these twoclassesandmorelikelytobeinthenormativeclassinstead, compared

withtheothergroupsofchildren.Theoddsratiosforbeinginthecomorbidversusnormativeclassatage4associatedwiththereceiptofinterventionis.16,asistheoddsratioforbeingintheage4internalizingversusnormativeclassinrelationtotreatmentstatus.However,interventionwasunrelatedtothelikelihood

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ofmembershipintheexternalizing-onlyclass.Theanalysisofothersignificantcovariateeffects

onclassmembershipresultedinfindingsonlyatage2.Malegenderpredictedasignificantlygreaterlikeli-hoodofmembershipintheexternalizingclassatage2,andethnicminoritystatuspredictedatrend-levelincreaseinthelikelihoodofmembershipintheage2comorbidclass.Elevatedmaternaldepressivesymp-tomspredictedasignificantlygreaterlikelihoodofmembershipintheage2comorbidclass,andatrend-levelincreaseinthelikelihoodofmembershipintheage2externalizingclass,relativetothenormativeclass.

DiscussionThegoalofthisstudywastoexaminethehypoth-esisthattheFCUwouldresultindecreasesinyoungchildren’stransitionsintoco-occurringemotionalandbehavioralproblemsbyage4.Stepsthatledtothetestofthishypothesisincludedestablishingthenumberofclasses(LCA)ofyoungchildrenatage2and4,examiningthedistributionoftheseclasses,andthentestingtheimpactofarandomizedinterventionwhencontrollingforethnicity,maternaldepression,andgender.

Asexpected,resultsofLCAmodelssupportedtheexistenceoffourclassesatage2and4years,cor-respondingwiththeinternalizing,externalizing,comorbid,andnormativegroupsthatwereexpectedtobecomeapparentonthebasisofpastresearchandtheory.Severalfindingsarenoteworthyregardingtheseclasses.First,membershipinthecomorbidgroupatage2waspredictedbyelevatedsymptomsofdepressioninmothers,andbyethnicminoritystatus.Second,membershipintheage2externalizinggroupwaspredictedbymaternaldepressivesymptomsalone.Interestingly,maternaldepressivesymptomsdidnotpredictmembershipintheinternalizing-onlyclassatthisearlyage,whichisinconsistentwithpreviousresearch(Connell&Goodman,2002).

Itisimportanttonotethat“psychopathology”atthisearlyageisatransientphenomenon.Manyyouthinthethreeat-riskclassestransitionedintothenor-mativegroupbyage4.Thistransitionintolowerriskstatuswasparticularlypronouncedforearlyexter-nalizing-onlyproblems,withnearlyhalfoftheearlyexternalizinggroupmovingintothenormativegroupbyage4.Thispatternoffindingsisconsistentwiththatofotherresearch(e.g.,Cote,Vaillancourt,Leb-lanc,Nagin,&Tremblay,2006;NICHDEarlyChildCareResearchNetwork,2004),suggestingthatearlyproblemswithaggressionmayabateformanyyouth(althoughotherformsofearlyconductproblemsmaypersist).

Anunexpectedfindingwasthatmanyyouthwith

earlyinternalizingproblemsappearedtodevelopco-occurringexternalizingproblemsbyage4,butnoyouthswitchedfromtheearlyinternalizingtotheage4externalizingclass.Conversely,fewyouthmovedfromtheearlyexternalizingclassintoeitherthelaterinternalizingorlatercomorbidclasses.Theseresultsmaysuggestthatearlyemotionalproblemsmaysetthestageforthelateremergenceofco-occurringbehavioralproblems,butthatearlybehavioralprob-lems,bythemselves,maynotpredicttheemergenceofproblemswithanxietyordepressionbyage4.Atthisstage,itisunclearwhetherthisisanassessmentissueoroneofdevelopmentalsignificance.Individualdif-ferencesininternalizingandexternalizingproblemsareimpactedbymethodvarianceandthereforearevulnerabletoreportingbiasesandinadequateitempools.Withrespecttothelatterissue,wesuspectthereisaneedtodevelopmeasuresofemergingpsy-chopathologythatareuniquelysensitivetopatternsevidentinearlychildhood.

Itisimportanttoconsiderthatchildrenwithearlybehaviorproblemsmaydevelopinternalizingprob-lemsastheyenterschoolandareexposedtopeerswhomayacceptorrejectthem.ThispossibilitywouldbepredictedbyPatterson’sdual-failuremodel(Pat-terson&Stoolmiller,1991),inwhichchildrenwithearlyexternalizingproblemsareatriskforaccumu-latingsocialandacademicfailureexperiences,whichmayinturnleadtotheemergenceoflaterproblemswithanxietyanddepression.Aswefollowthesechil-drenintoearlyelementaryschool,wewillbeabletoexaminelatertransitionpatternsforchildreninall4classes.

Intervention EffectsResultsrevealedthatparticipationintheFCUsig-nificantlyreducedthelikelihoodofchildcomorbidemotionalandbehavioralproblemsatage4.ChildreninthecomorbidproblemsclasswerelesslikelytohavebeenrandomlyassignedtotheFCUintervention,indicatingthatinterventionsubstantiallydecreasedthelikelihoodofeitherremaininginortransitioningintothisclassfromage2toage4.Similareffectswereobservedfortheinternalizing-onlygroup.

Theseresultsareparticularlynoteworthybecausethesechildrenmaybeparticularlyatriskforcon-tinuedproblemslaterindevelopment,andareoftenexcludedfrominterventionstudiesbecauseoftheirdualdiagnosis.Resultsofthisstudyindicatethatchildreninthecomorbidgroupmaybeparticularlyresponsivetoearlyfamilyinterventionefforts,show-ingsignificantreductionsinthelikelihoodofcontin-uedproblems.Giventhatmostinterventionstudieseitherexcludecomorbidcasesorfocusononlyoneoutcomeofinterest,itisdifficulttofitthefindings

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ofthisstudyinwiththegeneralpreventionorchildclinicalliterature.Itwouldbeveryhelpfuliffutureresearchoninterventionoutcomefocusedonmultipledomains(e.g.,depression,problembehavior)toevalu-atetheoveralleffectivenessofdiverseinterventionsofchildandadolescentmentalhealth,morebroadlyconceptualized.

Theseresultsareinlinewiththelimitednumberofpastinterventionstudies(i.e.,Beauchaineetal.,2000;Beauchaineetal.,2005),infindingthatyouthwithco-occurringemotionalandbehaviorproblemsappeartobeparticularlyresponsivetoearlyinterven-tion.Interestingly,researchfromastudyof2-to4-year-oldtwinsfoundthatco-occurringemotionalandbehavioralproblemswerestronglyrelatedtosharedfamilyenvironmentalinf luences,arelativelyrarefindinginthebehaviorgeneticsliterature(Gregory,Eley,&Plomin,2004).Thatfindingsupportstheeffi-cacyoffamily-centeredinterventionstoamelioratethedevelopmentofcomorbidinternalizingandexter-nalizingproblemsinchildhood.Furtherresearchisneededtoexaminemediatingprocessesrelativetotheintervention,aswellastheirassociationwiththeonsetandcourseofcomorbidemotionalandbehav-ioralproblemsinchildhood.Consistentwithpastresearchinvolvingthissample(Dishionetal.,2007),wesuspectthatimprovementsinfamilyfunction-ingsuchasincreasedparentalwarmthandproactivestructuringwillmediatetheeffectsofinterventiononthelikelihoodofexhibitingcomorbidproblemsbyage4.Methodologicalresearchisneeded,however,toimprovetheexaminationofmediationinthecontextofLTAmodels.

Similarinterventioneffectswerefoundforreducedlikelihoodofshowingonlyinternalizingproblemsbyage4,althoughtheseresultswereattrendlevel.Theseresultsindicatethatimprovingparentandfamilyfunctioningmayalsobeimportantforyouthexhibitingearlysymptomsofanxietyanddepression,alone.TheyareconsistentwithotherstudiesinwhichtheFCUwasassociatedwithreductionsininternal-izingproblemsinearlyadolescence(Connell&Dish-ion,2007).Takentogether,theseresultssupportthenotionthatfamily-centeredinterventionsarelikelytobeimportantforreducingproblemswithanxietyanddepressioninyouth.

Itisimportanttonotethatinterventioneffectswerenotfoundfortheexternalizing-onlyclass.DespitethefactthattheFCUwasoriginallydesignedtopreventearlyconductproblems,theexternalizingclasswastheonlyhigh-risklatentclassthatdidnotdemon-strateaninterventioneffect.Onepossiblereasonforthelackofeffectforthisclassofchildrenisthatmanymovedoutofthisclassandintothenorma-tiveclassontheirown.Thecurrentfindingsmayalso

qualifypriorresultsforthissample(Dishionetal.,2007;Shawetal.,2007),inwhichLGMwasusedtodocumentthatchildrenwhoseparentsparticipatedintheFCUexhibitedgreaterdeclinesinexternaliz-ingproblemsfromage2toage3relativetothoseinthecontrolgroup.ThecurrentLTAresultssuggestthatthoseinterventioneffectsonchangesinexter-nalizingproblemsmayhavebeenprimarilydrivenbychildrenexhibitingco-occurringemotionalandbehaviorproblemsratherthanbythosewithonlyearlybehaviorproblems.

LimitationsSeveralmethodologicallimitationstothecurrentstudymeritconsideration.Firstandforemostistheissueofpotentialreporterbias.Thereisconsistentevi-denceintheliteraturethatmotherswithelevatedlev-elsofdepressivesymptomsshowatendencytoreporthigherlevelsofchildren’sproblembehavior(Fergus-son,Lynskey,&Horwood,1993).Becausemothersreportedonboththeirowndepressivesymptomsandonchildren’sexternalizingandinternalizingproblembehavior,reductionsinmaternaldepressivesymptomsthatappearedtobeafunctionofrandomizationtotheinterventiongroupmayhavealsoamplifiedgroupdifferencesinproblembehaviorandmaternalpercep-tionsoftheseverityofexternalizingsymptoms.Ontheonehand,itispossiblethatgroupdifferencesarepartiallyresponsibleforperceivedchangesinchildproblembehavior.However,Dishionandcolleagues(2007)recentlyfoundthatobservedparentingbehav-iorspredictedimprovementsinmother-ratedbehav-iorproblemsinthissample,supportingthenotionthatmother-reportedproblemsrelatedtoindepen-dentlyobservedparentingbehaviorinthisstudy.Itshouldalsobenotedthataselevatedlevelsofdepres-sivesymptomsduringthetoddlerperiodhavebeenrelatedtoteacherreportsoflow-incomechildren’sconductproblems,itisstillpossiblethatmodifyingmaternaldepressionduringthetoddlerperiodwillbeassociatedwithreducedproblembehaviorduringtheschool-ageperiod.Futureplannedassessmentsthatincludeteacherandafter-careproviderreportswillshedlightontheextenttowhichimprovementsinproblembehaviorarelimitedtomaternalperceptionsandthehomeenvironment,aswellastime.

Second,althoughwepresentedevidencetosug-gestthattheFCUisassociatedwithimprovementsinchildproblembehaviorandmaternaldepressivesymptoms,effectsizes,albeitmeaningfulfromapublichealthperspective,wererelativelymodest(dsrangedfrom.14to.19).FurtherrefinementoftheFCUwillbeneededtoincreaseitsefficacyforfamilieswithyoungchildren.

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Implications and Future DirectionsThis study’s findings corroborate previous evi-dencethatlongitudinalchangesinchildemotionalandbehavioraldifficultiescanbeachievedwithabrieffamily-centeredinterventionfortoddlers.Thechangesobservedinourstudywereachievedamonglow-incomefamiliesparticipatinginanexisting,nationallyavailableservicedeliverysetting(WIC).Thefamilieshadchildrenatriskforearly-startingpathwaysofexternalizingbehavioranddidnottypi-callyusementalhealthservices(Haines,McMunn,Nazroo,&Kelly,2002).Wehopethatfuturefollow-upofthepresentcohortwillclarifyconcernsregardingtheintervention’senduranceandgeneralizabilitytoothercontexts,andlaterdevelopmentaltransitionsinchildren’spatternsofemotionalandbehavioraldif-ficultiesastheyenterschoolage.

referencesAchenbach, T. M., & Rescorla, L. A. (2000). Manual for the

ASEBA preschool forms & profiles. Burlington VT: Uni-versity of Vermont Department of Psychiatry.

Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbid-ity. Journal of Child Psychology and Psychiatry, 40(1), 57–87.

Asarnow, J. R., & Carlson, G. (1988). Suicide attempts in preadolescent child psychiatry inpatients. Suicide and Life-Threatening Behavior, 18(2), 129–136.

Asarnow, J., Scott, C., & Mintz, J. (2002). A combined cognitive–behavioral family education intervention for depression in children: A treatment development study. Cognitive Therapy and Research, 26, 221–229.

Beauchaine, T. P., Gartner, J., & Hagen, B. (2000). Comor-bid depression and heart rate variability as predictors of aggressive and hyperactive symptom responsiveness dur-ing inpatient treatment of conduct-disordered ADHD boys. Aggressive Behavior, 26, 425–441.

Beauchaine, T. P., Webster-Stratton, C., & Reid, M. J. (2005). Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset con-duct problems: A latent growth curve analysis. Journal of Consulting and Clinical Psychology, 73(3), 371–388.

Brent, D., Holder, D., Kolko, D., Birmaher, B., Baugher, M., Roth, C., et al. (1997). A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy. Archives of General Psychiatry, 54, 877–885.

Briggs-Gowan, M., Carter, A., Bosson-Heenan, J., Guyer, A., & Horwitz, S. (2006). Are infant–toddler social–emo-tional and behavioral problems transient? Journal of the American Academy of Child & Adolescent Psychiatry, 45, 849–858.

Briggs-Gowan, M., Carter, A., Irwin, J., Wachtel, K., & Cicchetti, D. (2004). The Brief Infant–Toddler Social and Emotional Assessment: Screening for social–emotional problems and delays in competence. Journal of Pediatric Psychology, 29, 143–155.

Brinkmeyer, M. Y., & Eyberg, S. M. (2003). Parent–child

interaction therapy for oppositional children. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychother-apies for children and adolescents (pp. 204–223). New York: Guilford.

Brook, J. S., Whiteman, M., & Finch, S. (1992). Childhood aggression, adolescent delinquency, and drug use: A longitudinal study. Journal of Genetic Psychology, 153, 369–383.

Brook, J. S., Whiteman, M., Gordon, A. S., & Cohen, P. (1986). Dynamics of childhood and adolescent personal-ity traits and adolescent drug use. Developmental Psy-chology, 22(3), 403–414.

Campbell, S. B., Pierce, E. W., Moore, G., Marakovitz, S., & Newby, K. (1996). Boys’ externalizing problems at ele-mentary school age: Pathways from early behavior prob-lems, maternal control, and family stress. Development and Psychopathology, 8, 701–719.

Campbell, S. B., Shaw, D. S., & Gilliom, M. (2000). Early externalizing behavior problems: Toddlers and pre-schoolers at risk for later maladjustment. Development and Psychopathology, 12, 467–488.

Capaldi, D. (1992). Co-occurrence of conduct problems and depressive symptoms in early adolescent boys II: A two-year follow-up at grade eight. Development and Psycho-pathology, 4, 125–144.

Caspi, A., Moffitt, T. E., Newman, D. L., & Silva, P. A. (1998). Behavioral observations at age 3 years predict adult psychiatric disorders: Longitudinal evidence from a birth cohort. In M. E. Hertzig & E. A. Ellen (Eds.), An-nual progress in child psychiatry and child development (pp. 319–331). Philadelphia, PA: Brunner/Mazel, Inc.

Collins, L., Hyatt, S., & Graham, J. (2000). Latent transition analysis as a way of testing models of stage-sequential change in longitudinal data. In T. Little, K. Schnabel, & J. Baumert (Eds.), Modeling longitudinal and multilevel data: Practical issues, applied approaches, and specific examples (pp. 147–161). Mahway, NJ: Lawrence Erlbaum Associates.

Collins, L., Murphy, S., & Bierman, K. (2004). A concep-tual framework for adaptive preventive interventions. Prevention Science, 5, 185–196.

Connell, A., & Dishion, T. (2007). Reducing depression among at-risk early adolescents: Three-year effects of a family-centered intervention embedded within schools. Manuscript under review.

Connell, A., Dishion, T., & Deater–Deckard, K. (2006). Variable- and person-centered approaches to the analy-sis of early adolescent substance use: Linking peer, family, and intervention effects with developmental trajectories. Merrill-Palmer Quarterly (Special issue on variable and person-centered analysis), 52, 421–448.

Connell, A., Dishion, T., Yasui, M., & Kavanagh, K. (in press). An ecological approach to family intervention to reduce adolescent problem behavior: Intervention en-gagement and longitudinal change. In S. Evans (Ed.) Ad-vances in school-based mental health: Vol. 2. Kingston, New Jersey: Civic Research Institute.

Connell, A., & Goodman, S. (2002). The association between child internalizing and externalizing behavior problems and psychopathology in mothers versus fathers: A meta-

MANUSCRIPT UNDER REVIEW : Journal of Abnormal Child Psychology ��Unauthorized reproduction of this article is prohibited.


analysis. Psychological Bulletin, 128, 746–773.Cote, S., Vaillancourt, T., Leblanc, J., Nagin, D., & Trem-

blay, R. (2006). The development of physical aggression from toddlerhood to pre-adolescence: A nationwide lon-gitudinal study. Journal of Abnormal Child Psychology, 34, 71–85.

Diamond, G., Reis, B., Diamond, G., Siqueland, L., & Isaacs, L. (2002). Attachment-based family therapy for depressed adolescents: A treatment development study. Journal of the American Academy of Child and Adoles-cent Psychiatry, 41, 1190–1196.

Dishion, T. J. (2000). Cross-setting consistency in early adolescent psychopathology: Deviant friendships and problem behavior sequelae. Journal of Personality, 68, 1109–1126.

Dishion, T. J., & Kavanagh, K. (2003). Intervening in ado-lescent problem behavior: A family-centered approach. New York: Guilford.

Dishion, T. J., Kavanagh, K., Schneiger, A., Nelson, S. E., & Kaufman, N. (2002). Preventing early adolescent substance use: A family-centered strategy for the public middle-school ecology. In R. L. Spoth, K. Kavanagh, & T. J. Dishion (Eds.), Universal family-centered prevention strategies: Current findings and critical issues for public health impact. Prevention Science, 3, 191–201.

Dishion, T .J., & Patterson, G. R. (2006). The development and ecology of antisocial behavior in children and ado-lescents. In D. Cicchetti & D. J. Cohen (Eds.), Develop-mental psychopathology. Volume 3: Risk, adaptation and disorder (2nd ed., pp. 503–541).Hoboken, NJ: John Wiley & Sons.

Dishion, T. J., Shaw, D. S, Connell, A., Gardner, F., Weav-er, C., & Wilson, M. (2007). The Family Check-Up with high-risk indigent families: Outcomes of positive parent-ing and problem behavior from ages 2 through 4. Manu-script under review.

Dishion, T. J., & Stormshak, E. (2007). Intervening in chil-dren’s lives: An ecological, family-centered approach to mental health care. Washington, DC: APA Books.

Fagot, B., & Kavanaugh, K. (1993). Parenting during the second year: Effects of children’s age, sex, and attach-ment classification. Child Development, 64, 258–271.

Fergusson, D. M., Lynskey, M. T., & Horwood, L. J. (1993). The effect of maternal depression on maternal ratings of child behavior. Journal of Abnormal Child Psychology, 21(3), 245–269.

Fombonne, E., Wostear, G., Cooper, V., Harrington, R., & Rutter, M. (2001). The Maudsley long-term follow-up of child and adolescent depression: I. Psychiatric out-comes in adulthood. British Journal of Psychiatry, 179, 210–217.

Forgatch, M. S., Patterson, G. R., & DeGarmo, D. S. (2005). Evaluating fidelity: Predictive validity for a measure of competent adherence to the Oregon Model of Parent Management Training. Behavior Therapy, 36, 3–13.

Gardner, F. (1987). Positive interaction between moth-ers and conduct-problem children: Is there training for harmony as well as fighting? Journal of Abnormal Child Psychology. 15, 283–293.

Gardner, F. (1994). The quality of joint activity between

mothers and their children with behaviour problems. Journal of Child Psychology and Psychiatry, 35, 935–948.

Gardner, F., Shaw, D., Dishion, T. J., Burton, J., & Supplee, L. (in press). Randomized prevention trial for early con-duct problems: Effects on proactive parenting and links to toddler disruptive behavior. Journal of Family Psy-chology.

Gardner, F., Sonuga-Barke, E., & Sayal, K. (1999). Parents anticipating misbehaviour: An observational study of strategies parents use to prevent conflict with behaviour problem children. Journal of Child Psychology and Psy-chiatry, 40, 1185–1196.

Graham, J., Collins, L., Wugalter, S., Chung, N., & Hansen, W. (1991). Modeling transitions in latent stage-sequen-tial processes: A substance use prevention example. Jour-nal of Consulting and Clinical Psychology, 59, 48–57.

Gregory, A., Eley, T., & Plomin, R. (2004). Exploring the association between anxiety and conduct problems in a large sample of twins aged 2–4. Journal of Abnormal Child Psychology, 32, 111–122.

Haines, M. M., McMunn, A., Nazroo, J. Y., & Kelly, Y. J. (2002). Social and demographic predictors of parental consultation for child psychological difficulties. Journal of Public Health Medicine, 24, 276–284.

Hawkins, J. D., Lishner, D. M., Catalano, R. F., & Howard, M. O. (1986). Childhood predictors of adolescent sub-stance abuse: Toward an empirically grounded theory. Journal of Children in Contemporary Society, 18, 11–47.

Humphreys, K., & Janson, H. (2000). Latent transition analysis with covariates, nonresponse, summary statis-tics, and diagnostics. Multivariate Behavioral Research, 35, 89–118.

Lewinsohn, P. M., Rohde, P., & Seeley, J. R. (1995). Ado-lescent psychopathology: III. The clinical consequences of comorbidity. Journal of the American Academy of Child & Adolescent Psychiatry, 34(4), 510–519.

Lewinsohn, P., Rohde, P., Seeley, J., Klein, D., & Gotlib, I. (2003). Psychosocial functioning of young adults who have experienced and recovered from major depressive disorder during adolescence. Journal of Abnormal Psy-chology, 112, 353–363.

Lyons-Ruth, K., Zeanah, C. H., & Benoit, D. (1996). Dis-order and risk for disorder during infancy and toddler-hood. In E. J. Mash & R. A. Barkley (Eds.), Child Psycho-pathology (pp. 457–491). New York: Guilford.

Miller, T. R. (2004). The social costs of adolescent problem behavior. In A. Biglan, P. A. Brennan, S. L. Foster, & H. D. Holder (Eds.), Helping adolescents at risk: Prevention of multiple problem behaviors. New York: Guilford.

Miller, W. R., & Rollnick, S. (2002). Motivational inter-viewing: Preparing people for change (2nd ed.). New York: Guilford.

Muthén, B. & Muthén, L. (2000). Integrating person-cen-tered and variable-centered analysis: Growth mixture modeling with latent trajectory classes. Alcoholism: Clinical and Experimental Research, 24, 882–891.

NICHD Early Childcare Research Network. (2004). Trajec-tories of physical aggression from toddlerhood to middle childhood. In Monographs of the Society for Research in

�� MANUSCRIPT UNDER REVIEW: Journal of Abnormal Child Psychology, Unauthorized reproduction of this article is prohibited.


Child Development, 69. Boston: Blackwell Publishing.Nottelmann, E. D., & Jensen, P. S. Comorbidity of depres-

sive disorders: Rates, temporal sequencing, course, and outcome. (1999). In C. A. Essau & F. Petermann (Eds.), Depressive disorders in children and adolescents: Epide-miology, risk factors, and treatment (pp. 137–191). Lan-ham, MD: Jason Aronson.

Nylund, K., Asparouhov, T., & Muthén, B. (2006). Deciding on the number of classes in mixture modeling: A mon-tecarlo simulation study. Structural Equation Modeling: An Interdisciplinary Journal. Manuscript submitted for publication.

Nylund, K., Muthén, B., Nishina, A., Bellmore, A., & Gra-ham, S. (2007). Stability and instability of peer victim-ization during middle school: Using Latent Transition Analysis with covariates, distal outcomes, and modeling extensions. Manuscript submitted for publication.

Olds, D. L., Eckenrode, J., Henderson, C. R., Jr., Kitzman, H., Powers, J., Cole, R., et al. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized tri-al. Journal of the American Medical Association, 278 (8), 637–643.

Patterson, G. R., & Stoolmiller, M. (1991). Replications of a dual failure model for boys’ depressed mood. Journal of Consulting and Clinical Psychology, 59(4), 491–498.

Pickles, A., & Hill, J. (2006). Developmental pathways. In D. Cicchetti & D. J. Cohen (Eds), Developmental psy-chopathology, Vol 1: Theory and method (2nd ed., pp. 211–243). Hoboken, NJ: John Wiley & Sons, Inc.

Radloff, L. S. (1977). The CES–D scale: A self-report depres-sion scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

Reboussin, B., Reboussin, D., Liang, K., & Anthony, J. (1998). Latent transition modeling of progression of health-risk behavior. Multivariate Behavioral Research, 33, 457–478.

Rohde, P., Lewinsohn, P. M., & Seeley, J. R. (1995). Psychi-atric co-morbidity with problematic alcohol use in high school students. Journal of American Academy of Child and Adolescent Psychiatry, 35, 101–109.

Shaw, D. S., Bell, R. Q., & Gilliom, M. (2000). A truly early-starter model of antisocial behavior revisited. Clinical Child and Family Psychology Review, 3, 155–172.

Shaw, D., Dishion, T., Connell, A., Wilson, M., & Gardner, F. (2007). Maternal depression as a mediator of inter-vention in reducing early child problem behaviour. Man-uscript submitted for publication.

Shaw, D. S., Dishion, T. J., Supplee, L., Gardner, F., & Arnds, K. (2006). A family-centered approach to the prevention of early-onset antisocial behavior: Two-year effects of the Family Check-Up in early childhood. Journal of Consult-ing and Clinical Psychology, 74, 1–9.

Shaw, D. S., Gilliom, M., Ingoldsby, E. M., & Nagin, D. (2003). Trajectories leading to school-age conduct prob-lems. Developmental Psychology, 39, 189–200.

Shaw, D. S., & Gross, H. (in press). Early childhood and the development of delinquency: What we have learned from recent longitudinal research. In A. Lieberman (Ed.), The yield of recent longitudinal studies of crime and delin-

quency. New York: Springer.Shaw, D. S., Owens, E. B., Vondra, J. I., Keenan, K., & Win-

slow, E. B. (1996). Early risk factors and pathways in the development of early disruptive behavior problems. De-velopment and Psychopathology, 8, 679–699.

Shaw, D. S., Vondra, J. I., Hommerding, K. D., Keenan, K., & Dunn, M. (1994). Chronic family adversity and early child behavior problems: A longitudinal study of low in-come families. Journal of Child Psychology and Psychia-try 35, 1109–1122.

Shaw, D. S., Winslow, E. B., Owens, E. B., & Hood, N. (1998). Young children’s adjustment to chronic family adversity: A longitudinal study of low-income families. Journal of the American Academy of Child and Adoles-cent Psychiatry, 37, 545–553.

Supplee, L. Unikel, E., & Shaw, D. (2007). Physical envi-ronmental adversity and the protective role of maternal monitoring in relation to early child conduct problems. Journal of Applied Developmental Psychology, 28, 166–183.

Vicary, J. R., & Lerner, J. V. (1983). Longitudinal predictors of drug use: Analyses from the New York Longitudinal Study. Journal of Drug Education, 13, 275–285.

Warren, S., Huston, L., Egeland, B., & Sroufe, A. (1997). Child and adolescent anxiety disorders and early at-tachment, Journal of the American Academy of Child & Adolescent Psychiatry, 36, 637–644.

Webster-Stratton, C. (1990). Long-term follow-up of fami-lies with young conduct problem children: From pre-school to grade school. Journal of Clinical Child Psychol-ogy, 19(2), 144–149.

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