prevalence of antisocial personality disorder in three groups of

Longer Term Outcomes of Longer Term Outcomes of Two Universal, FirstTwo Universal, First--Grade Grade

Preventive Intervention Trials Preventive Intervention Trials NicholasNicholas IalongoIalongo, ,

Lisa Ulmer, Sheppard Lisa Ulmer, Sheppard KellamKellam, & , & C. Hendricks BrownC. Hendricks Brown

Prevention Intervention Research Center Prevention Intervention Research Center Johns Hopkins Bloomberg School of Johns Hopkins Bloomberg School of

Public HealthPublic Health

22

Major Contributors to the Development of PIRC Interventions:

Mary Alice Bond, M.A.Mary Alice Bond, M.A.Joyce Epstein, Ph.D.Joyce Epstein, Ph.D.Becky Becky FetrowFetrow, M.A., M.A.Elizabeth Ramsey, Ph.D.Elizabeth Ramsey, Ph.D.Ruth Handel, Ph.D.Ruth Handel, Ph.D.Nancy Nancy KarweitKarweit, , Ph.DPh.DIrving Sigel, Ph.D.Irving Sigel, Ph.D.Grover Whitehurst, Ph.D.Grover Whitehurst, Ph.D.Carolyn WebsterCarolyn Webster--Stratton, Ph.D.Stratton, Ph.D.

33

Juanita Lewis, Director, Office of Superintendent (CoJuanita Lewis, Director, Office of Superintendent (Co--Chair)Chair)Sheppard Sheppard KellamKellam, Director, Prevention Research Center (Co, Director, Prevention Research Center (Co--Chair)Chair)Elva J. Edward, Community Relations and Crisis ResponseElva J. Edward, Community Relations and Crisis ResponseLouise Fink, Coordinator, Special Pupil ServicesLouise Fink, Coordinator, Special Pupil ServicesCarla Ford, Interim Coordinator, Office of Early Learning YearsCarla Ford, Interim Coordinator, Office of Early Learning YearsClaudia Brown, Principal, Claudia Brown, Principal, BrehmsBrehms Lane Elementary SchoolLane Elementary SchoolLinda Linda ChinniaChinnia, Principal, Liberty Elementary School, Principal, Liberty Elementary SchoolJanet Cooper, Principal, Grove Park Elementary SchoolJanet Cooper, Principal, Grove Park Elementary SchoolCharlene CooperCharlene Cooper--Boston, Principal, Boston, Principal, BeechfieldBeechfield Elementary SchoolElementary SchoolElaine Davis, Principal, Hilton Elementary SchoolElaine Davis, Principal, Hilton Elementary SchoolLillian Jones, Principal, Callaway Elementary SchoolLillian Jones, Principal, Callaway Elementary SchoolBarbara Lee, Principal, Cross Country Elementary SchoolBarbara Lee, Principal, Cross Country Elementary SchoolAngela Peck, Principal, Angela Peck, Principal, YorkwoodYorkwood Elementary SchoolElementary SchoolShirley Shirley ZongkerZongker, Principal, , Principal, FarringFarring Elementary SchoolElementary School

Schools Committee: Classroom and Family Schools Committee: Classroom and Family Prevention TrialsPrevention Trials

44

Intervention Types:Intervention Types:

UniversalUniversalSelectedSelectedIndicatedIndicatedTreatment / ServicesTreatment / Services

55

JHU PIRC Interventions JHU PIRC Interventions Integrate 4 Perspectives:Integrate 4 Perspectives:

Public HealthPublic HealthEpidemiologyEpidemiologyLife Course DevelopmentLife Course DevelopmentSociologySociology

66

Preventive Intervention Preventive Intervention Trials Serve a Dual Purpose:Trials Serve a Dual Purpose:

Test for intervention efficacy / Test for intervention efficacy / effectivenesseffectiveness

Test developmental theoryTest developmental theory

77

Immediate objectives of Immediate objectives of the interventions:the interventions:

Promote first gradersPromote first graders’’::Academic achievementAcademic achievementSelfSelf--esteem and psychological wellesteem and psychological well--beingbeing

Reduce first gradersReduce first graders’’::Attention problemsAttention problemsAggressive and shy behaviorsAggressive and shy behaviors

88

LongLong--term objectives of term objectives of the interventions:the interventions:

Promote:Promote:Educational, social, and occupational Educational, social, and occupational successsuccess

Prevent: Prevent: Antisocial behaviorAntisocial behaviorSubstance abuseSubstance abuseDepressionDepression

99

Two firstTwo first--grade grade interventionsinterventions

FamilyFamily--School Partnership (FSP) Intervention School Partnership (FSP) Intervention targeting:targeting:

ParentParent--school communicationschool communicationParent Parent ““teachingteaching”” and discipline practicesand discipline practices

ClassroomClassroom--Centered (CC) Intervention Centered (CC) Intervention targeting:targeting:

Teacher classroom behavior management practicesTeacher classroom behavior management practicesTeacher instructional practicesTeacher instructional practices

Both delivered over course of firstBoth delivered over course of first--grade yeargrade year

1010

FamilyFamily--School Partnership: School Partnership: Parent Components / ToolsParent Components / Tools

Parent workshops (led by teacher and school Parent workshops (led by teacher and school mental health professional) aimed at:mental health professional) aimed at:

Establishing effective parentEstablishing effective parent--school partnershipsschool partnershipsStrategies to enhance their childStrategies to enhance their child’’s learnings learningEffective ways to discipline their childEffective ways to discipline their child

Learning tools available to parents:Learning tools available to parents:Parent lending libraryParent lending libraryA A ““Fun MathFun Math”” kitkitVoice mail system to communicate with teachersVoice mail system to communicate with teachers

1111

FamilyFamily--School Partnership: School Partnership: Teacher Components / ToolsTeacher Components / Tools

InIn--service training for teachers to assist them service training for teachers to assist them in:in:

Creating an environment that invites parent Creating an environment that invites parent involvementinvolvementCommunicating more appropriately with culturally Communicating more appropriately with culturally diverse familiesdiverse familiesIdentifying classroom factors and teaching practices Identifying classroom factors and teaching practices that hinder or promote parent involvementthat hinder or promote parent involvementPlanning and executing a successful parentPlanning and executing a successful parent--teacher teacher conferenceconference

1212

ClassroomClassroom--Centered (CC) Centered (CC) Intervention ComponentsIntervention Components

Curriculum to promote math and reading Curriculum to promote math and reading achievement achievement -- ““Mastery LearningMastery Learning””

Classroom behavioral components:Classroom behavioral components:Good Behavior GameGood Behavior Game -- to promote positive to promote positive behavior using peer supportsbehavior using peer supportsWeekly class meetingWeekly class meeting –– teachers guide teachers guide students in a 6students in a 6--step problem solving protocol step problem solving protocol to resolve conflicts and develop social to resolve conflicts and develop social competenciescompetencies

1313

Hypothesized Mechanisms: Hypothesized Mechanisms: Antisocial Behavior & Antisocial Behavior & Substance AbuseSubstance Abuse

Improved parent and teacher behavior Improved parent and teacher behavior management practicesmanagement practicesReductions in early coercive / aggressive Reductions in early coercive / aggressive behaviorbehaviorReduced likelihood of peer, teacher, and Reduced likelihood of peer, teacher, and parent rejectionparent rejectionIncreased likelihood of acquiring Increased likelihood of acquiring ““social social survival skillssurvival skills””Less likely to drift into deviant peer groupsLess likely to drift into deviant peer groups

1414

Hypothesized Mechanisms: Hypothesized Mechanisms: Anxious / Depressive Anxious / Depressive SymptomsSymptoms

Improved teacher and parent Improved teacher and parent instructional practices provide support for instructional practices provide support for learninglearningImproved achievementImproved achievementImproved perceptions of competence and Improved perceptions of competence and controlcontrolImproved psychological wellImproved psychological well--beingbeing

1515

DesignDesign

Effectiveness trial Effectiveness trial –– existing teachers and existing teachers and school mental health professionals delivered school mental health professionals delivered interventionsinterventionsCompletely randomized block design:Completely randomized block design:

3 first grade classrooms in 9 urban elementary 3 first grade classrooms in 9 urban elementary schools (primarily Africanschools (primarily African--American)American)Randomly assigned to an intervention or a standard Randomly assigned to an intervention or a standard setting classroomsetting classroomChildren and teachers randomly assigned to Children and teachers randomly assigned to classrooms within each schoolclassrooms within each school

1616

Assessment design and Assessment design and methodsmethods

Pretest assessment early fall of first Pretest assessment early fall of first gradegrade

Teacher, school mental health professional, Teacher, school mental health professional, parent, peer, and youth reportsparent, peer, and youth reports

PostPost--test late spring of first gradetest late spring of first gradeAnnual followAnnual follow--up each spring since 1up each spring since 1stst

gradegrade

1717

Constructs assessed:Constructs assessed:

Proximal targets:Proximal targets:Grades, standardized achievement scores, Grades, standardized achievement scores, attendance, special education, disciplinary removalsattendance, special education, disciplinary removalsAttention / concentration problemsAttention / concentration problemsAggressionAggressionShy / withdrawn behaviorsShy / withdrawn behaviors

Distal targets:Distal targets:Conduct, affective, anxious, substance abuse Conduct, affective, anxious, substance abuse symptoms and disorderssymptoms and disordersGrades, standardized achievement scores, Grades, standardized achievement scores, attendance, special education, disciplinary removalsattendance, special education, disciplinary removals

Ialongo, Werthamer, Brown, Ialongo, Werthamer, Brown, Kellam, & Wang (1999)Kellam, & Wang (1999)

1818

Proximal Impact Grades 1Proximal Impact Grades 1--22

Improved reading and math achievementImproved reading and math achievementDecreased teacherDecreased teacher--rated total problem rated total problem behaviorsbehaviorsDecreased peerDecreased peer--nominated aggressionnominated aggressionDecreased parentDecreased parent--rated total problem rated total problem behaviorsbehaviorsIncreased psychological wellIncreased psychological well--beingbeing

Highlights of Highlights of Intervention Impact: Intervention Impact:

End of 6End of 6thth GradeGrade

2020

Classroom Centered vs. Control Classroom Centered vs. Control (6(6thth grade boys)grade boys)

0.000.010.020.030.040.050.060.070.080.090.10

Conduct Disorder

ControlClassroom Centered

Odds Ratio: 0.42, 95% CI (0.18-0.98)

P r o

b a

b I

l I t

y o

f E

v e

n t

*

2121

Classroom Centered vs. Control Classroom Centered vs. Control (6(6thth grade)grade)

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

Suspension


*

P r o

b a

b I

l I t

y o

f E

v e

n t

Odds Ratio: 0.73, 95% CI (0.56-0.95)

2222


0.00

0.05

0.10

0.15

0.20

0.25

Parent Report: Child Receive MentalHealth Service


*

P r o

b a

b I

l I t

y o

f E

v e

n t

Odds Ratio: 0.53, 95% CI (0.38-0.76)

2323


0.000.050.100.150.200.250.300.350.40

School Mental Health ProfessionalReport: Child Receive Mental Health

Service


*

P r o

b a

b I

l I t

y o

f E

v e

n t

Odds Ratio: 0.56, 95% CI (0.32-0.99)

2424


0.00

0.05

0.10

0.15

0.20

0.25

Teacher Report: Child Needs MentalHealth Service


*

P r o

b a

b I

l I t

y o

f E

v e

n t

Odds Ratio: 0.37, 95% CI (0.20-0.70)

2525

Family Family –– School Partnership vs. Control School Partnership vs. Control (6(6thth grade)grade)

0.000.010.020.030.040.050.060.070.080.09

Conduct Disorder

Control

Family-SchoolPartnership

P r o

b a

b I

l I t

y o

f E

v e

n t

Odds Ratio: 0.69, 95% CI (0.32-1.49)

2626


0.00

0.05

0.10

0.15

0.20

0.25

0.30

Suspension

Control


*

P r o

b a

b I

l I t

y o

f E

v e

n t

Odds Ratio: 0.59, 95% CI (0.35-0.97)

2727


0.000.020.040.060.080.100.120.140.160.180.20

Parent Report: Child Receive MentalHealth Service

Control


P r o

b a

b I

l I t

y o

f E

v e

n t

Odds Ratio: 0.66, 95% CI (0.32-0.1.32)

2828


0.000.050.100.150.200.250.300.35

School Mental Health ProfessionalReport: Child Receive Mental Health

Service

Control


P r o

b a

b I

l I t

y o

f E

v e

n t

Odds Ratio: 0.66, 95% CI (0.32-1.33)

2929


0.00

0.05

0.10

0.15

0.20

0.25

Teacher Report: Child Needs MentalHealth Service

Control


P r o

b a

b I

l I t

y o

f E

v e

n t

Odds Ratio: 0.72, 95% CI (0.47-1.11)

Storr, Ialongo, Kellam, & Anthony Storr, Ialongo, Kellam, & Anthony (2002)(2002)

3030

14131211109876

Intervention StatusControlClassroom CenteredFamily-School Partnership

Kaplan-Meier Estimates of Impact of Interventions on Youth Tobacco Smoking

AGE

40

30

20

10

0P e

r c e

n t

S t

a r t

I n

g T

o b

a c

c o

U s

e

Highlights of Highlights of Intervention Impact: Intervention Impact:

1111thth GradeGrade

3232


0.00

0.01

0.02

0.03

0.04

0.05

0.06

0.07

Experimentation with Illicit/Hard Drugs


Odds Ratio: 0.30, 95% CI (0.12-0.78)

P r o

b a

b I

l I t

y o

f E

v e

n t

*

3333

Classroom Centered vs. Control Classroom Centered vs. Control (11(11thth grade boys only)grade boys only)

0.00

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0.08

Conduct Disorder: Youth Report (boys)


Odds Ratio: 0.48, 95% CI (0.20-1.17), p < .10

P r o

b a

b I

l I t

y o

f E

v e

n t

+

3434


0.00

0.05

0.10

0.15

0.20

0.25

0.30

School Suspension in Last Year


Odds Ratio: 0.40, 95% CI (023.-0.70)

P r o

b a

b I

l I t

y o

f E

v e

n t

*

3535


0.00

0.05

0.10

0.15

0.20

0.25

0.30

Teacher Report: Youth ReceivedCounseling for Behavior Problems


Odds Ratio: 0.39, 95% CI (0.20-0.74)

P r o

b a

b I

l I t

y o

f E

v e

n t

*

3636


0.000.020.040.060.080.100.120.140.160.18

Received Special Education


Odds Ratio: 0.47, 95% CI (0.24-0.93)

P r o

b a

b I

l I t

y o

f E

v e

n t

*

3737


0.00

0.05

0.10

0.15

0.20

0.25

Teacher Report: Youth Needs SpecialEducation


Odds Ratio: 0.57, 95% CI (0.34-0.96)

P r o

b a

b I

l I t

y o

f E

v e

n t

*

3838

Preliminary ConclusionsPreliminary Conclusions

Evidence of distal impacts of firstEvidence of distal impacts of first--grade grade universal interventions (10 years later)universal interventions (10 years later)Effects for school and externalizing outcomes Effects for school and externalizing outcomes but not internalizing outcomesbut not internalizing outcomesEffects of CC interventions stronger and longer Effects of CC interventions stronger and longer lasting than FSP effectslasting than FSP effects

CC = Teachers received 60 hours training / CC = Teachers received 60 hours training / supervisionsupervisionFSP = Parents received nine 90FSP = Parents received nine 90--minute sessions; minute sessions; children wellchildren well--behavedbehaved

Impact seems to be greatest for youth at Impact seems to be greatest for youth at moderate riskmoderate risk

3939

Future Directions for Future Directions for Understanding Distal ImpactUnderstanding Distal Impact

Moderator analyses Moderator analyses –– for whom, to what for whom, to what degree, for how long and in what contexts are degree, for how long and in what contexts are interventions most effectiveinterventions most effectiveMediationalMediational analyses to examine hypothesized analyses to examine hypothesized mechanismsmechanismsUse of growth modeling methods to examine Use of growth modeling methods to examine change in change in trajectoriestrajectories over timeover time

Growth mixture methods to examine differential Growth mixture methods to examine differential intervention effects for different trajectoriesintervention effects for different trajectories

4040

Future Directions for Future Directions for Prevention TrialsPrevention Trials

Combinations of CC and FSP Combinations of CC and FSP interventions may lead to additive if not interventions may lead to additive if not synergistic effectssynergistic effectsIntegration of selected and indicated Integration of selected and indicated interventions within universalsinterventions within universalsVisit Visit http://www.bpp.jhu.eduhttp://www.bpp.jhu.edu for slides for slides and more information regarding new and more information regarding new PIRC trialsPIRC trials

http://www.bpp.jhu.edu/

prevalence of antisocial personality disorder in three groups of

Documents