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Abstract
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VioLit summary:
OBJECTIVE:
The aim of this study by the Conduct Problems Prevention Research Group was to describe the theoretical underpinnings and clinical strategies of the FAST Track (Families and Schools Together) Program designed for the treatment of conduct disorder in children. Developmental and Clinical Perspectives were utilized.
METHODOLOGY:
The authors conducted a non-experimental review of the pertinent literature. A developmental model of conduct disorder was provided. A brief description, followed by an evaluation, of the proposed, clinical, FAST Track Program for the treatment of conduct disorder was also presented.
FINDINGS/DISCUSSION:
The authors stated that, based on the difficulty of treating conduct disorder at the adolescent stage of development, prevention models should be focused towards working with younger children with conduct disorder, their families, and peer relationships. The authors argued that past conduct disorder prevention efforts have been mostly unsuccessful. They reported that limited effectiveness, displayed in small post-test change and the non-maintenance of change, often resulted. The authors stated that, to date, the successful long term prevention of conduct disorder had not been cited. The authors stated that past efforts had been problematic because researchers had failed to project and hypothesize about how short-term, proximal goal, intervention would affect the long term prevention of conduct disorder. The authors argued that successful conduct disorder prevention required a theory of its psycho-pathological development. The authors also contended that most researchers had neglected to consider the effects of age-related stressors (e.g., school entry), and the effects of continued intervention across developmental stages. Further, it was argued that many previous interventions had directed their efforts towards focusing on only one aspect of conduct disorder (e.g,. behavioral deficits), rather than responding to the multi-determinants (e.g., parenting deficits, family stress, school and family alienation, academic failure etc). The authors argued that a preventative approach to conduct disorder should be comprehensive. Finally, the authors stated that many preventative interventions had neglected to consider the heterogeneity of high-risk children populations. The authors contended that the needs of families and children were variable. It was suggested that researchers should evaluate the effectiveness of interventions with particular groups, and develop models for use with multiple groups.
The authors argued that to the establish timing of specific interventions, a developmental model of conduct disorder was required. The authors stated that interventions should focus on changing interaction patterns between the child and the child's social milieu (e.g,. family, peers, school). The authors explained that, according to research, conduct disorder had its roots in maladaptive behavior (e.g., irritability, discipline problems, inattentiveness, impulsivity) during pre-school years. Families of these children were often characterized as unstable and stressed, in which parents used punitive discipline methods and were often psycho-pathological. The authors outlined Patterson's (1982, 1986) "coercive family process" short-term developmental model of family dynamics surrounding conduct disorder. It's believed that aversive behavior develops from the lack of parental support that results from stress. This was said to result in children learning, through a series of aversive exchanges with parents, to respond to parent requests defiantly. In turn this was described as feeding into the child's skilled use of maladaptive behavior in future social situations. The authors stated that parents may, through demoralization, withdraw from interacting with outside support sources, which in turn, may create further family stress. It was suggested that rising aversive parent-child interactions may also impede adaptive social-cognitive skill development in children. Further, the authors stated that conduct disorder children often lacked cognitive stimulation and support from their parents which potentially impedes academic readiness at time of school entry. The authors stated that during middle-school, adjustment difficulties of conduct disorder children were further intensified because of negative school, and social, experiences. Maladaptive behavior towards peers was reported to result in peer rejection. Poor teacher-child relations was said to result in less school support. Parents' negative interactions with teachers and their children were said to lead to rejection of their child and less adolescent interest. The authors stated that this spiralling negative relationship pattern could result in early adolescence problems such as deviant peer group behavior, poor school outcomes, and negative self-concept. The authors argued that rejection from conventional culture, and deviant peer associations, may promote adolescent delinquency. The authors stated that a sociological model was also needed for a more comprehensive understanding of conduct disorder. It was argued that sociology could offer insight into the impact of the child's ecosystem and the child's bonding to social institutions (e.g., school, family), and the family's positive linking with the child and their school. The authors argued that consequently preventative efforts needed to be considerate of the development of healthy relationships between these institutions. The authors suggested that it was critical that parents be positively linked with a child's school; this would then develop other healthy relationships.
Suggestions for developmental interventions included 1) helping children with alternatives to aggressive behavior (e.g., by controlling anger, developing social skills); 2) helping parents to develop less punitive parenting styles; 3) preparing teachers to work with high-risk, conduct disorder, children; 4) providing case management to highly stressed families. According to the authors, further intervention with middle school children should include aggressive behavior control, prosocial skill acquisition, and concentrated academic skill assistance. Further, schools and parents should work together.
The authors provided a basic synopsis of their proposed clinical, FAST Track Program designed to treat conduct disorder in children. Children were chosen for the program, and a future evaluation of the program was to take place based on the outcome of the selected children. The authors provided a limited overview of the design of the program and the selection process of children involved in the evaluation. These children varied on gender, ethnicity, urban versus rural living situations, social class, and family structure. Criteria for clinical intervention included children's disruptive behavior and poor school, and home, peer relations. These were measured using teacher and parent ratings of behavior. Schools selected included schools from the Durham, NC region, Nashville, TN region, Seattle, WA, and rural central Pennsylvania. The authors reported that schools were selected based on high conduct problem prevalence rates. Agreeing schools were randomly assigned to an intervention or control condition. The authors stated that the aims of the intervention included: a) disruptive behavior reductions in the home and parent-child relationship improvements; b) disruptive and aggressive behavior reductions in the school setting; c) increases in social-cognitive skills; d) improvement in the quality of peer relations; e) academic skill gains, especially reading; f) improvements in the quality of family/school relations. The authors hypothesized that achieved improvement in these 6 domains would result in long-term conduct disorder prevention. The authors stated that the FAST Track model consisted of 5 integrated intervention programs. 1) Parent training which included 22 sessions during the child's 1st grade---this covered positive family-school relationship development and teaching social-learning parenting skills. The authors stated that session material had been adapted from Hawkins and Catalano, University of Washington, programs. The 1st 6 sessions were aimed at ways in which parents could positively assist children's learning and nurture family-school relationships. During sessions 7-9, parents were taught ways to practice the anger control and problem-solving strategies they had learned in the classroom. Self-control of oneself was also taught to parents. Sessions 10-22 were specifically directed towards teaching parenting skills aimed at developing positive parent-child relations and reducing conduct maladaptive behaviors. The parent-skills section of the FAST Track Program was adapted from a program by Forehand and associates. 2) Home visiting included bi-weekly home visits as supplements to skill training. Skills were practiced, application concepts were implemented in the family environment, and individual resistance to employing learned skills was responded to. The 3 major goals of home visits were: a) life-management, problem-solving, competence among parents; b) the promotion of empowerment and confidence among parents; and c) organizing the family environment so that it's safe and supportive for children. The authors stated that family coordinators employed a solution-focused approach to problem solving for parents. Enhancement of self-efficacy was a major goal. 3) Social-skills training was said to be designed for child's social-cognitive skills improvement, and social adjustment with peers. The FAST Track Program focused on friendship and play skills enhancement, self-control skills, anger coping strategies, and interpersonal problem-solving skills. Skills were expected to be practiced in structured activities and naturalistic peer interactions, and in peer associations at school. 4) Academic tutoring involved tutoring reading skills to enhance academic performance and facilitate improvements in behavior. The authors adopted the phonics-oriented program constructed by Wallach and Wallach, 1976. This program was directed at enhancing phonemic awareness skills often lacking in young children. This program was stated to enhance teacher-parent collaboration also. 5) Class intervention included training teachers to implement the PATH's (Promoting Alternative Thinking Strategies) curriculum. The PATH program was implemented from 1st-5th grade and was designed to augment self-control development, positive peer climate, emotional awareness, and interpersonal problem-solving skills among primary grade children. The authors reported that educational co-ordinators check PATH lessons weekly and consult with teachers weekly about classroom management.
An integration of the above components was said to promote complementary child behavior and adjustment improvements. The authors argued that a co-ordinated effort was critical to long-term treatment benefits. A cross-situational approach was reported to aid generalized and sustained child adaptation improvements. The authors stated that FAST Track Program employees were expected to be experienced at working with at-risk families, and have Social Work training. Teaching experience, and experience with at-risk children, was also required by educational co-ordinators. The authors argued that since the FAST Track Program was based on prevention, it was critical that parents be approached as equal and paid participants (e.g., as collaborators and potential staff members to help their children succeed). The authors stated that it was important that the program be made to fit with the particular community (e.g., on levels such as ethnic composition, socio-economic status, school priorities, travel constraints, and child interests).
The authors argued that the aim of their program was to decrease conduct problems in large schools and in a high-risk sample. The authors stated that integrated intervention would enhance learning and social opportunities of children not at high risk also. The authors recognized that the above processes would take several years. They also realized that they need to contend with selection bias and attrition. The authors have developed process measures that aim to record participation and quality of implementation levels.
The authors concluded that the implementation, and testing, of such a comprehensive approach to conduct disorder problems would contribute towards the development of improved service to conduct disorder children.
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