How Does the Fast Track Intervention Prevent Adverse Outcomes in Young Adulthood?

Cascading Effects of the Family Check-Up on Mothers' and Fathers' Observed and Self-Reported Parenting and Young Adult Antisocial Behavior: a 12-Year Longitudinal Intervention Trial

Over a 12-year period, this study examined the effects of the Family Check-Up preventive intervention model on both observed and self-reported parenting behaviors of mothers and fathers as well as how those parenting behaviors were associated with young adult antisocial behavior. Teachers identified 641 early adolescent youth from school settings to be at elevated risk for the development of externalizing behavior and/or substance use. These youth and their families were randomly assigned to the Family Check-Up intervention model (consisting of an adaptive, multi-tiered model of support, including a school-based family resource room, the Family Check-Up, and targeted follow-up services) or a control condition. Using an intent-to-treat approach, the Family Check-Up intervention model positively impacted mothers' observed parenting approximately 5 years later in middle adolescence but was not associated with changes in fathers' observed or self-reported parenting. Mothers' observed adaptive parenting and fathers' self-reported adaptive parenting in middle adolescence were associated with lower risk for young adult antisocial behavior. The cascading effects of brief, family-focused interventions are discussed along with implications for the measurement of parenting in mothers and fathers in the context of preventive intervention trials.

Impulsivity profiles across five harmonized longitudinal childhood preventive interventions and associations with adult outcomes

This study aimed to parse between-person heterogeneity in growth of impulsivity across childhood and adolescence among participants enrolled in five childhood preventive intervention trials targeting conduct problems. In addition, we aimed to test profile membership in relation to adult psychopathologies. Measurement items representing impulsive behavior across grades 2, 4, 5, 7, 8, and 10, and aggression, substance use, suicidal ideation/attempts, and anxiety/depression in adulthood were integrated from the five trials (N = 4,975). We applied latent class growth analysis to this sample, as well as samples separated into nonintervention (n = 2,492) and intervention (n = 2,483) participants. Across all samples, profiles were characterized by high, moderate, low, and low-increasing impulsive levels. Regarding adult outcomes, in all samples, the high, moderate, and low profiles endorsed greater levels of aggression compared to the low-increasing profile. There were nuanced differences across samples and profiles on suicidal ideation/attempts and anxiety/depression. Across samples, there were no significant differences between profiles on substance use. Overall, our study helps to inform understanding of the developmental course and prognosis of impulsivity, as well as adding to collaborative efforts linking data across multiple studies to better inform understanding of developmental processes.

Intergenerational Effects of the Fast Track Intervention on Next-Generation Child Outcomes: A Preregistered Randomized Clinical Trial

OBJECTIVE

The authors sought to determine whether the Fast Track mental health intervention delivered to individuals in childhood decreased mental health problems and the need for health services among the children of these individuals.

METHODS

The authors examined whether Fast Track assignment in one generation of children (generation 2; G2) from grades 1 through 10 reduced parent-reported mental health problems and health services use in these children's children (generation 3; G3) 18 years later relative to a control group. The Fast Track intervention blended parent behavior-management training, child social-cognitive skills tutoring, home visits, and classroom social-ecology changes across grades 1-10 to ameliorate emerging conduct problems among the G2 children. For this study, 1,057 G3 children of Fast Track participants (N=581 intervention group, N=476 control group) were evaluated.

RESULTS

G3 children of G2 parents who were randomized to the Fast Track intervention group used fewer general inpatient services and fewer inpatient or outpatient mental health services compared with G3 children of G2 parents randomized to the control group. Some of these effects were mediated: randomization to Fast Track predicted fewer internalizing problems and less use of corporal punishment among G2 adults at age 25, which subsequently predicted less general inpatient service use and outpatient mental health service use among the G3 children by the time the G2 parents were 34 years old. There were no significant differences between G3 children from these two groups on the use of other health services or on mental health measures.

CONCLUSIONS

Fast Track was associated with lower use of general inpatient services and inpatient and outpatient mental health services intergenerationally, but effects on parent-reported mental health of the children were not apparent across generations. Investing in interventions for the mental health of children could reduce service use burdens across generations.

The Intergenerational Transmission of Maladaptive Parenting and its Impact on Child Mental Health: Examining Cross-Cultural Mediating Pathways and Moderating Protective Factors

Using a sample of 1338 families from 12 cultural groups in 9 nations, we examined whether retrospectively remembered Generation 1 (G1) parent rejecting behaviors were passed to Generation 2 (G2 parents), whether such intergenerational transmission led to higher Generation 3 (G3 child) externalizing and internalizing behavior at age 13, and whether such intergenerational transmission could be interrupted by parent participation in parenting programs or family income increases of > 5%. Utilizing structural equation modeling, we found that the intergenerational transmission of parent rejection that is linked with higher child externalizing and internalizing problems occurs across cultural contexts. However, the magnitude of transmission is greater in cultures with higher normative levels of parent rejection. Parenting program participation broke this intergenerational cycle in fathers from cultures high in normative parent rejection. Income increases appear to break this intergenerational cycle in mothers from most cultures, regardless of normative levels of parent rejection. These results tentatively suggest that bolstering protective factors such as parenting program participation, income supplementation, and (in cultures high in normative parent rejection) legislative changes and other population-wide positive parenting information campaigns aimed at changing cultural parenting norms may be effective in breaking intergenerational cycles of maladaptive parenting and improving child mental health across multiple generations.

Children's social emotional competence in Pakistan and Sweden: Factor structure and measurement invariance of the Social Competence Scale (teacher edition)

Introduction

Social emotional competence is fundamental to the positive development of children and youth. Accurately understanding and assessing children's social emotional competencies, using psychometrically sound instruments, are essential to global efforts to support children's social emotional learning, academic achievements, and health. This study examined the psychometric properties of a teacher-reported measure of young children's social emotional competence, the Social Competence Scale - Teacher edition (SCS-T), in two samples of children growing up with varied economic resources/conditions, cultural norms, and educational experiences, namely Pakistan (N = 396) and Sweden (N = 309).

Methods

Participants were aged 4-6 years old. The study design was cross-sectional.

Results and Discussion

Using structural equation modelling, bi-factor confirmatory factor analysis models implying shared variance, among all items and domain-specific shared variance, among the prosocial items, emotion regulation items, and academic skills items resulted in good fitting models in each respective sample. Invariance testing across samples revealed a subset of items from each factor structure with partial scalar invariance, whereby five items had equal thresholds and could be comparable across the two samples. Thus, results provided partial support for hypotheses 1, 2, and 3, in that the posited three factor model (H1) was not clearly supported and a bi-factor model evidenced the best fit, among tested models, for both samples. Further, partial scalar invariance (H3) was found for five items out of 25 items, concerning social competence and academic skills. In regards, to the posited research question, the results of Z-tests showed significant (p < 0.001) latent mean differences between the samples. Compared to the Swedish sample, the Pakistani sample was 1.80 units lower on social competence (z = -6.41, p < 0.001) and 1.86 units lower on academic skills (z = -7.87, p < 0.001). The implications of these findings in light of efforts to promote positive child development in diverse parts of the world are considered.

A defensive mindset: A pattern of social information processing that develops early and predicts life course outcomes

The hypothesis was tested that some children develop a defensive mindset that subsumes individual social information processing (SIP) steps, grows from early experiences, and guides long-term outcomes. In Study 1 (Fast Track [FT]), 463 age-5 children (45% girls; 43% Black) were first assessed in 1991 and followed through age 32 (83% retention). In Study 2 (Child Development Project [CDP]), 585 age-5 children (48% girls, 17% Black) were first assessed in 1987 and followed through age 34 (78% retention). In both studies, measures were collected of early adverse experiences, defensive mindset and SIP, and adult outcomes. Across both studies, a robust latent construct of school-age defensive mindset was validated empirically (comparative fit index = .99 in each study) and found to mediate the impact of early child abuse (38% in FT and 29% in CDP of total effect) and peer social rejection (14% in FT and 7% in CDP of total effect) on adult incarceration.

Pathways from maternal depressive symptoms to children's academic performance in adolescence: A 13-year prospective-longitudinal study

The pathways through which exposure to maternal depressive symptoms in early childhood are linked to academic performance during adolescence are poorly understood. This study tested pathways from maternal depressive symptoms (age 2–5) to adolescent academic performance (age 15) through cumulative parenting risk (age 7) and subsequent child functioning (age 10), using multi‐informant data from a prospective longitudinal community study spanning 13 years (N = 389, 47% male, 68% White). Structural equation models testing indirect effects revealed small associations between maternal depressive symptoms and increased cumulative parenting risk and poorer child functioning, and, via these pathways, with poorer academic performance. Thus, childhood exposure to maternal depressive symptoms may be associated with pathways of risk that could limit children's educational opportunities.

Promoting Voter Turnout: an Unanticipated Impact of Early-Childhood Preventive Interventions

Preventive interventions in early childhood have a range of behavioral and health effects. However, there is an emerging literature extending this work to include acts of civic engagement, such as voting. Given that America has one of the lowest and most disparate rates of voter turnout in the world-and most of the current efforts aimed at boosting voter turnout and making the electorate more representative of the general public are proximal to the voting experience-there is a need for a better understanding of the potential long-term impact of early-childhood programming on civic engagement in adulthood. This paper builds on theories of political socialization and prior research demonstrating significant impacts of the Fast Track preventive intervention on voter turnout to examine the extent to which there are positive impacts on voter participation for other evidence-based preventive interventions targeting children's social and emotional capacities. Specifically, we leveraged data from a randomized controlled trial of the classroom-centered (CC) and the family school partnership (FSP) preventive interventions delivered in first grade. We analyzed data from approximately 700 urban, predominately African American, public school students who were randomly assigned to classrooms that either implemented (1) the classroom-centered intervention (which included the good behavior game), (2) the FSP intervention, or (3) the business as usual (i.e., control group). Data from the trial were combined with archival voter data when the youth were in their early 30s. Analyses demonstrated positive impacts of the CC preventive intervention on voter turnout more than two decades after exposure to the prevention program. Taken together, these findings provide additional evidence that some of the attributes that promote active participation in democracy can be fostered in early childhood-long before most interventions that have previously tried, and often failed, to increase voter turnout.

A Cluster Randomized Trial of Promoting Alternative Thinking Strategies (PATHS®) With Swedish Preschool Children

The preschool edition of Promoting Alternative THinking Strategies (PATHS^®) is a school-based, teacher implemented universal intervention developed in the United States designed to promote social emotional competence (SEC) in children as a foundation for improved mental health. PATHS is delivered as a curriculum and it is based on theories and research regarding SEC, brain development, and optimal school environments. A majority of children in Sweden attend preschool, which is government-subsidized and follows a national curriculum focusing on both academic and social emotional learning. However, there is not so much focus on formal instruction nor manual-based lessons. The purpose of this study was to assess the short-term (pre- to post-test) effects of PATHS in the Swedish preschool setting. Using a two-wave cluster randomized trial with multi-method and informant assessment (N = 285 4 and 5-year-old Swedish children; n = 145 wait-list control; n = 140 intervention; K = 26 preschools; k = 13 intervention; k = 13 control) we assessed changes in child emotional knowledge, emotional awareness, social problem solving, prosocial play, inhibitory control, and working memory using structural equation modeling (SEM). We included schools with at least one classroom of 4–5-year-old children from three municipalities. We excluded open preschools, parent cooperative preschools, and family day homes. After random assignment, schools were informed of condition assignment. Research team members were not blind to assignment. We hypothesized that relative to children in control schools, children in intervention schools would evidence improvements in social emotional competence as well as other outcomes. Children in PATHS, relative to children in the control, evidenced improvements in working memory and prosocial play, but also showed an increase in hyperactive behaviors. Girls in PATHS, relative to girls in the control, showed improvement in emotional knowledge and reduced anxiety. These results are considered in light of efforts to promote positive development and mental health. The trial registration number at ClinicalTrials.gov is NCT04512157. Main funding was from Swedish Council for Working Life and Social Research, the Swedish Research Council, Formas, and VINNOVA (dnr: 259-2012-71).

Increasing Effectiveness of Cognitive Behavioral Therapy for Conduct Problems in Children and Adolescents: What Can We Learn from Neuroimaging Studies?

Cognitive behavioral therapy (CBT) is particularly relevant for children from 7 years on and adolescents with clinical levels of conduct problems. CBT provides these children and adolescents with anger regulation and social problem-solving skills that enable them to behave in more independent and situation appropriate ways. Typically, CBT is combined with another psychological treatment such as behavioral parent training in childhood or an intervention targeting multiple systems in adolescence. The effectiveness of CBT, however, is in the small to medium range. The aim of this review is to describe how the effectiveness of CBT may be improved by paying more attention to a series of psychological functions that have been shown to be impaired in neuroimaging studies: (1) anger recognition, (2) the ability to generate situation appropriate solutions to social problems, (3) reinforcement-based decision making, (4) response inhibition, and (5) affective empathy. It is suggested that children and adolescents first become familiar with these psychological functions during group CBT sessions. In individual sessions in which the parents (and/or child care workers in day treatment and residential treatment) and the child or adolescent participate, parents then learn to elicit, support, and reinforce their child’s use of these psychological functions in everyday life (in vivo practice). In these individual sessions, working on the psychological functions is tailored to the individual child’s characteristic impairments of these functions. CBT therapists may also share crucial social-learning topics with teachers with a view to creating learning opportunities for children and adolescents at school.

A nationwide school-based study of violence in Brazil (PeNSE, 2015)

The study aims to describe victimization for domestic violence (DV), knife-related violence (KV), firearm-related violence (FV) and sexual violence (SV). This was a nationwide Brazilian survey with school-based interviews. All 9th grade students from public and private schools in Brazil were invited to participate. The sampling process was at random and cluster-based and performed in three stages: municipalities, schools, and classrooms. Univariate, bivariate and multivariate analyses were carried out considering the sample weights. A total of 100,540 individuals were assessed and the prevalence of victimization for DV, KV, FV and SV was 14.5%, 7.9%, 5.7% and 4.0%, respectively. The DV was more frequent in the South-eastern region, FV was more frequent in the Central-Western region and the KV and SV were more frequent in the Northern region. The victimization for DV and SV was higher among the girls, while the FV and KV were greater among the boys. All forms of victimization were more frequent among public school students, among those at age 16 or older, for those whose mothers have a lower educational level and those who have used alcohol or illegal drugs.

Cumulative early childhood adversity and later antisocial behavior: The mediating role of passive avoidance

Twenty-six percent of children experience a traumatic event by the age of 4. Negative events during childhood have deleterious correlates later in life, including antisocial behavior. However, the mechanisms that play into this relation are unclear. We explored deficits in neurocognitive functioning, specifically problems in passive avoidance, a construct with elements of inhibitory control and learning as a potential acquired mediator for the pathway between cumulative early childhood adversity from birth to age 7 and later antisocial behavior through age 18, using prospective longitudinal data from 585 participants. Path analyses showed that cumulative early childhood adversity predicted impaired passive avoidance during adolescence and increased antisocial behavior during late adolescence. Furthermore, poor neurocognition, namely, passive avoidance, predicted later antisocial behavior and significantly mediated the relation between cumulative early childhood adversity and later antisocial behavior. This research has implications for understanding the development of later antisocial behavior and points to a potential target for neurocognitive intervention within the pathway from cumulative early childhood adversity to later antisocial behavior.

The Fast Track intervention's impact on behaviors of despair in adolescence and young adulthood

How to mitigate the dramatic increase in the number of self-inflicted deaths from suicide, alcohol-related liver disease, and drug overdose among young adults has become a critical public health question. A promising area of study looks at interventions designed to address risk factors for the behaviors that precede these -often denoted-"deaths of despair." This paper examines whether a childhood intervention can have persistent positive effects by reducing adolescent and young adulthood (age 25) behaviors that precede these deaths, including suicidal ideation, suicide attempts, hazardous drinking, and opioid use. These analyses test the impact and mechanisms of action of Fast Track (FT), a comprehensive childhood intervention designed to decrease aggression and delinquency in at-risk kindergarteners. We find that random assignment to FT significantly decreases the probability of exhibiting any behavior of despair in adolescence and young adulthood. In addition, the intervention decreases the probability of suicidal ideation and hazardous drinking in adolescence and young adulthood as well as opioid use in young adulthood. Additional analyses indicate that FT's improvements to children's interpersonal (e.g., prosocial behavior, authority acceptance), intrapersonal (e.g., emotional recognition and regulation, social problem solving), and academic skills in elementary and middle school partially mediate the intervention effect on adolescent and young adult behaviors of despair and self-destruction. FT's improvements to interpersonal skills emerge as the strongest indirect pathway to reduce these harmful behaviors. This study provides evidence that childhood interventions designed to improve these skills can decrease the behaviors associated with premature mortality.

Community Interventions to Promote Mental Health and Social Equity

(Reprinted with permission from Current Psychiatry Reports (2020) 21: 35).

Promoting Self-Regulation in Young Children: The Role of Parenting Interventions

Self-regulation is a foundational skill in childhood and underpins various positive and negative outcomes throughout childhood, adolescence and into adulthood. Parents and the way they parent their children play a key role in the development of young children's self-regulatory capacity. However, there is limited evidence for the effectiveness of parenting interventions on child self-regulatory outcomes. This paper provides an overview of the role of parenting in the development of child self-regulation and a summary of the evidence base for parenting interventions to promote self-regulation in children under age eight, focusing on infancy, the toddler/preschooler period, and early school-age. We conclude by examining the gaps in this field of research and providing directions for future research.

Community Interventions to Promote Mental Health and Social Equity

PURPOSE OF REVIEW

We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions.

RECENT FINDINGS

There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.

[FAST TRACK rehabilitation in patients after laparoscopic repair of hiatal hernia]

AIM

To assess an effectiveness of FAST TRACK rehabilitation in patients after laparoscopic repair of hiatal hernia.

MATERIAL AND METHODS

There were 87 patients with hiatal hernia who underwent laparoscopic Nissen-Rossetti procedure with wrapping only anterior wall of the stomach. FAST TRACK approach was applied in 49 patients, standard protocol - in 38 cases. Effectiveness of FAST TRACK rehabilitation was assessed in this report considering early postoperative morbidity, length of hospital-stay, time of postoperative intestinal paresis, complaints by GSRS questionnaire.

CONCLUSION

FAST TRACK rehabilitation is followed by reduced early postoperative morbidity, length of hospital-stay and number of postoperative complaints.

THE PERSISTENCE OF PRESCHOOL EFFECTS FROM EARLY CHILDHOOD THROUGH ADOLESCENCE

Using data from the Early Childhood Longitudinal Study Kindergarten Cohort of 1998 (n = 15,070), this study used propensity scores to examine the short- and long-term academic and psychosocial benefits of preschool education for a diverse sample of middle-class children. Compared with children who attended informal care at age 4, preschool attendees consistently performed better on achievement tests from age 5 through early adolescence, but exhibited less optimal psychosocial skills. These negative behavioral effects of preschool were concentrated among children who attended preschool for 20 or more hours per week, but otherwise, there was little evidence of heterogeneity as a function of program type or child- and family-characteristics. The long-term academic advantages of preschool were, however, largely explained by their positive effects on academic skills early in formal schooling and there was evidence for convergence in children's academic test scores, which was partially attributed to the differences in children's social skills during the early elementary school years.

Promoting Positive Youth Development Through School-Based Social and Emotional Learning Interventions: A Meta-Analysis of Follow-Up Effects

This meta-analysis reviewed 82 school-based, universal social and emotional learning (SEL) interventions involving 97,406 kindergarten to high school students (M_age  = 11.09 years; mean percent low socioeconomic status = 41.1; mean percent students of color = 45.9). Thirty-eight interventions took place outside the United States. Follow-up outcomes (collected 6 months to 18 years postintervention) demonstrate SEL's enhancement of positive youth development. Participants fared significantly better than controls in social-emotional skills, attitudes, and indicators of well-being. Benefits were similar regardless of students' race, socioeconomic background, or school location. Postintervention social-emotional skill development was the strongest predictor of well-being at follow-up. Infrequently assessed but notable outcomes (e.g., graduation and safe sexual behaviors) illustrate SEL's improvement of critical aspects of students' developmental trajectories.

More or less likely to offend? Young adults with a history of identified developmental language disorders

BACKGROUND

There is now substantial literature demonstrating that a disproportionate number of young people who come into contact with youth justice services evidence unidentified language difficulties. These young people, therefore, have received little or no professional input in this area. Conversely, there is a dearth of research pertaining to criminality outcomes among those individuals with identified developmental language disorders (DLD) who have received such interventions.

AIMS

To examine police-initiated contact and substance use outcomes of young adults with a history of identified DLD versus age-matched peers (AMP). Additionally, self-reported rule breaking behaviours and aggression are considered. We hypothesize that early identification/intervention reduces engagement with risky behaviour such as substance and alcohol use as well as offending-related behaviours.

METHODS & PROCEDURES

Adversarial police-initiated contacts were examined in 84 young adults with a history of DLD and 88 AMP. Rule-breaking and aggression were evaluated using the Achenbach Adult Self-Report for ages 18-59 years.

OUTCOMES & RESULTS

Adults with a history of DLD who received targeted intervention during their school years reported less contact with their local police service compared with AMPs at age 24. Comparable proportions of both groups reported current alcohol consumption, but group differences were found relating to alcohol use. No group differences in rule-breaking behaviours were found, but the DLD group was found to have a statistically significant higher raw score on the aggressive behaviour scale.

CONCLUSIONS & IMPLICATIONS

There is a need for early identification of children with DLD. Early intervention aimed at ameliorating such difficulties could possibly have distal outcomes in relation to offending.

Developmental Origins of Chronic Physical Aggression: A Bio-Psycho-Social Model for the Next Generation of Preventive Interventions

This review describes a bio-psycho-social approach to understanding and preventing the development of chronic physical aggression. The debate on the developmental origins of aggression has historically opposed genetic and environmental mechanisms. Recent studies have shown that the frequency of physical aggression peaks in early childhood and then decreases until old age. Molecular genetic studies and twin studies have confirmed important genetic influences. However, recent epigenetic studies have highlighted the important role of environments in gene expression and brain development. These studies suggest that interrelated bio-psycho-social channels involved in the development of chronic physical aggression are generally the product of an intergenerational transmission process occurring through assortative mating, genetic inheritance, and the inheritance of physical and social environmental conditions that handicap brain functioning and support the use of physical aggression to solve problems. Given these intergenerational mechanisms and physical aggression onset in infancy, it appears clear that preventive interventions should start early in pregnancy, at the latest.

Differential Third-Grade Outcomes Associated With Attending Publicly Funded Preschool Programs for Low-Income Latino Children

This study examined the third-grade outcomes of 11,902 low-income Latino children who experienced public school pre-K or child care via subsidies (center-based care) at age 4 in Miami-Dade County, Florida. Regression and propensity score analyses revealed that children who experienced public school pre-K earned higher scores on standardized assessments of math and reading in third grade and had higher grade point averages than those who attended center-based care 4 years earlier. The sustained associations between public school pre-K (vs. center-based care) and third-grade outcomes were mediated by children's kindergarten entry preacademic and social-behavioral skills, and among English-language learners, English proficiency. Implications for investing in early childhood programs to assist with the school readiness of young Latino children in poverty are discussed.