2016 CHILDREN'S MENTAL HEALTH REPORT
Prevention and Early Intervention
Intervening early in school helps prevent behavioral issues from developing into problems that lead to suspension, expulsion and dropping out. Enlisting parents and teachers can make these interventions more effective—and prevention approaches can be effective at various developmental stages, as indicated below.
Infancy and Early Childhood
The Incredible Years is a widely disseminated program engaging teachers, parents and children to reduce disruptive behavior disorders, violence and delinquency. It has been used with general populations and adapted for children with early onset conduct problems and other risk factors, including socioeconomic status and other mental health disorders. The program is designed to train parents and teachers to help children from birth through school age.
Studies show robust positive effects of the intervention for decreasing disruptive behavior and increasing prosocial behavior. A meta-analysis of research studies reported a 15.5% improvement across domains of behavior³¹ for children whose families and school communities participated in the Incredible Years prevention program.
Teacher-Child Interaction Training (TCIT) is a classroom intervention for children aged 3-7, based on an individualized treatment for disruptive behavior and family conflict called Parent-Child Interaction Therapy (PCIT).
One study showed that after teacher training and coaching, positive teacher behavior improved more than 100%, from 9% of interactions to 20% of interactions. Focused positive encouragement — “labeled praise” — increased fivefold.³²
Another study showed significant improvement in ratings of resilience and behavioral control.³³
One assumption behind TCIT is that by improving the classroom environment, teachers will have more time and attention for teaching and encouraging each child, and young students will experience more of the benefits of focused early education and fewer of the distractions and ill effects of problematic behavior and disruption.
The Good Behavior Game (GBG) is a classroom-based behavioral management program shown to have long-lasting effects in preventing later poor outcomes. In a study, first and second graders in GBG classrooms were divided into teams that “compete” for rewards by adhering to teacher-defined rules for behavior. All teams can win by keeping the number of infractions down. The goal of the intervention is to encourage a positive learning environment and healthy social communication. ³⁴
GBG is effective in reducing problem behaviors in the classroom, and it also has significant effects many years later. A follow-up study of children in GBG classrooms when they reached the age of 19-21 found significantly lower rates of drug and alcohol use disorders, regular smoking, antisocial personality disorder, delinquency and incarceration for violent crimes and suicide thoughts.
Young adult outcomes for children in the GBG group showed a 50% reduction in risk of drug abuse or dependence; a 35% risk reduction for alcohol abuse or dependence; a 59% decreased risk for regular smoking; and a 32% reduction in risk of developing antisocial personality disorder.³⁵
Middle Childhood and Early Adolescence
Daily Report Card (DRC) is another evidence-based behavior modification program developed for children with disruptive behavior disorders including ADHD. The DRC intervention works as a collaboration between school and home, and is constructed to address and reward progress related to problem behaviors identified in a child’s individualized education plan (IEP). Each DRC intervention is unique to the child and to the relationship between child, teacher and parents.
One study showed that children aged 6-12 with ADHD participating in the DRC intervention were:
- Twice as likely to be rated as unimpaired at the end of the study when compared to the control group.³⁶
³¹ Menting, A.T.A., de Castro, B.O., Matthys, W. (2013). Effectiveness of the Incredible Years parent training to modify disruptive and prosocial child behavior. Clinical Psychology Review. 33(8): 901-913. doi:10.1016/j.cpr.2013.07.006
³² Lyon, A.R., Gershenson, R.A., Farahman, F.K., Thaxter, P.J., Behling, S., Budd, K.S. (2009). Effectiveness of Teacher-Child Interaction Training (TCIT) in preschool setting. Behavior Modification. 33(6): 855-884. doi: 10.1177/0145445509344215
³³ Budd, K.S., Garbacz, L.L., Carter, J.S. (2015). Collaborating with public school partners to implement Teacher-Child Interaction Training (TCIT) as universal prevention. School Mental Health. doi: 10.1007/s12310.015.9158-8
³⁴ Kellam, S. G., Mackenzie, A. C. L., Brown, C. H., Poduska, J. M., Wang, W., Petras, H., & Wilcox, H. C. (2011). The Good Behavior Game and the Future of Prevention and Treatment. Addiction Science & Clinical Practice, 6(1), 73–84
³⁵ Kellam, S. G., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., Toyinbo, P., … Wilcox, H. C. (2008). Effects of a Universal Classroom Behavior Management Program in First and Second Grades on Young Adult Behavioral, Psychiatric, and Social Outcomes. Drug and Alcohol Dependence, 95(Suppl 1), S5–S28. doi: 10.1016/j.drugalcdep.2008.01.004
³⁶ Fabiano, G.A., Vujnovic, R.K., Pelham, W.E., Waschbusch, D.A., Massetti, G.M., Pariseau, M.E., Naylor, J., Yu, J., Robins, M., Carnefix, T., Greiner, A.R., Volker, M. (2010). Enhancing the effectiveness of special education programming for children with attention-deficit hyperactivity disorder using a Daily Report Card. School Psychology Review. 39(2): 219-239