Early Intervention for At-Risk Youth Has Benefits Into Adulthood

There is solid evidence that children who display chronic conduct problems such as aggressive, disruptive, or antisocial behavior are at high risk to carry these issues into adulthood. There is no consensus, however, on how best to respond to these at-risk children. Early-intervention programs to foster proper social behavior in young children have shown some short-term benefits, but none yet have reported long-lasting effects.

The Fast Track program, about which there have been previously published findings showing that early intervention starting in kindergarten improves behaviors in both elementary and high school students, has now released its latest results showing that getting an early start on prevention can reduce problem behaviors in adults.

Compared with 25-year-olds who had been identified as problem children but received no special interventions, 25-year-olds who had been a part of Fast Track had a 10 percent lower prevalence of psychiatric problems (59 percent vs. 69 percent). Fast Track participants also had fewer convictions for violent or drug-related crimes.

“Early-starter children are at high risk for problems that will cost themselves and society a tremendous amount of pain,” said Kenneth Dodge, Ph.D., director of the Center for Child and Family Policy at Duke University, one of the four sites participating in Fast Track. “These findings demonstrate for the first time that we can successfully reduce the rates of problem outcomes for this risk group, even years after we’ve last seen them.”

Dodge added that Fast Track was not all about reducing the negative. “We saw positive improvements as well in the happiness and overall well-being of these children.”

The findings were published September 15 in AJP in Advance.

Fast Track began in 1991 and over the next three years enrolled about 900 kindergarteners identified with conduct problems from four communities: Durham, N.C.; Nashville; Seattle; and rural Pennsylvania. The children were then divided into two groups, with half receiving the Fast Track intervention while the others served as a control group that received standard interventions available in their community.

The Fast Track enrollees then began a 10-year program aimed at instilling them with social competencies that would carry throughout their lifetimes. Fast Track took an all-inclusive approach, addressing multiple components of antisocial development and involving both the children and their families for the whole program.

Dodge admitted it was not the most efficient method of designing a program, but as he stated, “Our goal, first and foremost, was to demonstrate that early intervention works.”

The approach appeared to pay off; participants showed improvements in a diverse range of internal, external, and substance use problems, including significant decreases in antisocial or avoidant personality disorder, attention-deficit/hyperactivity disorder, binge drinking, serious drug use, and risky sexual behaviors.

Improvements were also consistent among all 13 subgroups within the larger cohort (males and females, African Americans and those of European descent, high- and moderate-risk category, each of the four study sites, and each of the three enrolled years).

“We view Fast Track as more of a prototype than a model,” Dodge said. “We hope that future research and development will continue to refine the program and hone in on the elements that work best for particular groups.” In the meantime, Fast Track is soldiering on, with the first enrollees now approaching their 30th birthdays and researchers hope that more positive data are on the horizon.

As with other prototypes, cost will be an issue for any wide implementation, though Dodge noted that their comprehensive program cost only around $58,000 per child for the 10 years. “It may seem like a lot at first, but that is less expensive than sending a child to special education for 10 years, and certainly much cheaper than sending an adult to prison.”

The Fast Track project is run by the Conduct Problems Prevention Research Group and is supported by grants from the National Institute of Mental Health, National Institute on Drug Abuse, and Department of Education. ■