Lixin Qu

Evidence-based preventive intervention for preadolescent aggressive children: One-year outcomes following randomization to group versus individual delivery.

OBJECTIVE Some research suggests that group interventions with antisocial youth may, on occasion, have iatrogenic effects. This is the first study to test the effects of group versus individual delivery of evidence-based intervention for aggressive children. METHOD Three hundred sixty fourth-grade children were randomly assigned by school to group coping power (GCP) or individual coping power (ICP). Longitudinal assessments of teacher and parent reports of behavior (Behavior Assessment System for Children [BASC]; Peer Affiliation and Social Acceptance [PASA]) were collected from baseline through a 1-year follow-up. RESULTS Growth curve analyses revealed that children in both conditions reduced teacher- and parent-reported externalizing behavior problems and internalizing behavior problems by the end of the 1-year follow-up. However, the degree of improvement in teacher-reported outcomes was significantly greater for children receiving an individual version of the program. In addition, childrens baseline level of inhibitory control moderated intervention effects, showing children with low initial levels of inhibitory control to respond poorly in teacher-rated outcomes to group interventions compared to those delivered individually. CONCLUSIONS This study suggests overall benefits to children for either group or individual delivery of the Coping Power program under high-fidelity conditions; however, for children with low levels of initial self-regulation, individualized interventions will likely yield the most significant reduction in externalizing behavior in the school setting in preadolescence.

Coping Power Dissemination Study: Intervention and Special Education Effects on Academic Outcomes.

This study examines whether a school-based preventive intervention for children with aggressive behavior affects childrens academic outcomes when it is implemented by school counselors in a dissemination field trial. The Coping Power program targets empirical risk factors for aggressive behavior and focuses primarily on teaching social and emotional skills rather than directly intervening around academic performance. This study examined the long-term effects (2 years postintervention) of Coping Power on language arts and mathematics grades in 531 children from 57 schools. Prior analyses found that students of counselors who received intensive training in how to implement Coping Power (CP-IT) had broad improvements in teacher-rated social and academic skills and in teacher-, parent-, and self-reported externalizing behavior problems in comparison to children in a control group and to children whose counselor received more basic training in Coping Power (Lochman et al., 2009). In the present study, students with CP-IT counselors had smaller declines in language arts grades through a 2-year follow-up than children in the control group. Significant effects of CP-IT on mathematics grades were not observed. Special education status did not moderate intervention effects, indicating that special education students’ academic outcomes were affected in similar ways by the intervention in comparison with students not in special education. Intervention effects were not evident for children who had basic-trained counselors. These findings have implications for educational policy and underscore the potential for school-based social-emotional interventions such as Coping Power to have a long-term impact on childrens academic outcomes.

Internalizing problems as a predictor of change in externalizing problems in at-risk youth

Intervention and prevention programs for children with externalizing problems frequently involve children with co-occurring internalizing problems. Little is known about how these co-occurring internalizing problems predict outcomes, particularly for programs involving cognitive-behavioral strategies. The current study examined how a set of child-related risk factors (including anxiety and depressive symptoms) predicted change in parent- and teacher-reported externalizing problems following a school-based preventative intervention for children at risk for externalizing problems. Participants included 112 preadolescent children (ages 9–12) who participated in a study designed to evaluate the efficacy of the Coping Power Program (Lochman & Wells, 2004). Participants included 81 boys (68%) who were primarily African American (69%) or Caucasian (30%). Regression analyses were conducted to examine predictors of change in parent- and teacher-reported externalizing problems on the Behavior Assessment System for Children (Reynolds & Kamphaus, 1992). Results indicated that greater child depression symptoms (as reported by parent or teacher) were associated with a larger reduction in externalizing behavior problems based on parent or teacher report. This effect was found in both the parent and teacher models and held after controlling for a number of child-oriented baseline variables including baseline aggression. Future research studies should examine whether co-occurring symptoms of depression relate to enhanced changes in externalizing problems following intervention for externalizing problems, particularly when cognitive-behavioral interventions are utilized. In addition, it will be important for studies to examine such effects relative to a control group and/or alternative treatment conditions and to further explore possible mechanisms of change.

Variation in Response to Evidence-Based Group Preventive Intervention for Disruptive Behavior Problems: A View from 938 Coping Power Sessions

Prior research suggests that under some conditions, interventions that aggregate high-risk youth may be less effective, or at worse, iatrogenic. However, group formats have considerable practical utility for delivery of preventive interventions, and thus it is crucial to understand child and therapist factors that predict which aggressive children can profit from group intervention and which do not. To address these questions we video-recorded group Coping Power intervention sessions (938 sessions), coded both leader and participant behavior, and analyzed both leader and children’s behaviors in the sessions that predicted changes in teacher and parent, reports of problem behavior at 1-year follow up. The sample included 180 high-risk children (69% male) who received intervention in 30 separate Coping Power intervention groups (six children assigned per group). The evidence-based Coping Power prevention program consists of 32 sessions delivered during the 4th and 5th grade years; only the child component was used in this study. The behavioral coding system used in the analyses included two clusters of behaviors for children (positive; negative) and two for the primary group leaders (group management; clinical skills). Growth spline models suggest that high levels of children’s negative behaviors predicted increases in teacher and parent rated aggressive and conduct problem behaviors during the follow-up period in the three of the four models. Therapist use of clinical skills (e.g., warmth, nonreactive) predicted less increase in children’s teacher-rated conduct problems. These findings suggest the importance of clinical training in the effective delivery of evidence-based practices, particularly when working with high-risk youth in groups.

Oxytocin Receptor Gene Variant Interacts with Intervention Delivery Format in Predicting Intervention Outcomes for Youth with Conduct Problems

Coping Power is an evidence-based preventive intervention program for youth with aggressive behavior problems that has traditionally been delivered in small group formats. Because of concerns about iatrogenic effects secondary to aggregation of high risk youth, the current study examined whether genetic risk may moderate intervention outcome when youth were randomly assigned to group versus individual formats of an intervention. The oxytocin receptor gene (OXTR) has been associated with social behavior and may influence susceptibility to social reinforcement in general and deviant peer influence in particular. One variant of OXTR (rs2268493) was examined in 197 fourth-grade African-American children (64% male) who were randomly assigned to Group Coping Power or Individual Coping Power (Lochman et al. 2015). Longitudinal assessments of teacher- and parent-reported behavior were collected through a 1-year follow-up. Growth curve analyses revealed a genotype by delivery format interaction. Youth with the A/A genotype demonstrated reductions in externalizing problems over the course of the intervention regardless of intervention format. In contrast, carriers of the G allele receiving the group-based intervention showed little improvement during the intervention and a worsening of symptoms during the follow-up year, while those receiving the individual format demonstrated reductions in externalizing problems. Given the associations between this OXTR variant and social bonding, carriers of the G allele may be more sensitive to social rewards from deviant peers in the group setting. This study suggests that genetic factors may be useful in predicting which type of intervention will be most effective for a particular individual.

Toward Tailored Interventions: Sympathetic and Parasympathetic Functioning Predicts Responses to an Intervention for Conduct Problems Delivered in Two Formats

Coping Power is an evidence-based preventive intervention for youth with aggressive behavior problems that has traditionally been delivered in small group formats, but because of concerns about potentially diminished effects secondary to aggregation of high-risk youth, an individual format of Coping Power has been developed. The current study examined whether physiological characteristics of the child may provide information about which intervention delivery format works best for that individual. Indicators of sympathetic and parasympathetic nervous system functioning were examined in 360 fourth-grade children (65% male; 76.4% self-reported African-American) who were randomly assigned to Group Coping Power (GCP) or Individual Coping Power (ICP) (Lochman et al. 2015). Longitudinal assessments of teacher- and parent-reported proactive and reactive aggression were collected through a 1-year follow-up. For children with higher initial levels of aggression, those with lower parasympathetic functioning at pre-intervention showed greater reductions in teacher-rated proactive aggression in the ICP condition than the GCP condition. For children with high parasympathetic functioning, there was no differential effect of intervention format. Regardless of intervention format, youth with lower levels of sympathetic functioning at pre-intervention demonstrated greater reductions in teacher-rated proactive aggression. These findings suggest that physiological indicators may be worth considering in future studies examining which youth respond best to specific types of interventions.

Pre–Post Tornado Effects on Aggressive Children’s Psychological and Behavioral Adjustment Through One-Year Postdisaster

Using a risk-resilience framework, this study examined how varying levels of exposure to a natural disaster (EF-4 tornado) and children’s characteristics (sex; anxiety) influenced the behavioral and psychological adjustment of children who shared a common risk factor predisaster (elevated aggression) prior to exposure through 1-year postdisaster. Participants included 360 children in Grades 4–6 (65% male; 78% African American) and their parents from predominantly low-income households who were already participating in a longitudinal study of indicated prevention effects for externalizing outcomes when the tornado occurred in 2011. Fourth-grade children who were screened for overt aggressive behavior were recruited in 3 annual cohorts (120 per year, beginning in 2009). Parent-rated aggression and internalizing problems were assessed prior to the tornado (Wave 1), within a half-year after the tornado (Wave 2), and at a 1-year follow-up (Wave 3). Children and parents rated their exposure to aspects of tornado-related traumatic experiences at Wave 3. Children displayed less reduction on aggression and internalizing problems if the children had experienced distress after the tornado or fears for their life, in combination with their pre-tornado level of anxiety. Higher levels of children’s and parents’ exposure to the tornado interacted with children’s lower baseline child anxiety to predict less reduction in aggression and internalizing problems 1 year after the tornado. Higher levels of disaster exposure negatively affected at-risk children’s level of improvement in aggression and internalizing problems, when life threat (parent- and child-reported) and child-reported distress after the tornado were moderated by baseline anxiety.