Nicole P. Powell

Cognitive-Behavioral Therapy for Externalizing Disorders in Children and Adolescents

This article focuses on the use of cognitive-behavioral therapy (CBT) strategies for children and adolescents with externalizing disorders. Following a description of risk factors for youth antisocial behavior, several components common to CBT interventions for youth with externalizing behaviors will be described. Using the Coping Power Program as a model, child treatment components including Emotion Awareness, Perspective Taking, Anger Management, Social Problem Solving, and Goal Setting will be reviewed. CBT strategies for parents of youth with disruptive behaviors will also be described. Finally, the article summarizes the evidence for the effectiveness of CBT strategies for externalizing disorders and presents specific outcome research on several programs that include CBT techniques.

Does a Booster Intervention Augment the Preventive Effects of an Abbreviated Version of the Coping Power Program for Aggressive Children

Booster interventions have been presumed to be important methods for maintaining the effects of evidence-based programs for children with behavioral problems, but there has been remarkably little empirical attention to this assumption. The present study examines the effect of a child-oriented booster preventive intervention with children who had previously received an abbreviated version (24 child sessions, 10 parent sessions) of the Coping Power targeted prevention program. Two hundred and forty-one children (152 boys, 89 girls) were screened as having moderate to high levels of aggressive behavior in 4th grade, then half were randomly assigned to receive the abbreviated Coping Power program in 5th grade, and half of the preventive intervention children were then randomly assigned to a Booster condition in 6th grade. The Booster sessions consisted of brief monthly individual contacts, and were primarily with the children. Five assessments across 4xa0years were collected from teachers, providing a three-year follow-up for all children who participated in the project. Results indicated that the abbreviated Coping Power program (one-third shorter than the full intervention) had long-term effects in reducing children’s externalizing problem behaviors, proactive and reactive aggression, impulsivity traits and callous-unemotional traits. The Booster intervention did not augment these prevention effects. These findings indicate that a briefer and more readily disseminated form of an evidence-based targeted preventive intervention was effective. The findings have potential implications for policy and guidelines about possible intervention length and booster interventions.

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

OBJECTIVEnSome 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.nnnMETHODnThree 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.nnnRESULTSnGrowth 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.nnnCONCLUSIONSnThis 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.

Integrating the Family Check-Up and the parent Coping Power program

Engaging families in school-based preventive interventions for aggressive youth can be especially challenging. The current article describes an integration of a parent engagement model, called the Family Check-Up, with an evidence-based intervention for youth with aggressive behaviours called Coping Power. The overall goal of the integration was to increase parental involvement and exposure to the core elements of the Coping Power programme to optimize impact on families and their children. We describe both models, summarize evidence of their efficacy when implemented alone, and provide a rationale for their integration. We also provide case examples to illustrate the implementation of the integrated programme in schools as well as feasibility data to support its continued study and implementation.

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.

Counselor-Level Predictors of Sustained Use of an Indicated Preventive Intervention for Aggressive Children

Despite widespread concern about the frequent failure of trained prevention staff to continue to use evidence-based programs following periods of intensive training, little research has addressed the characteristics and experiences of counselors that might predict their sustained use of a program. The current study follows a sample of school counselors who were trained to use an indicated preventive intervention, the Coping Power program, in an earlier dissemination study, and determines their levels of continued use of the program’s child and parent components in the 2xa0years following the counselors’ intensive training in the program. Counselor characteristics and experiences were also examined as predictors of their sustained use of the program components. The Coping Power program addresses children’s emotional regulation, social cognitive processes, and increases in positive interpersonal behaviors with at-risk children who have been screened to have moderate to high levels of aggressive behavior. The results indicated that counselors’ perceptions of interpersonal support from teachers within their schools, their perceptions of the effectiveness of the program, and their expectations for using the program were all predictive of program use over the following 2xa0years. In addition, certain counselor personality characteristics (i.e., conscientiousness) and the level of actual teacher-rated behavior change experienced by the children they worked with during training were predictors of counselors’ use of the program during the second year after training. These results indicate the central importance of teacher support and of child progress during training in the prediction of counselors’ sustained use of a prevention program.

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.