John E. Lochman - US grants

This study will examine the longer term preventive effects of a school-based intervention with three cohorts of boys referred by classroom teachers as highly aggressive and disruptive. Aggressive boys have been identified as being at significant risk for later mental health, alcohol and drug problems. The preventive intervention used cognitive behavioral and social problem solving techniques, and was based on a model of anger arousal which focussed on cognitive deficits identified in prior research. Immediate effects of these groups have been analyzed, and an initial date base exists for these subjects. Behavioral changes have been produced in the classroom and at home after the intervention and at a seven month follow-up. The proposed study will generate additional outcome data on these subjects, and three groups of subjects will be contrasted. Over a two year period, boys who have received an Anger Coping intervention will be compared, to other aggressive boys who were either untreated or who received a minimal treatment condition, and to a group of boys who had at least average social status and were not perceived as aggressive by their peers. The subjects will be assessed two to three years after the end of the intervention while most of the boys are in junior high school. Data to be collected will include questionnaires completed by subjects and their parents, problem behavior checklists completed by parents and teachers, independent classroom behavior observations, sociometric ratings and a self esteem measure. The questionnaire will be administered during structured interviews, and will assess alcohol and drug use, general behavioral deviance, and will yield a multi-problem behavior index score. A psychiatric diagnosis will be made, based on the interview and other measures. Subsequent analyses will compare conditions which have received different variations of the Anger Coping intervention. In addition, this study will examine which subject characteristics and mediating factors predict subsequent behavioral changes, and alcohol, drug and mental health difficulties. Prior research has explored subject characteristics predictive of change immediately after the intervention.

This study will examine the longer term preventive effects of a school-based intervention with three cohorts of boys referred by classroom teachers as highly aggressive and disruptive. Aggressive boys have been identified as being at significant risk for later mental health, alcohol and drug problems. The preventive intervention used cognitive behavioral and social problem solving techniques, and was based on a model of anger arousal which focussed on cognitive deficits identified in prior research. Immediate effects of these groups have been analyzed, and an initial date base exists for these subjects. Behavioral changes have been produced in the classroom and at home after the intervention and at a seven month follow-up. The proposed study will generate additional outcome data on these subjects, and three groups of subjects will be contrasted. Over a two year period, boys who have received an Anger Coping intervention will be compared, to other aggressive boys who were either untreated or who received a minimal treatment condition, and to a group of boys who had at least average social status and were not perceived as aggressive by their peers. The subjects will be assessed two to three years after the end of the intervention while most of the boys are in junior high school. Data to be collected will include questionnaires completed by subjects and their parents, problem behavior checklists completed by parents and teachers, independent classroom behavior observations, sociometric ratings and a self esteem measure. The questionnaire will be administered during structured interviews, and will assess alcohol and drug use, general behavioral deviance, and will yield a multi-problem behavior index score. A psychiatric diagnosis will be made, based on the interview and other measures. Subsequent analyses will compare conditions which have received different variations of the Anger Coping intervention. In addition, this study will examine which subject characteristics and mediating factors predict subsequent behavioral changes, and alcohol, drug and mental health difficulties. Prior research has explored subject characteristics predictive of change immediately after the intervention.

This study of secondary prevention of drug abuse will examine the effectiveness of cognitive behavioral intervention (CBI), and a combination intervention using both CBI and Behavioral Parent Intervention (BPI)with high risk aggressive, preadolescent boys. A multiple-gating procedure will be used to identify 4th and 5th grade boys rated by both teachers & parents as having a relatively high number of aggressive behaviors. The two annual cohorts of aggressive boys will be randomly assigned to one of three conditions; cognitive behavioral intervention (CBI), combined cognitive behavioral intervention and behavioral parent intervention (CBI + BPI), and an untreated aggressive comparison group(UA). These three conditions will be compared to a nonaggressive comparison group (Comp) to determine if the identified aggressive boys move within normal ranges of dependent measures. The design will permit two follow-up assessments during the first two years after the treatment period. The CBI and BPI are derived from previous prevention and intervention research. Both of these interventions are based on models of how moderating variables (children's social cognitive processes; family interactional behavior) affect children's behaviors. The CBI is a school-based intervention that includes 46 weeks of group & individual sessions over a 1 year period. The BPI consists of an initial intensive treatment period ranging from 10 to 16 consecutive weekly sessions, followed by an open-ended follow-up behavioral assessment, and children's reports of self-esteem. The longitudinal design will asses the secondary prevention effects of the interventions. Since childhood aggression has been identified as a risk marker for later drug use, successfully treated aggressive boys should also display a lower incidence of drug use at the follow-up periods. In addition, the direct effects of interventions on boys' drug use and behavioral changes will be determined. Finally, the relationship between boys' behavior change and boys' initial levels of social cognitive processes and family moderating variables will be examined, and the relationship between changes over time on these sets of variables will be assessed. These analyses will further understanding of child and family characteristics which predict drug use and prevention outcomes, and will permit testing of the relationship between the models of moderating variables, boys' behavior, and boys' drug use.

human therapy evaluation; substance abuse related disorder; male; aggression; drug abuse prevention; middle childhood (6-11); behavior modification; high risk behavior /lifestyle; family therapy; parents; child behavior; prognosis; child rearing; cognition; social behavior; longitudinal human study; behavioral /social science research tag; clinical research; human subject;

DESCRIPTION (provided by applicant): This field trial will examine whether the Coping Power prevention program, which has been demonstrated to have preventive effects on youths' substance use and delinquency in prior efficacy and effectiveness studies, can be usefully taken "to scale" and delivered in an effective manner by existing staff in a range of urban school sites. This study will have substantial policy implications for implementation of prevention programs in real-world settings. The Coping Power program is based on a contextual social-cognitive developmental model, and is designed to be provided to preadolescent children who are at risk for later substance use because of their high levels of aggressive behaviors. The multi-component program impacts mediating processes in the child (social cognitive and self-regulation processes) and family (parenting practices), while working closely with classroom teachers. The Child Component of the Coping Power program is directly derived from an Anger Coping program, which has itself been shown to prevent high levels of adolescent substance use. In this planned field study, existing school staff (school counselors, school psychologists, school social workers, school resource officers) will be trained to use the Coping Power program with high-risk children at the time of transition to middle school in the 5th and 6th grades. This innovative field study will address three primary gaps in the literature: (a) whether this type of prevention program can be taken "to scale" and produce positive substance use outcomes, good intervention integrity, and sustained use in the years following training; (b) whether the intensity level of training (Coping Power - Intensive Training: CP-IT; versus Coping Power - Basic Training: CP - BT) will impact the intervention outcomes, intervention integrity, and sustained intervention use; and (c) whether organizational and student population characteristics of the schools, and characteristics of the school site staff who will implement the intervention, will impact intervention outcomes, intervention integrity, and sustained intervention use. To address these gaps, this field trial will randomly assign 60 elementary schools to one of three conditions: CP-IT, CP-BT, or Control. Ten children in each school will be screened as being at-risk because of 4th grade teachers' ratings of students' aggressive behaviors, resulting in a total sample of 600 target children (20 schools and 200 children per condition).

DESCRIPTION (provided by applicant): Meta-analyses suggest that aggregating children with externalizing behavior problems into groups has the potential of reducing the effectiveness of preventive interventions (Lipsey, 2006). There are two major gaps in the literature that limit our understanding of this phenomenon. First, intervention content is often confounded with the intervention format, so it is difficult to clearly disentangle the two issues about intervention effects. Few studies have randomly assigned children to a single intervention delivered in either group vs individual format. Second, rarely do intervention studies carefully study individual responses to an intervention vis a vis direct observation of group sessions, to identifiy specific processes and events that may enhance or detract from the intervention's effectiveness (Dishion &Dodge, 2006). This research proposes to do both within the context of a randomized trial. This research will be most productive if it can test variations in format for an intervention that has already established an evidence base and has the potential for wide dissemination. The current application will use the child component of the Coping Power program, based on a contextual social- cognitive model, as the focal intervention. The Coping Power prevention program has been demonstrated to have preventive effects on youths'aggression, delinquency and substance use in prior efficacy and effectiveness (Lochman &Wells, 2002a, 2002b, 2003, 2004) studies. The planned study will randomly assign aggressive children to one of two versions of the Coping Power child component. The Coping Power child component will either be delivered in the usual small group format (Group Coping Power: GCP) or in a newly-developed individual format (Individual Coping Power: ICP). It is hypothesized that ICP will produce greater reductions in substance use, children's externalizing behavior problems and delinquency at a one-year follow-up assessment, in comparison to GCP. This study will also determine whether children's characteristics (e.g., effortful control;outcome expectations;severity of aggression;callous-unemotional traits;impulsive decision-making;peer rejection and victimization;demographic variables) and group leaders'behaviors will influence children's susceptibility to deviant peer effects in groups in the GCP condition (based on coding of videotaped group sessons and leader ratings), and weaken the intervention's effects on substance use, delinquency and externalizing behavior problems. PUBLIC HEALTH RELEVANCE: A significant central public health issue involves the provision of evidence-based preventive interventions to reduce youth substance abuse and violence. Within the youth prevention field, a critical concern has arisen that working with at-risk antisocial children in group formats has the potential for deviant peer effects, whereby children escalate or maintain their behavior problems, rather than reducing them. This application offers an innovative opportunity to empirically examine conditions under which deviant peer processes are promoted or prevented during the course of intervention in a randomized trial, and will be the first study to directly compare the effects of group versus individual administration of the same evidence-based preventive intervention on long-term youth outcomes.

DESCRIPTION (provided by applicant): This proposal will develop and test the feasibility of a hybrid internet-enhanced version of the Coping Power program for aggressive 5th grade children who are at risk for substance use. Coping Power is a preventive intervention with demonstrated efficacy and effectiveness for preadolescent children at-risk for substance abuse and delinquency. Despite its demonstrated preventive effects, the length of time required to implement Coping Power and similar evidence-based prevention programs has been identified as a barrier to providers' adoption of such programs and parents' attendance and engagement. To address this barrier, this application will develop a hybrid version of Coping Power which will permit it to be delivered more efficiently, with substantially fewer face-to-face sessions, while retaining all of the core content (Coping Power-Internet Enhanced; CP-IE). This innovative, targeted prevention approach will include 12 child sessions held every other week over a 6 month period, 7 parent sessions, and internet-delivered media components, which participants will access between in-person sessions. The use of internet-delivered media to augment the intervention is expected to further enhance children's and parents' interest in and retention of intervention- related content. This is consistent with empirical evidence that individuals pay more attention to and learn more deeply from multimedia presentations than from verbal-only messages, resulting in greater problem-solving transfer, as described in Kennedy's cognitive interaction model of multimedia interactivity research. This proposal will allow CP-IE to be developed and pilot-tested. Then, 96 at-risk, aggressive 5th grade students from 8 schools will be randomly assigned to participate in CP-IE or Care-as-Usual, using a matched pairs sampling design. CP-IE participants will access internet-delivered intervention content between in-person sessions, including animated videos that were developed to model key Coping Power topics. The primary aims of this proposal are to: 1) Develop an efficient, internet-augmented hybrid version of the Coping Power program for children who are at-risk for substance abuse and their parents; 2) Assess the feasibility of the CP-IE program in retaining participants, and in determining if children and families view a high rate of the CP-IE internet- delivered content; 3) Assess the acceptability of the CP-IE program, as indicated by child, parent and school counselor ratings, and ability to deliver CP-IE with high intervention integrity and implementation quality; 4) Assess if CP-IE promotes a high level of participant motivation in the program, comprehension and retention of intervention content, and change in children's social cognition, self-regulation, and social competence abilities and in parents' parenting practices; and 5) Use the planned feasibility study as a basis for a large-scale randomized trial of CP-IE. Preliminary outcome effects of CP-IE within the feasibility study will also be explored. If its feasibility and subsequent efficacy are documented, the hybrid CP-IE program can be disseminated much more widely, and thus have broad public health significance in substance use prevention.

DESCRIPTION (provided by applicant): This study will examine the effects of a tornado-related natural disaster on children and parents participating in an ongoing substance use prevention trial and will allow a unique opportunity to examine changes in children's and parents' predisaster and postdisaster functioning on a comprehensive range of biopsychic- social indicators and on substance abuse and mental health service use in an already at-risk sample. Research on the service use, substance use, behavioral and emotional effects of natural disasters on children and their caretakers has received limited empirical attention, even though such disasters have considerable public health significance due to increases in disordered emotional and behavioral functioning and service use demands. Existing studies of the aftereffects of natural disasters on children are limited by not knowing how much the disaster changed the children's predisaster functioning. This will be the first disaster study that includes extensive data on children's behavioral, emotional, (teacher, parent, peer, and self reports), social (children's peer relations based on peer, teacher and self report) and psycho- physiological (skin conductance, heart rate, respiratory sinus arrhythmia) functioning both before and after disaster exposure. Another important innovation of the proposed study is that it will follow a sample of preadolescent children identified as being at-risk prior to the disaster. Thus, the sample is likely to be more heavily influenced by the disaster (Kaminer et al., 2005; Resnick, 1995; Weems et al., 2010), because the tornado that devastated the study area adds another set of risk factors to already vulnerable children. The specific aims of the project are: 1 To explore changes in functioning pre-to-post tornado in children (emotional, behavioral, social, academic, and autonomic nervous system functioning and substance use) and primary caretakers (emotional functioning and parenting practices); 2) To explore moderation of changes in child and caretaker functioning pre-to-post tornado by degree of tornado exposure, by pre- tornado child (sex, ethnicity, temperamental anxiety) and family (socioeconomic status, post-tornado negative life events, levels of family social support, parenting practices) characteristics and by gene-by- environment (degree of exposure to the tornado) effects; 3) To explore moderation of post-tornado rates of substance abuse, mental health service use and diagnostic outcomes by degree of tornado exposure and pre-tornado child and family characteristics and by caretakers' and children's changes in functioning; 4) To determine whether cognitive behavioral intervention (Coping Power) delivered after the tornado (Cohort 3 versus Cohorts 1 and 2) attenuates increases in behavioral and emotional problems after the tornado in a transdiagnostic fashion. The funding sought here would make it possible to address these aims by supporting the assessment of the existing intervention sample at more frequent and longer-term time points and on additional measures linked to the specific aims.

DESCRIPTION (provided by applicant): This study will examine the effects of a tornado-related natural disaster on children and parents participating in an ongoing substance use prevention trial and will allow a unique opportunity to examine changes in children's and parents' predisaster and postdisaster functioning on a comprehensive range of biopsychic- social indicators and on substance abuse and mental health service use in an already at-risk sample. Research on the service use, substance use, behavioral and emotional effects of natural disasters on children and their caretakers has received limited empirical attention, even though such disasters have considerable public health significance due to increases in disordered emotional and behavioral functioning and service use demands. Existing studies of the aftereffects of natural disasters on children are limited by not knowing how much the disaster changed the children's predisaster functioning. This will be the first disaster study that includes extensive data on children's behavioral, emotional, (teacher, parent, peer, and self reports), social (children's peer relations based on peer, teacher and self report) and psycho- physiological (skin conductance, heart rate, respiratory sinus arrhythmia) functioning both before and after disaster exposure. Another important innovation of the proposed study is that it will follow a sample of preadolescent children identified as being at-risk prior to the disaster. Thus, the sample is likely to be more heavily influenced by the disaster (Kaminer et al., 2005; Resnick, 1995; Weems et al., 2010), because the tornado that devastated the study area adds another set of risk factors to already vulnerable children. The specific aims of the project are: 1 To explore changes in functioning pre-to-post tornado in children (emotional, behavioral, social, academic, and autonomic nervous system functioning and substance use) and primary caretakers (emotional functioning and parenting practices); 2) To explore moderation of changes in child and caretaker functioning pre-to-post tornado by degree of tornado exposure, by pre- tornado child (sex, ethnicity, temperamental anxiety) and family (socioeconomic status, post-tornado negative life events, levels of family social support, parenting practices) characteristics and by gene-by- environment (degree of exposure to the tornado) effects; 3) To explore moderation of post-tornado rates of substance abuse, mental health service use and diagnostic outcomes by degree of tornado exposure and pre-tornado child and family characteristics and by caretakers' and children's changes in functioning; 4) To determine whether cognitive behavioral intervention (Coping Power) delivered after the tornado (Cohort 3 versus Cohorts 1 and 2) attenuates increases in behavioral and emotional problems after the tornado in a transdiagnostic fashion. The funding sought here would make it possible to address these aims by supporting the assessment of the existing intervention sample at more frequent and longer-term time points and on additional measures linked to the specific aims.

Abstract Reducing Youth Violence and Racism/Discrimination: The Efficacy of Comprehensive Prevention Strategies (CPS) project is being submitted to National Institute of Health: Youth Violence Prevention Interventions that Incorporate Racism/Discrimination Prevention (R01). This study will evaluate the effects of a comprehensive intervention addressing (a) individual, (b) educator, (c) school, and (d) community-levels variables. Specifically, interracial and intraracial youth aggression and school disengagement will be analyzed through a quasi-randomized control trial of Coping Power versus Coping Power+, a newly developed version with racism and discrimination content. Educator outcomes will be evaluated by school-level randomization to traditional SWPBIS alone or SWPBIS+ implicit bias training and culturally responsive adaptations. Finally, community risk will be evaluated through parental involvement in either traditional Coping Power Parent program or the Coping Power Parent Program+, that includes racism and discrimination content. The purpose of the CPS intervention which includes CP+ and SWPBIS+ is to preventatively address individual, school, and community risk for youth violence and aggression, particularly related to racially based aggression and violence by intervening at multiple entry points and leveraging the evidence-based Coping Power and SWPBIS approaches to include much-needed adaptations. This project will include a 5-year randomized control trial with four conditions: (a) SWPBIS and CP (serving as control), (b) SWPBIS+ and CP, (c) SWPBIS and CP+, and (d) SWPBIS+ and CP+. Project planning and student screening will occur in Year 1, with three cohorts of schools and students in intervention in Years 2-4, and follow-up data for the Year 4 cohort collected in Year 5. Twenty middle schools (6th to 8th grade) in large districts in Alabama, representing diverse student populations across race and poverty levels will be included in the project. To address Aim 1, 20 schools implementing Tier 1 SWPBIS to criterion (i.e., a score of at least 70% on a validated fidelity measure; Mercer et al., 2017) will be randomly assigned to the Tier 1 conditions: SWPBIS+ training or continued SWPBIS implementation. Within each middle school (6th and 7h grade), students with high levels of externalizing behavior (top 25% based on screening, described below) will be recruited and randomly assigned to CP or CP+. At each of the 20 schools, 17 children will be included for CP intervention for each new cohort in Years 2-4, yielding 1,020 students total with 510 students in each condition for the CP vs. CP+ contrast.