Fast track randomized controlled trial to prevent externalizing psychiatric disorders: Findings from grades 3 to 9
Fast track randomized controlled trial to prevent externalizing psychiatric disorders: Findings from grades 3 to 9
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DOI：
10.1097/chi.0b013e31813e5d39
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发表时间：
2007-10-01
影响因子：
13.3
通讯作者：
Pinderhughes, Ellen E.
中科院分区：
文献类型：
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作者：
Bierman, Karen L.;Coie, John D.;Pinderhughes, Ellen E.
目的：本研究测试快速通道计划在预防不同初始风险群体中的反社会行为和精神疾病方面的功效。方法：根据社区犯罪和贫困水平，将四个地点（北卡罗来纳州达勒姆、田纳西州纳什维尔、华盛顿州西雅图和宾夕法尼亚州中部农村）内的学校选为高风险机构。在对这些学校的 9,594 名幼儿园儿童进行筛查后，891 名最高风险和中等风险儿童（69% 为男性，51% 为非洲裔美国人）被随机分配到匹配的学校组中进行干预或控制条件。这项为期 10 年的干预措施（从 1991 年开始，每年进行三组）包括家长行为管理培训、儿童社会认知技能培训、阅读辅导、家访、指导和通用课堂课程。结果包括 3、6 和 9 年级后的行为障碍、对立违抗障碍、注意力缺陷/多动障碍、任何外化障碍和自我报告的反社会行为的标准计数和精神病学诊断。根据队列的不同，在 2000 年至 2003 年间对 9 年级的成绩进行了评估。结果：干预措施与初始风险水平之间存在显着的交互作用，但在 9 年级之后最为强烈。干预措施的分配对于降低品行障碍、注意力缺陷/多动障碍和任何外化障碍的标准计数得分和诊断以及降低反社会行为得分具有显着的积极作用，但仅限于最初风险最高的人群。结论：预防严重反社会行为对于不同性别、种族和城乡居住地的人来说都是有效的，但筛查至关重要。
Objective: This study tests the efficacy of the Fast Track Program in preventing antisocial behavior and psychiatric disorders among groups varying in initial risk. Method: Schools within four sites (Durham, NC; Nashville, TN; Seattle, WA; and rural central Pennsylvania) were selected as high-risk institutions based on neighborhood crime and poverty levels. After screening 9,594 kindergarteners in these schools, 891 highest risk and moderate-risk children (69% male and 51 % African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention (begun in 1991 with three yearly cohorts) included parent behavior-management training, child social-cognitive skills training, reading tutoring, home visiting, mentoring, and a universal classroom curriculum. Outcomes included criterion counts and psychiatric diagnoses after grades 3, 6, and 9 for conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, any externalizing disorder, and self-reported antisocial behavior. Grade 9 outcomes were assessed between 2000 and 2003, depending upon cohort. Results: Significant interaction effects between intervention and initial risk level were found at each age but most strongly after grade 9. Assignment to intervention had a significant positive effect in lowering criterion count scores and diagnoses for conduct disorder, attention-deficit/hyperactivity disorder, and any externalizing disorder, and lowering antisocial behavior scores, but only among those at highest risk initially. Conclusions: Prevention of serious antisocial behavior can be efficacious across sex, ethnicity, and urban/rural residence, but screening is essential.