Not an Onion Study: $58k/Child, 10-year Early Intervention Program Yields 10% Less Psychopathology, Based on Self Reports

Rob Wipond
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The Fast Track program of early intervention in children and teens “can significantly reduce adult psychopathology and violent crime,” according to a study in the American Journal of Psychiatry. The program took ten years, involved comprehensive, ongoing interventions of many different kinds with students, teachers and families, cost $58,000 per child, and ultimately produced a 10% improvement in the intervention group over controls. Study co-author Kenneth Dodge admitted to Psychiatric News that it was not the most efficient program, but said, “Our goal, first and foremost, was to demonstrate that early intervention works.”

According to Psychiatric News, “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.” So the study of the Fast Track program, involving about 900 children at four US sites and researchers from a number of universities has been an ongoing effort since 1991 to provide that evidence.

Half the children were separated into a control group. For the other half, the intervention program involved regular social skills training, parent behavior-management training with home visits, peer coaching, weekly reading tutoring, specialized teacher assistance and training, and classroom social-emotional curricula. Participants were then rated by themselves and by a peer as to whether or not they had any of a range of behavior, substance abuse or psychological problems. In the most recent follow-up, “69% of participants in the control arm displayed at least one externalizing, internalizing, or substance abuse psychiatric problem (based on self- or peer interview) at age 25, in contrast with 59% of those assigned to intervention,” reported the researchers.

“The most important conclusion from this study is that a comprehensive, multicomponent developmental science-based intervention targeted toward early-starting conduct-problem children can significantly reduce adult psychopathology and violent crime,” wrote the researchers. “The findings run counter to claims that prevention fails, made by advocates of cuts to federal funding for prevention…” Some of the authors of the study also designed the program and disclosed holding publishing and royalty arrangements for some of the program materials.

Early Intervention for At-Risk Youth Has Benefits Into Adulthood (Psychiatric News, October 16, 2014)

(Abstract) Impact of Early Intervention on Psychopathology, Crime, and Well-Being at Age 25 (Conduct Problems Prevention Research Group. Am J Psychiatry 2014. Published online ahead of print September 15, 2014. doi:10.1176/appi.ajp.2014.13060786)

18 COMMENTS

  1. Oh dear.

    You know I sort of think there are some things that have been proved to work, but I don’t have the research base to prove it. So I’ll just float some ideas and see what people think:

    Youth clubs
    Reducing inequality between rich and poor
    Tackling racism and homophobia
    Tackling domestic violence
    Tackling child sexual assault
    Making phsycial punishment of children (slapping etc) illegal
    Paying, training and supporting teachers well

    Any comments, or additional ideas?

  2. Creating genuinely safe, loving relationships with children and a being willing to advocate for what a given child truly wants (this arbitrary standard of doing what is “in the best interests of the child,” rarely seems to work out in the best interests of anyone but the adults calling all the shots) seem to work as much more effective “prevention.” The association between “psychopathology” and violent crime is very disturbing, especially in regard to children, who really shouldn’t be thrown into either category. I’ve worked with children who were involved with gangs and committed a range of violent acts, and found that for most of them, with some love, stability, and empowering support, were able to break free of these gangs, as they often described their reasons for joining as a need to belong and feel that someone cared about them. Oh yeah, and for several years, my volunteers and I accomplished all this for about $150/child.

  3. You’re guys both right 100%. Having parents or other adult caregiver actually care for you and spend time with you (which is very hard for many working parents these days) is probably one of the most effective ways to prevent psychopathology.
    It’s crazy that government agencies don’t mind spending tons of money on kids in foster homes and other places like that but would not give this money directly to child’s parents so it can stay with his/her family when the reasons for neglect and other problems are mostly economic in nature.
    Also what is wrong with asking the kids what they want? It’s the same paternalistic approach we have to “mentally ill” – I’ll take all your decisions for you because I know better and then be all surprised when you’re not grateful in the end of the day.

    • That is so true. Children are taught that their views, goals, hopes and dreams are inconsequential and that they are completely at the mercy of whatever adults happen to be related to or otherwise responsible for them. Then, we blame children for not telling anyone when those same adults, who have absolute power of their lives, abuse them. Anyone else see a problem?

      I have this crazy theory about how to interact with children. It’s that children are actually human beings. They are not lumps of clay to be molded by those around them who have existed on this planet for a longer period of time. They have innate empathy and wisdom that cannot be ignored, and no matter what has happened to them, they are unbelievably resilient when they are provided with safety, loving support, and opportunities to talk about their experiences without facing any judgment. Yes, children often need guidance from adults, but there is a massive distance between collaborating with a child to help him make the best possible decisions and simply demanding compliance.

      • Perfect comment. It takes poisonous pedagogy to create the messed up adults we find around us and when we look in our mirrors. Alice Miller wrote about this 30 years ago. Why is it not conventional wisdom by now? (It’s because she was right and the problem is so pervasive that we have thus far been unable to collectively face it.)

        • Exactly.

          The Adverse Childhood Experiences Study proved that large numbers of children are sexually and physically abused each and every year and almost nothing is done about it because we as a society don’t want to admit that we’re capable of doing such horrible things to our children. We stick our heads in the sand and continue to allow people that we know and often live with abuse the very kids that we’re supposed to protect. On the average an abused child has to tell seven adults about the abuse before they’re believed and something is finally done about it. By the time something is done the child is traumatized for life. You can transcend trauma but you can never recover from it, its effects are with you forever.

          As you stated, Alice Miller wrote about this all the time and almost no one has given any attention to what she exposed for all of us to see and do something about.

    • Yes, Oy. Then consider how in community replication this approach would work. I doubt even the nominal improvement over the control group would hold true. After all, fidelity to any practice model has never been the hallmark of the mental health system.

      For those of us who spent anytime in the children’s system it is not hard to imagine the intervention group faring worse then the control group in practice.

  4. Prevention? When real prevention would mean no early intervention, and when studies show negative outcomes for such intervention, we will take a survey of patient/clients. They couldn’t be doing poorly if they say they’re doing better. Yeah, right. Take a little time, follow the money, and watch the psychopathology [sic] rate rise.

  5. And… based… on… self reports… so there isn’t even any empirical evidence here.

    No, I don’t believe this is not an onion study. I can only imagine the amount of money or other kick backs these people got to take the humiliation that will come from standing behind such a ridiculous study. 58 thousand (tax dollars, certainly) per child and ONLY a 10% reduction and even THAT is based on SELF REPORTS! And never even mind that the sort of children these programs are aimed toward are often poor and unprivileged and could and should feel abused by knowing their government would spend so much money on nonsense to stroke psychiatry’s ego instead of spending it on them in ways that will improve their lives and their future!

    • And never even mind THAT for a second. Do the math instead. If this program were offered to 100 children, it would — by their own measures — waste approximately five million dollars! Now imagine it being offered to THOUSANDS of children. Now think of where that money goes…

    • Agreed. I’d love to see the day when, instead of telling someone that they’re “clinically depressed” and have a “chemical imbalance” because they’re stressed about overwhelming financial problems, that a psychiatrist could write a prescription for cash, in the amount of the 8+ drug cocktails that his colleagues often prescribe. In fact, here are some other things that would have helped me far more than the psychotropics that were prescribed to me for years:

      1. A safe shelter from abuse;
      2. Empathy;
      3. Hearing that the traumas I endured were not my fault;
      4. Doing absolutely nothing, and not pushing drugs that simply dulled my emotions and made it impossible for me to truly heal.