ARTICLES
Fast Track Randomized Controlled Trial to Prevent Externalizing Psychiatric Disorders: Findings From Grades 3 to 9

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ABSTRACT

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.

Section snippets

Participants

Local public elementary schools within the four sites (Durham, NC; Nashville, TN; Seattle, WA; and rural central Pennsylvania) were selected as high risk based on neighborhood crime and poverty. Within each site, schools were divided into multiple paired sets matched for demographics (size, percentage free or reduced lunch, ethnic composition), and one of each pair was randomly assigned to intervention and control conditions. Although there were substantial differences across sites in the

Criterion Counts.

Assignment to intervention did not result in a significant main effect for any of the three variables (CD, ODD, or ADHD); however, significant interaction effects between intervention and severity of initial risk were found for ODD and ADHD. In each case the positive effect of intervention increased linearly as the severity of initial risk increased. Group means listed in Table 2 and statistical contrasts indicate that the intervention and control groups differ significantly only for the

DISCUSSION

According to study findings, random assignment to the Fast Track intervention had a statistically significant and clinically meaningful positive effect on preventing childhood and adolescent externalizing psychiatric disorders and antisocial behavior, but only among the highest risk subgroup of kindergarteners. Intervention effects were detected as early as grade 3 and were robust through grade 9. Among the highest risk group in grade 9 assignment to intervention was responsible for reducing

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    This work was supported byNational Institute of Mental Health (NIMH) grantsR18 MH48043,R18 MH50951,R18 MH50952, andR18 MH50953. The Center for Substance Abuse Prevention and the National Institute on Drug Abuse also provided support for Fast Track through a memorandum of agreement with the NIMH. This work was also supported in part byU.S. Department of Education grantS184U30002 andNIMH grantsK05MH00797 andK05MH01027. Although these funding agencies approved the initial design of the study, they had no role in approving the analysis and interpretation of the data or in preparation and review of this manuscript. We are grateful for the close collaboration of the Durham Public Schools, Metropolitan Nashville Public Schools, Bellefonte Area Schools, Tyrone Area Schools, Mifflin County Schools, Highline Public Schools, and Seattle Public Schools. We appreciate the dedication of hundreds of staff members who implemented the project, collected the evaluation data, and assisted with data management. The statistical data analyses have been completed by Jennifer Godwin and Patrick Malone, Center for Child and Family Policy, Duke University, and we are grateful. Kenneth A. Dodge has had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    For additional information concerning Fast Track, see http://www.fasttrackproject.org

    Disclosure: Drs. McMahon, Coie, Greenberg, Lochman, and Bierman are the developers of the Fast Track curriculum and have a publishing agreement with Oxford University Press. Dr. Greenberg is an author on the PATHS curriculum and has a royalty agreement with Channing-Bete, Inc. Dr. Greenberg is a principal in PATHS Training, LLC. Dr. McMahon is a coauthor of “Helping the Noncompliant Child” and has a royalty agreement with Guilford Publications, Inc.; he is also a member of the Treatments That Work Scientific Advisory Board with Oxford University Press. The other authors have no financial relationships to disclose.

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