• By Kevin Mount
  • Posted on Monday 19th November, 2007

Stop and think now; cope better later?

It is a common failing among prevention programs that they will demonstrate an immediate impact on children’s behavior around the time they are being applied, but any beneficial effect soon fades. A few years afterwards many of the children who participated will have lapsed into their old, problematic ways. Much rarer – and more sought after, perhaps because they resemble the elegance of inoculation in preventative medicine – are interventions that have no discernible effect when they are being administered but pay off years later when the risks they are intended to mitigate are most severe.An emerging case in point is the Utrecht Coping Power Program (UCPP), which has been found by a bi-national US-Netherlands research team to protect children diagnosed with Disruptive Behavior Disorder (DBD) in middle childhood from progressing to substance abuse in early adolescence. Nicolle Van De Wiel, of the Central RINO Group in the Netherlands compared children aged 8-13 and diagnosed with disruptive behavior disorder, who had been randomly selected to participate in UCPP, to similar children randomly selected to participate in other behavior therapies. The Utrecht program involved children and their parents in weekly group sessions in outpatient psychiatry clinics or mental health centers over a period of about nine months. It focused on helping children simply to “stop and think” before reacting to problems – by considering potential solutions and their consequences – and by training them how to choose the best response. Perhaps the usefulness of these behavior lessons took time to sink in, because when Van De Wiel and colleagues from the University Medical Center in Utrecht surveyed children in the study five years later, they found that the ones in the program were doing better than those who experienced other therapies. Significantly more teens in the non-program group reported smoking cigarettes in the previous month and having used marijuana. Indeed, the UCPP kids’ use of cigarettes and marijuana was comparable to that of children who had no earlier behavior problems. However, the Utrecht program did not appear to be any more effective in reducing delinquent behavior over time than the other therapies.Van De Wiel found that UCPP was more cost effective than the other therapies. Therapists leading the sessions had masters degrees in psychology but little clinical experience and thus received less money for their work than the other therapists in the study, who tended to have extensive clinical experience. Immediately following the program, children in UCPP had improved their behavior about as much as children experiencing the other therapies.Add these findings together and UCPP appears to be something of an anomaly: a relatively inexpensive program with lasting (if not immediate) effects. [see also: Repairing children's mental health – through thick and thin]Summary of “Preventive Effects of Treatment of Disruptive Behavior Disorder in Middle Childhood on Substance Use and Delinquent Behavior” by Marjo Zonnevylle-Bender, Walter Matthys, Nicolle Van De Wiel, and John E. Lochman in the Journal of the American Academy of Child and Adolescent Psychiatry, Volume 46(1), January 2007, pp 33-39.

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