Faculty Bibliography

CONTEXT: Salivary cortisol levels during social challenge relate to adaptive functioning in children and adults. Low cortisol levels have been related to conduct problems and antisocial behavior. Although studies in rodents implicate early-life social experience in cortisol regulation, no studies with humans have examined the effects of an experimentally manipulated early-life social experience on cortisol regulation. OBJECTIVE: To examine the effects of experimental manipulations of social experience on cortisol response to a social challenge in preschoolers at risk for antisocial behavior. DESIGN: Randomized controlled trial. SETTING: Department of Child and Adolescent Psychiatry, New York University School of Medicine. PARTICIPANTS: Ninety-two preschool-age siblings of youths adjudicated for delinquent acts. Intervention Family-based intervention included 22 weekly group sessions for parents and preschoolers and 10 biweekly home visits conducted during a 6- to 8-month period. MAIN OUTCOME MEASURES: Salivary cortisol levels before and after a social challenge (entry into an unfamiliar peer group). RESULTS: Relative to controls, children in the intervention condition had increased cortisol levels in anticipation of the peer social challenge. Increases were relative to both preintervention cortisol levels during the challenge and cortisol levels in the home, which were not altered by the intervention. CONCLUSIONS: A family-based preventive intervention for children at high risk for antisocial behavior alters stress response in anticipation of a peer social challenge. The experimentally induced change in cortisol levels parallels patterns found in normally developing, low-risk children

This study explored the factor structure and developmental trajectory of effortful control (EC), its relations with child adjustment, and the moderating role of age and gender in 75 4- to 6-year-old children at risk for psychopathology. Confirmatory factor analyses revealed two subcomponents of effortful control: Suppress/Initiate (the ability to inhibit a dominant response while initiating a new response) and Motor Control (inhibiting fine and gross motor activity). EC performance improved with age, and both subcomponents were associated with greater social competence at all ages. Associations with internalizing problems were moderated by child age such that greater EC was linked to fewer problems at age 4 but did not relate to problems at ages 5 or 6

The past decade witnessed an increased use of stimulants for the treatment of attention-deficit/hyperactivity disorder (ADHD) in preschool children. However, the reluctance of parents of preschoolers to place their young children on stimulants () coupled with the paucity of information regarding the long-term effects of stimulants in preschoolers makes the development and testing of nonpharmacological treatments for preschoolers with ADHD a major public health priority. This article addresses this issue. First, we highlight issues relating to the existence of ADHD in preschoolers as a clinically significant condition and the need for effective treatment. Second, we examine issues related to the use of pharmacological therapies in this age group in terms of efficacy, side effects, and acceptability. Third, we discuss existing nonpharmacological interventions for preschoolers and highlight the potential value of parent training in particular. Finally, we introduce one candidate intervention, the New Forest Parenting Package, and present initial evidence for its clinical value as well as data on potential barriers and limitations. ©2006Lippincott Williams & Wilkins, Inc.

This study evaluated the psychometric properties of an observational rating system for assessing preschoolers' peer entry and play skills: Observed Peer Play in Unfamiliar Settings (OPPUS). Participants were 84 preschoolers at risk for psychopathology. Reliability and concurrent validity are reported. The 30-min paradigm yielded reliable indexes of engaging and disruptive behavior. Adequate interrater reliability and stability were obtained with minimally trained observers. OPPUS scores were related in expected ways to independent observations of disruptive and engaging behavior during parent-child interactions. OPPUS scores were associated with parent-rated self-control and internalizing behaviors. OPPUS scores were associated with parent ratings of play skills for children with school experience and assertiveness for children without school experience. The OPPUS is a useful, brief method for assessing peer entry and play behaviors in preschoolers

This study investigated the immediate impact of an 8-month center- and home-based prevention program for preschoolers at high risk for conduct problems. We report immediate program effects on observed and self-rated parenting practices and observed child behavior with peers. Ninety-nine preschool-age siblings of adjudicated youths and their families were randomly assigned to an enhanced version of the Incredible Years Series (Webster-Stratton, 1989; n = 50) or to a no-intervention control condition (n = 49). In an intent-to-treat design, the intervention yielded significant effects on negative parenting, parental stimulation for learning, and child social competence with peers. Improvements in negative parenting, stimulation for learning, and child social competence support the potential of the intervention to prevent later conduct problems in high-risk children

This study evaluated sibling effects of a family-based intervention aimed at preventing conduct problems in preschool-age siblings of adjudicated youths. Ninety-two families of preschoolers who had older siblings adjudicated for delinquent acts were randomly assigned to intervention and control conditions. Of these, 47 families had nontargeted school-age (5-11 years) or adolescent siblings (12-17 years) living at home. These families were considered in this report. The authors hypothesized group differences on antisocial behavior and positive peer relations for older siblings of targeted preschoolers. The authors examined outcomes of parent- and teacher-reported behavior immediately postintervention and 8 months postintervention. Findings revealed significant intervention effects 8 months following intervention for adolescent siblings on parent-reported antisocial behavior and positive peer relations. Teacher reports confirmed group differences for antisocial behavior immediately postintervention. Findings document benefits for adolescent siblings

Widespread dissemination of evidence-based programs for underserved populations may require non-traditional means of service provision. Collaboration with paraprofessionals from communities that are targeted for intervention holds promise as a delivery strategy that may make programs more accessible and acceptable, especially to parents living in low-income, urban neighborhoods. We describe a paraprofessional training program for individuals living in a community targeted for preventive intervention based on high levels of poverty and community violence. The design and implementation of the training program are described in the context of issues related to the use of paraprofessionals in community-based, preventive interventions with parents of young children. We also provide insight into lessons learned from a feasibility study as well as general guidelines for the development of paraprofessional training programs for delivery of evidence-based programs. (journal abstract)