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following input:(1) a weekly group on child management for their parents,
including live coaching in the presence of their child; (2) individual
academic tutoring for two hours a week; (3) teachers were instructed in
classroom management skills; (4) twice a week all children had emotional
literacy classes that stressed understanding of their own feelings including
anger and frustration; and (5) each week, the index children had to
spend an hour with a well-adjusted classmate, to promote friendships with
prosocial, not anti-social peers. Despite the admirable theoretical ground-
ing of this enormous prevention project, effects were modest, typically
improving antisocial behaviour by only around 0.2 standard deviations,
and longer-term follow-up is showing diminution of these gains, with at
best some small effects on the most severe cases. However, since a total
population was involved (with over 75% of the at risk families attending),
the health gain is perhaps worthwhile, albeit at considerable cost.
Better results have been obtained in terms of absolute effectiveness
and cost effectiveness by delivering only the parent training element,
but using it to target multiple risk factors. One recent UK trial taught
parents child management skills and how to read with their children,
based on modern understanding of the acquisition of literacy. Antisocial
behaviour, hyperactivity and reading all improved by around 0.4 standard
deviations. A feature of this trial was the strong emphasis on high quality
implementation, leading to hightreatment fidelity. Evidence is emerging that
treatment fidelity has a strong influence on outcomes, with effectiveness
depending crucially on high quality training followed by high quality
ongoing supervision with videotaping of therapist activity.
Prevention of other disorders
Programmes exist for anxiety and depressive symptoms, and these have
been shown to be reasonably effective in trials. Some involve parents, and
some see the child or adolescent directly. One advantage of seeing the in-
dividual directly is that typically, a substantial proportion of parents do not
turn up for prevention programmes. As might be expected, they tend to
come from the families at greatest risk, for example, from disadvantaged,
poor single-parent families. If the child or adolescent can be seen alone
at school, parental involvement in the intervention may not be necessary
(although consent should be sought, and it is usually best to let them know
what is going on). Drug use prevention programmes abound in the USA,
usually targeting teenagers. Unfortunately only about a third of families at
risk take part, and results are modest.
Prevention of risky predicaments
A number of trials of parenting programmes have shown reductions
in abusive parenting and acts of child abuse. However, widespread