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4 Using a Developmental Framework to Guide Prevention and Promotion
Pages 71-112

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From page 71...
... The chapter goes on to discuss research on risk factors and protective factors for MEB disorders, with attention given both to factors associated with multiple disorders and to the multiple factors associated with specific disorders. The emphasis is on identifying the implications of findings from this research for the design and evaluation of developmentally appropriate preventive interventions.
From page 72...
... . Other studies also indicate that early onset of symptoms is associated with greater risk of adult disorders, including substance abuse and conduct disorder (Kellam, Ling, et al., 1998; Gregory, Caspi, et al., 2007)
From page 73...
... As illustrated in Figure 4-1, the range of intervention approaches includes promotion of healthy development, prevention of MEB disorders, and treatment of individuals who are experiencing disorders (the outer semicircle)
From page 74...
... Although the precise biopsychosocial processes leading to most disorders are not fully understood, considerable progress has been made in identifying the risk factors and protective factors that predict increased or decreased likelihood of developing disorders. Understanding the pathways of development enables prevention researchers to identify opportunities to change pathological developmental trajectories.
From page 75...
... identified multiple goals of programs designed to promote positive youth development: promote bonding; foster resilience; promote social, emotional, cognitive, behavioral, and moral competence; foster self-determination, spirituality, self-efficacy, clear and positive identity, belief in the future and prosocial norms; and provide recognition for positive behavior and prosocial involvement. The committee uses the term "developmental competencies" to refer to young people's ability to accomplish a broad range of social, emotional, cognitive, moral, and behavioral tasks at various developmental stages.
From page 76...
... Characteristics of Healthy Development Although there are no universally accepted taxonomy or agreed-on measures of positive mental health, several groups have attempted to inte
From page 77...
... assessed competent functioning in middle childhood in terms of successfully accomplishing developmental tasks, such as academic achievement, following rules for appropriate behavior, and developing positive peer relations. Resilience, or the ability to adapt to life stressors, is a widely accepted aspect of positive development (Catalano, Berglund, et al., 2002; Commission on Positive Youth Development, 2005; Masten, Burt, and Coatsworth, 2005)
From page 78...
... NRC and IOM (2000) Early Self-regulation Healthy physical environment Availability of high-quality child care Childhood -Attention regulation -Adequate prenatal and postnatal health -Nurturance -Appropriate emotional inhibitions and care -Support for early learning expression -Adequate prenatal and postnatal -Access to supplemental services, such as -Early mastery and intrinsic motivation nutrition feeding, screening for vision and hearing, -Executive functioning, planning, and support for working parents problem solving Nurturing relationships with caregiver -Stable secure attachment to child care -Secure attachment including: provider -Reliable support and discipline from -Low ratio of caregivers to children Communication and learning caregiver -Regulatory systems that support high -Functional language -Responsiveness quality of care -School attendance and appropriate -Protection from harms and fears conduct -Affection -Opportunities to resolve conflict Making friends and getting along with -Support for development of new skills peers -Reciprocal interactions -Initiating interactions and appropriate -Experience of being respected conduct -Stability and consistency in caregiver -Understanding of self and others' relationship emotions Socioeconomic resources for the family Adequate birth weight -Adequate income -Ability to provide adequate nutrition, child care, safe housing, health care -Higher parental education -Cognitive stimulation in the home -Parental low economic stress
From page 79...
... (2004) Childhood -Learning to read and write a language -Time in emotionally responsive Features of school environment that are -Learning basic mathematics interactions with children associated with positive development -Attending and behaving appropriately -Consistent discipline -Positive teacher expectancies at school -Language-based rather than physically -Perceived teacher support -Following rules for behavior at home, based discipline -Effective classroom management school, public places -Extended family support -Positive partnering between school and -Getting along with peers in school -Parental resources, including positive family -Making friends with peers personal efficacy, adaptive coping, self- -Culturally relevant pedagogy views high on potency and life -School policies and practices to reduce Wyman (2003)
From page 80...
... NRC and IOM (2002) Positive development in adolescence Features of positive developmental Features of positive developmental settings -Physical development (good health settings -Physical and psychological safety habits, good health risk management -Physical and psychological safety -Appropriate structure (limits, rules, skills)
From page 81...
... define a risk factor as a measurable characteristic of a subject that precedes and is associated with an outcome. Risk factors can occur at multiple levels, including biological, psycho­logical, family, community, and cultural levels.
From page 82...
... The distinctions between risk factors discussed above can also be applied to protective factors. The term "protective factors" has also been used to refer to interactive factors that reduce the negative impact of a risk factor on a problem outcome, or resilience (Luthar, 2003)
From page 83...
... When potentially modifiable risk and protective factors have been identified through epidemiological and developmental research, preventive approaches can be developed to change those factors to prevent the development of mental, emotional, and behavioral problems. Other risk factors can help define populations that are potential candidates for prevention, such as children exposed to divorce, poverty, bereavement, a mentally ill or substance-abusing parent, abuse, or neglect.
From page 84...
... 84 PREVENTING MENTAL, EMOTIONAL, AND BEHAVIORAL DISORDERS TABLE 4-2  Summary of Findings from Studies of Risk and Protective Factors and Their Implications for Design and Evaluation of Prevention and Promotion Programs Findings from Studies of Risk and Implications for the Design and Evaluation of Protective Factors Prevention Programs Risk and protective factors operate at • High-risk groups for prevention programs multiple levels of analysis can be identified at multiple levels, including individuals, families, and communities • Preventive interventions can be directed to change malleable risk and protective factors at multiple levels of analysis The effects of risk and protective factors • Children in high-risk groups are likely to are correlated and cumulative have multiple risk factors • Risk factors tend to be positively • Prevention programs may be most effective correlated with each other and when they impact multiple risk and negatively correlated with protective protective factors factors • Evaluation of prevention trials may • Risk factors tend to have a cumulative indicate which risk or protective factors effect on the development of mental, account for program effects, leading to emotional, and behavioral problems more efficient prevention strategies over • Protective factors have a cumulative time effect to reduce the development of mental, emotional, and behavioral problems Risk and protective factors have effects on • Preventive interventions with high-risk both specific mental, emotional, and groups may impact multiple outcomes behavioral problems and on multiple • Preventive interventions with general risk problems factors should be designed to identify • Some risk and protective factors have multiple outcomes across developmental general effects to impact multiple stages mental, emotional, and behavioral • Preventive interventions can target risk outcomes factors specific to particular MEB • Some risk and protective factors have disorders specific effects on single MEB disorders • Specific effects of risk and protective factors may be found in subgroups of gender or age
From page 85...
... . For example, a synthesis of 18 meta-analytic reviews of risk and protective factors for children found that the strongest risk factors for internalizing and externalizing problems include comorbid internalizing or externalizing problems, family environment stress (e.g., divorce, single parenting)
From page 86...
... Thus, some young people have multiple risk factors, and those with multiple risk factors are less likely to have protective factors. For example, in a five-state sample of 6th through 12th graders, those who were in the highest quintile on a cumulative measure of risk factors were likely to be in the lowest quintile on the measure of protective factors (Pollard, Hawkins, and Arthur, 1999)
From page 87...
... . A rigorous test of the specific versus the general effects of risk factors would require a prospective longitudinal study in order to ensure that the risk factors arise before the onset of disorders and to understand what earlier factors may have contributed to the appearance of a risk factor at a given time (e.g., unemployment leading to parental depression)
From page 88...
... For example, parental divorce is associated with other risk factors, such as interparental conflict, parental mental health problems, and harsh and inconsistent parenting. It is also associated with multiple problem outcomes, including substance abuse problems, internalizing and externalizing problems, and academic problems.
From page 89...
... . Parenting has been found to be a mediator of the effects of multiple risk factors, including poverty, parental divorce, parental bereavement, and parental mental health problems (Sampson and Laub, 1993; Simons, Johnson, et al., 1996; Kwok, Haine, et al., 2005; Grant, Compas, et al., 2003; Wolchik, Wilcox, et al., 2000; Wyman, Sandler, et al., 2000)
From page 90...
... . Similarly, biological factors may mediate the effects of psychosocial risk and protective factors, and conversely psychosocial risk and protective factors may moderate the effects of biological risk factors.
From page 91...
... . Four specific MEB disorders -- depression, anxiety, substance abuse, and schizophrenia -- are used to illustrate disorder-specific risk factors (see Appendix E for tables that list risk factors for each of these disorders across developmental stages and across the various contexts of the social ecology)
From page 92...
... Interventions to prevent depression in young people have primarily focused on three risk factors: parents with mood disorders, a depressogenic cognitive style, and elevated levels of depressive symptoms or a history of depression. Across studies, the rates of depression in adolescents with a depressed parent are three to four times higher than rates in those with nondepressed parents (Beardslee, Versage, and Gladstone, 1998)
From page 93...
... . Clarke's program included both the risk factor of depressogenic cognitive style and the presence of parental depression.
From page 94...
... , behavioral risk factors for anxiety disorders (e.g., behavioral inhibition; Rapee, Kennedy, et al., 2005) , or environmental risk factors (e.g., witnessing community violence; Cooley, Boyd, and Grados, 2004)
From page 95...
... Substance Abuse Substance abuse and dependence tend to emerge in mid-to-late adolescence and to be more common among boys. Substance abuse is greater among young people who experience early puberty, particularly among girls.
From page 96...
... For both children and adolescents, early drug use predicts later drug use. In young adulthood, different risk factors appear to represent different pathways to substance abuse.
From page 97...
... Underage Drinking Although not all those who drink in their youth develop substance abuse or substance dependence, underage drinking has received significant public health attention, given the prevalence of drinking among those under the legal drinking age, problematic drinking patterns, and their deleterious effects. A brief discussion of factors related to underage drinking provides an illustration of the developmental aspects of a problem behavior of significant public health concern and similarities with the trajectory of some MEB disorders.
From page 98...
... Second, with multiple risk factors across the developmental course, there should be multiple plausible routes to prevention. Third, with developmentally early risk factors influencing later ones, preventive interventions should be timed to protect
From page 99...
... Risk Factors Associated with Multiple Disorders Negative life events at the family, school or peer, and community levels have been associated with multiple psychopathological conditions, such as anxiety, depression, and disruptive disorders (see Craske and Zucker, 2001; La Greca and Silverman, 2002)
From page 100...
... . Poverty is a risk factor for several MEB disorders and is associated with other developmental challenges.
From page 101...
... Poor neighborhoods and schools are less likely to have the resources that promote healthy child development and are more likely to be settings that expose children to additional risk factors, such as violence and the availability of drugs and alcohol. Disentangling the effects of the neighborhood and the family is difficult, but there is evidence that many of the factors associated with poor neighborhoods and schools are associated with multiple mental, emotional, and behavioral problems for children (Gershoff and Aber, 2006)
From page 102...
... Child Maltreatment. Maltreatment of children by primary caregivers is one of the most potent risk factors for mental, emotional, and behavioral problems, and it has been found to be associated with other serious risk factors, such as poverty and parental mental illness.
From page 103...
... and warrants further investigation. However, finding high rates of disorder with abuse but no other risk factors emphasizes the importance of the negative effects of abuse.
From page 104...
... Following parental divorce, children are at increased risk for multiple mental, emotional, and behavioral problems, including physical health problems, elevated levels of alcohol and drug use, premarital childbearing, receiving mental health services, and dropping out of school (Troxel and M ­ atthews, 2004; Furstenberg and Teitler, 1994; Hoffmann and Johnson, 1998; ­ Goldscheider and Goldscheider, 1993; Hetherington, 1999)
From page 105...
... . These risks appear to remain after controlling for other risk factors, such as mental disorder of the deceased parent ­(Melhem, Walker, et al., 2008)
From page 106...
... In an externalizing pathway, conduct disorder and substance misuse lead to depressive disorder. In an adversity pathway, early childhood exposure to a disturbed family environment, childhood sexual abuse, and parental loss lead to low educational attainment, lifetime trauma, and low social support, which in turn lead to four adult risk factors (marital problems, difficulties in the past year, dependent stressful events, and independent stressful events)
From page 107...
... , and poor academic achievement is related to the development of multiple problem behaviors (e.g., substance abuse, antisocial behavior) as well as teenage ­pregnancy and low occupational attainment (Dryfoos, 1990)
From page 108...
... In school, students' relationships with their peers and teachers and the social climate in the classroom have a powerful effect on their development of mental, emotional, and behavioral problems as well as their development of age-appropriate competencies. For example, aggregate-level studentp ­ erceived norms favoring substance use, violence, or academic achievement are related to antisocial behavior.
From page 109...
... Factors both specific to a given disorder and that provide a more generalized risk for multiple disorders provide important opportunities for the development of interventions that modify these factors and explore possible mediating mechanisms. Conclusion: Research has identified well-established risk and protective factors for MEB disorders at the individual, family, school, and com munity levels that are targets for preventive interventions.
From page 110...
... Recommendation 4-2: The National Institutes of Health should develop measures of developmental competencies and positive mental health across developmental stages that are comparable to measures used for MEB disorders. These measures should be developed in consultation with leading research and other key stakeholders and routinely used in mental health promotion intervention studies.
From page 111...
... risk and protective factors that lead to multiple mental, emotional, and behavioral problems and dis­orders; and (3) promotion of indi vidual, family, school, and community competencies.


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