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Targeting the Most Aggressive Children May Be Cost-Effective Prevention of Later Conduct Disorders

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Science Update

Targeted preventive interventions may help reduce conduct problems in children displaying the most aggressive or disruptive behaviors. Such interventions also may be cost-effective when compared to the personal and societal costs of delinquency and crime that can arise from untreated childhood conduct disorders. NIMH-funded researchers provided an analysis of one targeted intervention program in the November 2006 issue of the Archives of General Psychiatry.

E. Michael Foster, Ph.D., University of North Carolina at Chapel Hill, and Damon Jones, Ph.D., Pennsylvania State University, in conjunction with the Conduct Problems Prevention Research Group, examined the cost effectiveness of the NIMH-funded Fast Track program, a 10-year intervention designed to reduce aggression among at-risk children. Risk for developing a conduct disorder was determined using parent and teacher reports of aggressive, oppositional, or other behaviorally disruptive behaviors in the children. Most study participants scored in the top 20 percent on these reports, representing those at elevated risk for developing later conduct disorders. The Fast Track evaluation enrolled 891 children from 55 schools. The schools were grouped into nine matched pairs and then randomly assigned as intervention or control groups. According to their schools' assignment, a total of 445 children and their families received the intervention, and 446 served as controls.

Previous results showed that among children moderately at risk for conduct disorder, there were no significant differences in outcomes between the intervention group and the control group. However, among the high-risk group, fewer than half as many cases of conduct disorder were diagnosed in the intervention group as in the control group. These results were extended in the current paper to consider also the cost effectiveness of providing the early intervention. By weighing the costs of the intervention relative to the costs of crime and delinquency found among the study participants, the researchers concluded that this early prevention program was cost-effective in reducing conduct disorder and delinquency, but only for those who were very high-risk as young children. Considering the disproportionate costs to society in crime and delinquency caused by a relatively small number of youth, the researchers concluded that the intervention program is likely cost-effective for high-risk children, but not for moderate risk children.

Additional study authors comprising the Conduct Problems Prevention Research Group include Karen L. Bierman, Ph.D.; John D. Coie, Ph.D.; Kenneth A. Dodge, Ph.D.; E. Michael Foster, Ph.D.; Mark T. Greenberg, Ph.D.; John E. Lochman, Ph.D.; Robert J. McMahon, Ph.D.; and Ellen E. Pinderhughes, Ph.D.

Foster EM, Jones D. Can a Costly Intervention Be Cost-effective?: An Analysis of Violence Prevention . Arch Gen Psychiatry. 2006 Nov;63(11):1284-91.