U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention

John J. Wilson, Acting Administrator

From the Administrator

While most youth who enter the

juvenile justice system never return,

a small number of serious, violent

juvenile offenders reoffend repeatedly, accounting for a disproportionate amount of juvenile crime.

To enhance our understanding of

these troubled and often dangerous

youth, the Office of Juvenile Justice

and Delinquency Prevention established its Study Group on Serious and

Violent Juvenile Offenders. Expanding

upon OJJDP’s formative work on the

Comprehensive Strategy for Serious,

Violent, and Chronic Juvenile Offenders, the 22 juvenile justice experts

who constituted the Study Group

analyzed research on the development of serious and violent juvenile

offending and effective interventions

to prevent its recurrence.

This Bulletin describes some of the

developmental precursors to such

offending and offers effective approaches to its prevention that are

family, parent, and child focused.

Examples of well-designed intervention programs are also provided.

It is my hope that the information

contained in this Bulletin will help

communities better understand and

address serious and violent juvenile

offending.

John J. Wilson

Acting Administrator

May 2000

proximal risk factors, reviews the early

developmental precursors to violent offending, and summarizes approaches to

prevention. It also discusses components

of intervention programs; limitations of

single-focus preventions; examples of

well-designed, multisystemic intervention

programs that target proximal risk factors;

and limitations of prevention strategies.

Prevention of Serious

and Violent Juvenile

Offending

Gail A. Wasserman, Laurie S. Miller, and Lynn Cothern

Serious and violent juvenile (SVJ) offenders, although few in number, are responsible for a disproportionate number of

crimes. The Office of Juvenile Justice and

Delinquency Prevention (OJJDP) has built

a research base to increase understanding

of this group of offenders among policymakers, youth service providers, and the

public. OJJDP’s Study Group on Serious

and Violent Juvenile Offenders expanded

on the Comprehensive Strategy for Serious,

Violent, and Chronic Juvenile Offenders

(Wilson and Howell, 1993). For 2 years, the

Study Group of 22 researchers collaboratively analyzed current research on risk

factors, protective factors, and the development of SVJ offenders. This Bulletin focuses

on one aspect of this work—prevention.

The best predictor of antisocial adolescent behavior is early conduct problems.

Most serious offenders have a history of

childhood misbehavior, including antisocial behaviors such as physical aggression, conduct disorders, and disruptive,

covert, oppositional, and defiant behaviors. Identifying the risk factors for these

behaviors is important in developing strategies to prevent violent offending. Risk

factors may include distal or communitylevel risk factors, such as poverty or

access to guns or drugs, and proximal

risk factors, such as parent management

practices, deviant peer groups, or low

intelligence. This Bulletin explores these
2

Primary prevention addresses the disease

or disorder, such as antisocial behavior.

One example of primary prevention would

be to decrease low-weight births by eliminating maternal smoking. Secondary prevention detects early signs of a disorder,

such as ADHD or academic underachievement, and curtails or cures the problem.

Tertiary prevention addresses the disabilities or damages caused by a disorder,

for example, treatment of academic difficulties resulting from chronic depression.

Family- and Parent-Focused

Components

Effective family- and parent-focused programs have used one of three strategies:

parent management training, functional

family therapy, or family preservation.1

Parent management training. This method

attempts to influence child behavior by

teaching parents better parenting strategies.

Parents of children with behavioral problems tend to be inconsistent and punitive in

establishing and enforcing rules, which often causes children to use aversive behavior such as whining to manipulate their environment.2

 Parent management training

offers parents individual or group training

at a school or clinic where they learn to:

◆ Communicate clear expectations about

behavior to their children.

◆ Identify positive and negative behaviors.

◆ Recognize antecedents of problem

behaviors.

◆ Provide positive consequences for

positive behavior.

◆ Impose noncoercive negative consequences for inappropriate and

noncompliant behavior.

Parents are given homework assignments

to practice the skills they learn in class, and

they receive feedback from the therapist.

Parent management training programs also

promote positive, shared family experiences by “prescribing” joint parent-child

playtime or shared family recreational

activities.3

Early Developmental

Precursors

Professionals who work with youth at risk

for serious and violent offending come

from a variety of disciplines, including juvenile justice, education, and mental

health. Each discipline has different concerns, treatment approaches, and descriptive terms. In juvenile justice, for example,

minors who have committed actions that

courts have found to be illegal are described as juvenile delinquents. In contrast,

educators and mental health practitioners

refer to the same youth as antisocial, aggressive, disruptive, or, in more severe

cases, conduct disordered.

Because of these different perspectives,

treatments used by one discipline may not

be known or used by another. This is particularly true of attention deficit hyperactivity disorder (ADHD), a risk factor for

serious antisocial behavior. ADHD is one

of a group of disorders, including conduct

disorder and oppositional defiant disorder

(ODD), that are collectively known as disruptive behavior disorders. Some of the

symptoms of conduct disorder, such as

theft, rape, and arson, are illegal activities

but others, such as lying, are not illegal.

Many of the symptoms involve physically

aggressive or violent behavior. ADHD and/

or ODD usually develop before conduct disorder does; it is therefore likely that some

children with ADHD will develop conduct

disorder and thus juvenile delinquency.

From a multidisciplinary perspective,

ADHD is often overlooked as a risk factor

in programs that target the development

of antisocial behavior. This Bulletin also

examines interventions that target ADHD.

Approaches to

Prevention

Approaches to prevention may be universal, selected, or indicated. Universal programs address an entire population of

children, such as those in classrooms,

schools, or neighborhoods, and usually

address a community-level risk factor such

as neighborhood poverty rather than a delinquency outcome. Selected programs,

on the other hand, target high-risk children who may have already shown some

antisocial behavior. Indicated programs

are for those children who have been

identified as showing clear signs of delinquent or antisocial behavior.

A program can address a specific population at one of three levels of prevention.

Although evaluations of parent management training programs demonstrate substantial changes in parent and child behavior, followup studies show that 25–40

percent of children whose parents participated in these programs continue to have

clinically significant behavior problems.4

Families are less likely to benefit from these

programs if the parents have limited economic and personal resources, psychiatric problems, little social support, or serious marital conflict.5

 Also, if the training

focuses solely within the home, the lessons

may not be generalized to other environments such as the school.

Functional family therapy. This approach6

increases communication and mutual problem solving by specifying clear rules and

consequences for breaking them; developing clear and contingent parent-child

contracts that link good child behavior to

specified rewards; using social reinforcement such as praise; instituting a token

economy (the exchange of privileges for

good behavior); and relying on cognitively

based interventions. The functional family therapy approach has been found to

improve family communication and lower

recidivism of youth.7

Family preservation. This multisystemic

crisis intervention is intended to prevent

placement of a child outside the home as

a result of abuse, neglect, or delinquency.

Family preservation’s intense, short-term

services (10–20 hours per week for 4–6

weeks) entail a low caseload—caseworkers usually handle fewer than five families—and include parent management

training, didactic training in life skills,

home and budget management, assertiveness training, and coordination of community services.

Evaluations have shown that although they

decrease the number of children placed

outside the home, family preservation

methods fail to improve the situation of the

family (Feldman, 1991; Miller, 1995). The

individualization of services is an advantage over “packaged” services, but the

reliability of these programs is difficult

to track (Miller, 1995). Also, given the

1

 Bulletins in OJJDP’s Family Strengthening Series discuss the effectiveness of family intervention programs

and provide resources to families and communities. For

more information about Bulletins in this series, contact

the Juvenile Justice Clearinghouse at 800–638–8736,

301–519–5212 (fax), or askncjrs@ncjrs.org (e–mail).

2

 Patterson, Reid, and Dishion, 1992; Wasserman et al.,

1996.

3

 Barkley, 1987; Eyberg and Boggs, 1989; Forehand

and McMahon, 1981; Hawkins et al., 1992; WebsterStratton, 1984.

4

 Forehand, Furey, and McMahon, 1984; WebsterStratton, 1991.

5

 Forehand, Furey, and McMahon, 1984; Strain,

Young, and Horowitz, 1981; Wahler, 1980; Wahler and

Dumas, 1984.

6

 Alexander et al., 1976; Alexander and Parsons, 1973;

Barton et al., 1985; Klein, Alexander, and Parsons, 1977.

7

 Alexander et al., 1976; Alexander and Parsons, 1973;

Klein, Alexander, and Parsons, 1977.
3

to others than they were before the

program.

◆ Under the Positive Adolescents Choices

Training (PACT) program, African American middle school students were trained

to give and accept feedback, resist peer

pressure, solve problems, and negotiate effectively (Hammond and Yung,

1991, 1992; Brewer et al., 1995). Suspensions and expulsions decreased among

students in the intervention group and

increased among students in the control group. Unfortunately, this study

encountered a number of problems.

Intervention and control groups may

not have been comparable at baseline,

teachers were not blind to the assignment of students to the two groups,

and the authors did not present the

statistical significance of their results

(Brewer et al., 1995).

◆ Lochman’s school-based anger coping

(AC) program helped aggressive and

disruptive boys understand the physiology of aggression, especially anger,

and taught them coping strategies such

as self-talk (e.g., calming oneself down

by telling oneself, “Maybe he didn’t

mean that. If I start a fight, I’ll get put

in detention”).10 Three years later, the

intervention group reported less substance abuse and greater self-esteem

and social problem-solving skills. However, neither self-reported delinquency

rates nor observations of classroom

behavior indicated a difference between

intervention and control groups. Researchers concluded that the program’s

long-term effects could be enhanced by

adding parent training (Lochman, 1992).

Academic skills enhancement. Poor

school achievement, poor attendance, and

school suspensions contribute to antisocial

behavior (American Psychological Association, Commission on Violence and

Youth, 1993). A review of the effects of welldesigned programs on the academic and

behavioral outcomes of at-risk youth found

that these programs have a positive impact

on academic functioning (Maguin and

Loeber, 1996; Moffitt, 1990). The most

effective are law-related moral education

programs, which educate youth about the

role of law in society (Arbuthnot and Gordon, 1986; Gottfredson and Gottfredson,

1992). Many academic programs, however,

target elementary or high school students

who have already developed academic and

behavioral problems. This may be the reason that programs offering reading instruction and tutoring are less effective than lawrelated education. Basic skills programs

may be more effective with younger children (Kellam et al., 1998).

Medication. ADHD, a common risk factor

for conduct disorder, is commonly and

effectively treated through psychostimulant medication (Abikoff and Klein, 1992;

Spencer et al., 1996), which can reduce

symptoms of inattentiveness, motor overactivity, and impulsiveness. The medication

can also improve poor peer interactions

(Gadow et al., 1990; Pelham et al., 1993) and

improve short-term academic functioning

for youth with ADHD (Greenhill, 1995).

The effect of medication on conduct disorder is not yet known, largely because of

the great overlap between children with

ADHD and conduct disorder. However, improvements in the behavior of children

diagnosed with both ADHD and conduct

disorder who are treated with stimulant

well-publicized instances of the failure of

social services to prevent the abuse and

death of children remaining in the home,

this approach may not always be the most

effective.

Child-Focused Components

Social competence training. Children

who lack social and cognitive skills tend

to be aggressive (Huesmann et al., 1992).

They fail to pay attention to social cues

(Dodge, Bates, and Pettit, 1990), have

poorer problem-solving abilities (Rubin

and Krasnor, 1986), and exhibit less empathy than their peers. Social competence

training helps youth learn positive social

behaviors (e.g., conversational skills,

academic achievement, and behavioral

control strategies) and to improve socialcognitive processes (e.g., problem solving

and self-control). These programs, often

school-based, focus on the consequences

of physical aggression or coercion and

are neither used to treat serious conduct

problems nor focused on covert antisocial behavior such as stealing or vandalism. Some examples of social competence

training programs follow:

◆ The Interpersonal Cognitive ProblemSolving curriculum uses games ranging

from simple word concepts to strategies

for finding solutions to interpersonal

problems, and for thinking consequentially and learning to empathize. Children in this program become less aggressive, more socially appropriate,

and better able to solve problems.8

◆ Kazdin’s social competence training

program9 treats antisocial psychiatric

inpatients and outpatients using the

methods described above. Participants

often made long-standing therapeutic

gains at home and in school but continued to exhibit deviant behavior after

the training.

◆ The Brainpower program seeks to reduce the number of times that African

American boys with high teacher/peer

ratings for aggressiveness attribute

hostile intentions to other people in

ambiguous scenarios (situations in

which the motivation of the participants

is unclear) (Hudley, 1994). After completing 12 weeks of cognitive retraining,

late-elementary school children were

less likely to attribute hostile intentions

8

 Shure and Spivack, 1980, 1982, 1988; Spivack and

Shure, 1989.

9

 Kazdin et al., 1989; Kazdin et al., 1987b. 10 Lochman, 1992; Lochman et al., 1984; Lochman and

Curry, 1986.
4

medications indicate that medication may

be useful in the treatment of conduct

disorder alone (Hinshaw, 1991; Spencer

et al., 1996).

Abikoff and Klein (1992) note the following

limitations of using stimulant medication

as a single intervention in treating ADHD:

◆ Medication wears off by the end of the

day, creating management problems at

home.

◆ Treatment gains are short-lived and limited to the length of the medication’s

effects.

◆ Not all children respond positively to

medication.

◆ Some families are unwilling to use

medication.

Other interventions. Other youth-focused

interventions include individual psychotherapy and behavioral anger control programs; however, there is little evidence

documenting the effectiveness of these

interventions for preventing antisocial

behavior (Tolan and Guerra, 1994).

Classroom-Focused

Components

Classroom contingency training. These

interventions may be classroom or individually based, but they take place within

the classroom as opposed to the entire

school. Classroom contingency training

applies the techniques of parent management training to the classroom by establishing clear routines and expectations

about attendance, behavior, and classroom procedures (Hawkins, Doueck, and

Lishner, 1988). Teachers are trained to

provide targeted and contingent encouragement and praise. Research has found

that disruptive behavior and vandalism

costs decreased in intervention schools

while they increased in control schools.11

Academic skills enhancement. Hawkins,

Doueck, and Lishner (1988) combined

classroom contingency training with

academic skills enhancement. The program also included teacher training and

supervision, proactive classroom discipline, use of student learning partners,

and clear learning objectives. At the end

of the academic year, students exposed to

the intervention were more positive, and

school disciplinary problems were fewer

among children who received classroom

contingency training than among those

who did not. There were no effects on

delinquency, however.

Token economy. In a Baltimore, MD, program, children in grades 7 to 9 with a history of suspensions were assigned to

small classes of 10 to 15 students (Safer,

1996). In a token economy, they received

points for good behavior that could be

used for privileges, including a shortened

school day. The program also attempted

to develop a home-based token economy

with parents. Youth in the intervention

group had fewer expulsions or suspensions, but there were no differences in

attendance or standardized achievement

scores. The program may have had longerterm effects, however. After students in

the intervention group completed the

program, they were more likely to enter

high school and have better attendance

and classroom behavior while there than

those in the control group.

Peer Group-Focused

Components

Peer mediation. Peer mediation programs

(Hawkins, Catalano, and Brewer, 1995) train

youth to act as mediators in school settings

by listening, communicating, identifying

points of agreement, and arriving at nonviolent solutions to conflicts (Brewer et al.,

1995). Most evaluations of these programs

have not been properly designed, and few

have shown positive effects (Lam, 1989).

Conflict resolution. School-based conflict

resolution programs are popular and

widely used in middle and high schools.

These psychoeducational programs increase students’ knowledge of the causes

and consequences of violence, improve

students’ self-control, and help students

develop social problem-solving skills.

Evaluations of some new programs that

suggest promise have emerged recently

(since the preparation of Loeber and

Farrington, 1997).

The Resolving Conflict Creatively Program

(RCCP) attempts to alter social processes

in elementary school children by changing classroom contexts, training staff and

students in conflict resolution, and promoting peer mediation (Aber et al., 1998).

Over the course of a school year, children

in classrooms where materials were presented showed lower levels of aggressive

fantasies and other social cognitive processes usually associated with aggressive

behavior. Another program for elementary

school children (Stevahn et al., 1996) compared promoting cooperative learning in

the classroom with didactic training in

conflict resolution in curriculums that

are integrated into academic programming.

Children exposed to both components

showed the most learning and retention

of conflict resolution strategies. Moving

beyond children’s responses to paper-andpencil measures is very much a concern

in this field, so that research needs to be

evaluated in terms of behavioral changes

that would indicate an impact on serious

and violent juvenile offending. One welldocumented program that has shown behavioral effects is the Second Step Curriculum (Grossman et al., 1997); direct

observations showed decreases in physically negative behavior that were maintained 6 months later. Preliminary results

from RCCP also suggest that the program

has a positive impact on teacher ratings

of children’s aggressive and prosocial behavior (Aber, Brown, and Henrich, 1999).

Webster (1993) is skeptical about the effectiveness of conflict resolution programs

for a number of reasons. First, these standardized programs assume that all students

are similar, when in fact youth begin exhibiting antisocial behavior at different points

and in response to different risk factors.

These programs are likely to intervene too

late in the development of youth whose

social skills deficits originate in childhood.

Second, social skills deficits, which these

programs try to remedy, may not be at the

root of interpersonal violence, so addressing the deficits will not necessarily reduce

the violence. Third, these programs may

not be sufficient because many other factors contribute to youth violence.

Examples of

Well-Designed

Programs

Much can be learned from established

programs. The following are systematically evaluated multicomponent programs

that focus on children at three developmental periods: preschool age, including

infants and toddlers; elementary school

age; and adolescence. These programs

may influence later antisocial behavior.

Programs for Preschool-Age

Children

Programs targeting children before they

enter school can address a range of individual and family risk factors that are precursors to antisocial behavior. Unfortunately, 11 Mayer and Butterworth, 1979; Mayer et al., 1983;

Sulzer-Azaroff and Mayer, 1994.
5

few of these programs have been tested

longitudinally because of cost and difficulty. Those that have been evaluated are

discussed in more detail below.

Early intervention programs for preschoolage children may help prevent antisocial

behavior, particularly because they intervene through the child’s broad environment rather than through a single risk factor. Because some of these programs were

instituted in the 1960’s, 10-year longitudinal

studies have been completed for the Syracuse University Family Development Research Project, the Yale Child Welfare

Project, the Houston Parent Child Development Center, and the High/Scope Perry

Preschool Project.

Although the results of these programs

have been encouraging (Yoshikawa, 1995),

the mechanisms of change could not be

identified. The programs shared a number

of features. They were intensive, included

home visits, and addressed the child’s

early development, some before birth.

They also included child education and

family support, a theoretical basis with

curriculums specified in treatment manuals, low staff-to-child/parent ratios, extensive training, and child- and familyfocused components.

Universal interventions. The Montreal

Home Visitation Study (Larson, 1980), an

example of a universal intervention for

infants and toddlers, tested the effects of

home visits on 115 women. The visits focused on caretaking, mother-infant interaction, the mother’s social support and social

interactions, and child development. Children in families that received prenatal and

postnatal visits sustained fewer injuries

than children in the other groups and also

received higher scores on the quality of

the home environment provided to them.

These interventions address risk factors

on a number of levels. For example, the

Syracuse University Family Development

Research Project (Lally, Mangione, and

Honig, 1988) provided educational, nutritional, health, safety, and human services

resources to 109 low-income, primarily

African American families. The program,

which also included home visits and quality childcare, decreased the children’s involvement with the juvenile justice system. When the children were between 13

and 16 years old, 4 of the 65 treated children had probation records at followup,

compared with 12 of the 54 children in the

control group.

The Yale Child Welfare Project12 targeted 17

impoverished, pregnant, African American

women between 1968 and 1970, matching

them with controls. The program provided

a variety of services that began during

pregnancy and continued until the children were 30 months old, including an average of 13 months of childcare. Ten years

later, mothers in the intervention group

had more education, were more likely to

be employed, and had fewer children who

were spaced farther apart, compared with

mothers in the control group. Children in

both groups remained the same in IQ and

academic achievement, but children in the

intervention group had better attendance

records and exhibited less antisocial behavior than those in the control group.

The Houston Parent Child Development

Program (Johnson and Walker, 1987) provided home visits, classes for mothers,

and 4 half-days per week of preschool for

children more than 2 years old in lowincome Mexican American families. In a

5- to 8-year followup, treated children

were found to be less obstinate, hostile,

and aggressive than children in the control group. Attrition from the program,

however, was very high.

The PARTNERS program supplemented

Head Start programs by providing training

to parents and teachers to promote consistency from home to school (WebsterStratton, 1998). Parents receiving training

were more positive, less critical, and used

less physical discipline than parents not

receiving training. Seventy-one percent of

parents in the experimental group showed

a decrease in critical statements compared

with 29 percent of parents in the control

group. Children in the experimental group

were more compliant and prosocial and

displayed less negative behavior than

those in the control group. Also, most eligible parents signed up for the program,

and participant satisfaction was high.

Selected interventions. The University of

Rochester Nurse Home Visitation Program,

an example of a selected intervention for

infants and toddlers, recruited 400 lowincome women who were pregnant and

raising children in semirural New York

(Olds et al., 1986; Olds et al., 1988). The

program offered four levels of intervention, including information and support

for child health and development, free

transportation to prenatal and well-child

medical visits, home visits by nurses during pregnancy, and followup visits until

the child’s second birthday.

The program found that treated mothers

who smoked were more likely to have

full-term, heavier babies than untreated

mothers who smoked. Treated mothers

were also less likely to punish their children or to be seen in emergency rooms

or by physicians for infant poisonings and

injuries. They were also more likely to provide their children with appropriate play

materials, return to school, be employed,

and delay future pregnancy (Olds, 1996).

The authors of a separate cost analysis

(Olds et al., 1993) found that the program saved the Federal Government

$1,772 per family (in 1980 dollars) and

$3,498 per low-income family, including

Aid to Families With Dependent Children,

child protective services, Medicaid, and

food stamps. These figures do not take

into account any long-term savings resulting from delinquency prevention.

The goal of the High Scope/Perry Preschool Project, a selected intervention

for preschoolers, was to prevent school

failure in poor 3- to 4-year-old African

Americans (Berrueta-Clement et al., 1984).

The program provided home visits and

monthly small group meetings for parents.

Children in the intervention group performed better academically, were more

likely to graduate from high school and

be employed, and were less likely to be

12 Provence and Naylor, 1983; Provence, Naylor, and

Patterson, 1977; Rescarla, Provence, and Naylor, 1982;

Seitz, Rosenbaum, and Apfel, 1985; Trickett et al., 1982.
6

on welfare than children in the control

group. Rates of juvenile delinquency

also were reduced.

Programs for Elementary

School Children

Universal interventions. The Seattle Social

Development Project, a universal intervention for elementary school children, is one

of the few programs to report significant

long-term reductions in violent criminal

behavior.13 The program offered parent

management training, social competence

training, and support for academic skills to

increase the child’s attachment to school

and family, reduce involvement with antisocial peers, and reduce aggressive behavior. Six years after program completion, students reported a lower incidence

of violent criminal behavior, heavy drinking, sexual intercourse, and pregnancy

(Hawkins et al., 1999). They also reported higher academic achievement

and less misbehavior in school. Checks

of school and court records supported

these reports, although not at statistically

significant levels.

The 2-year Baltimore Prevention Study

examined academic and behavioral interventions in three schools.14 While teacher

ratings of shyness and aggression were

lower and reading achievement was higher

in the intervention groups after 1 year,

the effects on behavior did not continue

after the end of intervention, particularly

for girls.

The practice of using teachers in universal

programs both to implement the program

and to evaluate change in participating

children biases the ratings. Using multiple

informants (persons supplying data to the

investigator) across settings will result in

more accurate and less biased evaluation

(Hawkins et al., 1992).

Selected interventions. Tremblay and colleagues, in a selected intervention for

elementary school children, used parent

management training and social competence training in a 2-year program, which

resulted in lower rates of delinquency

among treated boys after 6 years.15 Another

selected intervention, the FAST Track

program, addresses rural and urban kindergarten children and ethnic groups

with high rates of disruptiveness (Conduct

Problems Prevention Research Group,

1992). The program intervenes at school

entry and between elementary and middle

school and uses parent management training, weekly home visits, social competence

training, academic tutoring, and classroom

contingency training, which allows for

integration across settings. Results have

included more appropriate parenting,

greater problem solving among children,

and less disruptive and aggressive behavior (Conduct Problems Prevention

Research Group, 1996).

The Metropolitan Area Child Study addresses children’s understanding of their

context and social environmental risk

factors through classroom and family intervention, social competence training,

and parent management training.16 This

program shares important features with

the FAST Track program. They both use

multiple-stage screening procedures to

target high-risk children. They also use

randomized experimental designs with

multiple measures and multiple informants for assessment. Intervention

broadly targets the child and family in

both school and home settings. The programs also are sensitive to the communities in which they are implemented.

Children with ADHD, who are at greater risk

for antisocial behavior, can benefit from

selected interventions that include medication. Hinshaw and colleagues (1998) examined two types of behavioral programs:

direct contingency management procedures and those involving parent management training plus teacher consultation.

They found that these approaches can be

effective in combination with medication,

but that medication alone is more effective

than behavioral treatment alone.

Firestone and colleagues (1981) looked at

7-year-olds with ADHD who were treated

with parent management training alone,

medication alone, or both. Only medication enhanced attention and impulse control. Medication also improved academic

achievement more than parent management training alone. Gittelman and colleagues (1980) studied three groups of

6- to 12-year-olds, each of which received

one type of treatment: a combination of

parent management training and school

consultation; stimulant medication; and

both the training/consultation and medication. The latter group improved the most.

The group that received only medication

improved to a lesser degree, and the behavior management group improved the least.

Another study (Horn et al., 1991; Ialongo

et al., 1993) assigned 96 families with

ADHD children to one of six groups that

received either a placebo, a high dose of

medication, or a low dose of medication.

Half the children in these families also

received social competence training, with

their parents receiving parent management training. Researchers found that

combined treatment had no advantage

over medication alone and that none of

the groups maintained treatment gains

nine months later.

Pelham and coworkers (Carlson et al.,

1992; Pelham et al., 1993) examined a

treatment that combined stimulants and

classroom contingency training for boys

13 Hawkins et al., 1999; Hawkins, Von Cleve, and

Catalano, 1991; O’Donnell et al., 1995.

14 Kellam and Rebok, 1992; Kellam et al., 1994; Kellam

et al., 1991.

15 McCord et al., 1994; Tremblay, Mâsse et al., 1992;

Tremblay et al., 1991; Tremblay et al., 1995; Tremblay,

Vitaro et al., 1992; Vitaro and Tremblay, 1994. 16 Guerra et al., 1996; Guerra et al., 1995; Tolan and

McKay, 1996.
7

with ADHD at an intensive summer camp.

Medication, with or without classroom

contingency training, improved all behavioral and academic outcomes. The training,

without medication, improved only behavioral outcomes. Another study by this

group suggested that children with ADHD

who receive behavioral treatments might

be able to take less medication than those

who receive medication alone (Carlson

et al., 1992).

The longest trials of behavioral techniques

in comparative treatment studies for ADHD

have lasted only a few months. These comparative studies have only begun to build

on successful treatment components. One

early promising study (Satterfield, Satterfield, and Schell, 1987) found that longterm treatment packages that included

individual, family, and educational therapy

tailored to families’ needs were effective

in increasing academic skills and decreasing antisocial behavior.

Long-term, multicomponent treatment

packages may be best for treating children

with ADHD and may result in reduced delinquent behavior, as indicated by the New

York/Montreal Study (Abikoff and Hechtman, 1996). The largest study of this kind,

the National Institute of Mental Health

(NIMH) Multimodal Treatment Study of

Children with ADHD, cosponsored by the

U.S. Department of Education, Office of

Special Education Programs, involves 576

children (MTA Cooperative Group, 1999a,

1999b). It will evaluate the long-term effectiveness of medication or behavioral

treatment compared with a combination

of the two, at the same time comparing

these approaches to community care.

Psychostimulant medication is useful in

treating children with ADHD, but research

has not yet shown whether it can prevent

antisocial behavior in the long term. It

allows children to function better in the

short term, giving them the chance to

develop adaptive, protective skills.

Indicated interventions. Webster-Stratton

and Hammond (1997) conducted an indicated intervention for elementary school

children that divided families into a parent

management training group, a child training group, a child and parent training

group, and a waiting-list control group.

At the end of intervention, all three intervention groups had made significant

improvements that were maintained at a

1-year followup. Although the combined

group showed the most significant improvements in child behavior at followup, all

three groups showed decreased conduct

problems as reported by teachers.

Kazdin, Siegel, and Bass (1992) studied

97 children who had been in a child psychiatric hospital (Kazdin et al., 1987a) or

who had been referred for antisocial behavior problems to parent management

training, social competence training, or

both (Kazdin, Siegel, and Bass, 1992). One

year after treatment, both inpatient and

outpatient children and families who had

received combined treatment had improved their behavior, but only 50 percent

of these children moved into the normal

range of behavior problems, according to

parents and teachers (see also Kazdin et

al., 1987a).

Programs for Adolescents

Most youth who exhibit serious antisocial

behavior begin to do so by age 15. At this

point, it is usually easy to identify these

youth, but their behaviors may be so entrenched that they are resistant to change.

Also, adolescent peer groups, which exert

a powerful influence, are often targeted for

change or as a vehicle of change. That is,

the individual is encouraged to give up his

or her group, or members of the group are

used as counselors or mediators. Programs

for adolescents are less likely to involve

families than programs for other ages,

although the family still has a profound

influence on the youth.

Universal interventions. Aimed at reducing violence or resolving conflict, universal

interventions for adolescents are a recent

development;17 many of them target African

American youth.18 However, these programs have several problems, including:

◆ Reliance on self-report measures or

nonblind teacher evaluations that are

subject to bias.

◆ Use of anger control strategies that do

not have demonstrated effectiveness

(Tolan and Guerra, 1994).

◆ Lack of randomized assignment to intervention and control groups.

◆ High attrition rates (see Brewer et al.,

1995, for a review).

◆ Paradoxical effects, which may reflect

treatment unreliability or may lead to

worsened outcomes for some groups

of children.

Farrell and Meyer (1997) experienced this

last problem in a study testing a social

skills and problem-solving curriculum for

African American sixth graders. Boys in

both the intervention and control groups

had an increased number of problems during the study, although boys in the intervention group experienced a lower rate of

increase than did boys in the control group.

The rate of increase was higher among

girls in the intervention group than among

girls in the control group. The distinction

may have been caused by differences in

patterns of aggression among girls or by

the mixed-sex groups and male group

leaders used in the study.

Orpinas and colleagues (1995) examined

the Second Step curriculum (Committee

for Children, 1990), a conflict resolution

program using peer mediators. The study

reported that the intervention had no effect on aggressive behavior and produced

marginal improvements elsewhere. However, the choice of school or classroom

was not random (only “good” teachers

were assigned to implement the program),

and only self-report measures were used.

Selected interventions. Gottfredson

(1986) evaluated a selected intervention

for adolescents, Positive Action Through

Holistic Education (PATHE), a multicomponent school-based program for impoverished 11- to 17-year-olds. The program

sought to improve student attachment to

school, academic success, self-esteem,

17 Brewer et al., 1995; Hawkins, Catalano, and Brewer,

1995.

18 Hammond and Yung, 1991, 1992; Ringwalt et al., 1996.
8

and student-faculty communication through

teacher training and student counseling,

tutoring, and a student leadership system.

Communication with families was also enhanced. The program had no effect on antisocial behavior, and participants reported

higher drug involvement at posttest.

Gottfredson and Gottfredson (1992) evaluated Project STATUS, a supplemental lawrelated and moral development curriculum,

in which students took part in field trips

and structured role-play. This curriculum

positively affected academic performance,

as demonstrated by higher grades and

graduation rates for students in the intervention group. The same students also

reported less delinquency and drug use

and higher self-esteem than did students

in the control group.

Gabriel (1996) evaluated Self-Enhancement,

Inc., a violence prevention program for

African American students in grades 8 to

10. The program sought to enhance intermediary protective factors such as selfcontrol, self-efficacy, social competence,

and social bonding through field trips,

conflict resolution, and student-led antiviolence campaigns. Attrition was 28 percent, and targeted protective factors did

not improve. Intervention students reported decreased fighting and weapon

carrying after 1 year in the program.

Indicated interventions. Henggeler and

colleagues have examined multisystemic

therapy as an indicated intervention for

adolescents.19 Because this approach

specifically targets serious juvenile offending, the results are especially important.20

Multisystemic therapy combines family

therapy, parent management techniques

for older children, and problem-focused

interventions in peer and school settings

in an intensive family preservation treatment program. It has been found to increase family cohesiveness (Henggeler,

Melton, and Smith, 1992), increase the

adaptability and support of families of

serious juvenile offenders (Borduin et al.,

1995), and decrease father-mother and

father-child conflict (Henggeler and

Blaske, 1990). Treated adolescents were

less likely to be rearrested and spent

fewer days incarcerated than adolescents

in the control group (Henggeler, Melton,

and Smith, 1992). Overall recidivism for

those completing multisystemic therapy

was 22 percent; for those completing individual therapy, the rate was 71 percent.

Treatment gains were maintained, even at

the 4-year followup (Borduin et al., 1995).

The dropout rates for those receiving

multisystemic therapy were 10 percent

and 15 percent, compared with 38 percent

and 25 percent for those receiving individual therapy (Borduin et al., 1995;

Henggeler, Melton, and Smith, 1992),

probably because multisystemic therapy

targets three or more systems and individual therapy usually targets only one.21

Limitations to

Prevention Strategies

Evaluations of these prevention strategies

have brought to light a variety of problems,

including recognizing developmental issues

for children and adolescents, defining and

measuring outcomes, and relating selection

criteria and targeted outcomes to risk

factor research, and other practical issues,

all of which are discussed below. Careful

consideration of these problems will help

researchers and programmers design

programs that better identify and address

targeted risk factors and outcomes.

Recognizing Developmental

Issues

Infants and toddlers. Programs for infants

and toddlers focus on parent-child interactions through education and provision

of emotional and practical support to the

primary caregiver. They often target poor

families and are delivered in the hospital

or the family’s home. However, these intervention programs have not been standardized and thus may not be highly reliable

or easily disseminated. They do not include behavioral management techniques

for parents that can reduce antisocial

behavior among children and adolescents.

Finally, long-term followup on child behavior has been limited, focusing instead on

care of the child and child adjustment,

especially in terms of health.

Preschool children. Most programs for

preschool children have not included parent management training. Preschool interventions have not targeted peer relations,

which are indicators of outcome. Although

some of these programs have included

long-term followup and have shown positive effects on antisocial behavior, researchers have not been able to attribute

these positive outcomes to a specific

cause. The complex social and economic

changes of the past 20 years make analysis difficult (Yoshikawa, 1995). Current

studies should therefore include the standardized interventions described in

manuals and regular evaluations so that

successful programs can be replicated.

Elementary school children. Programs for

elementary school children are usually

school based. Unfortunately, families are

not often involved in these programs, and

children thus tend to drop out. Even if a

program offers parent groups, not all parents will take advantage of them. These

programs also rarely assess or address

20 Borduin et al., 1995; Henggeler et al., 1996; Henggeler

et al., 1993.

21 OJJDP supports multisystemic therapy programs.

For more information about multisystemic therapy, see

Henggeler, 1997, and Muller and Mihalic, 1999.

19 Borduin et al., 1995; Henggeler and Blaske, 1990;

Henggeler and Borduin, 1990; Henggeler et al., 1996;

Henggeler, Melton, and Smith, 1992.
9

ADHD. An additional problem in the design of school-based programs is the effect

of “spillover,” which occurs when both

control and intervention classrooms are

located within the same school. Control

classrooms may adopt elements of the

intervention (spillover), thus affecting the

results of the study.

Adolescents. Programs for adolescents

often focus on educational approaches but

lack family components, especially in universal programs where it is difficult to involve parents of nonreferred adolescents.

If the family is not involved, the youth may

have difficulty internalizing and generalizing intervention lessons across settings.

This may be one reason why conflict resolution programs show such uneven results

and sometimes paradoxical effects. Evaluators of conflict resolution programs

should supplement their usual psychoeducational approach with information from

independent records, such as arrest data

(Bry, 1982; Bry and George, 1980) or vandalism records,22 or raters who are blind

to the intervention; otherwise, the success of the curriculums will not be measurable (Webster, 1993).

Defining and Measuring

Outcomes

Defined targets. Programs should have

clearly defined targets. These should be

outcomes that are developmentally linked

to antisocial behavior or to specific risk

or protective factors. Targeting hypothesized risk factors such as moral reasoning may not result in a corresponding

change in child behavior.

Effectiveness. When some risk factors,

such as family process or early disruptive

behavior, are targeted, effect sizes are

small, even when the targeted processes

are influenced and the changes are statistically significant. The effectiveness of the

intervention may be called into question

because the targeted process is influenced

by a variety of factors that are highly interwoven and cannot be changed by a singlefocus intervention. One exception is medication studies of children with ADHD,

which show large effect sizes for inattention and disruptiveness or substantial gains

1 year after the treatment (Kazdin et al.,

1987a; Kazdin, Siegel, and Bass, 1992).

Specificity. Specificity is another issue.

Although antisocial children are likely to

have certain deficits, not all of them will

show the same pattern of problems. It is

important to choose an intervention that

directly addresses an identified deficit in

a subgroup of children. Otherwise, the

intervention or treatment evaluation may

give the false impression that the program

was only moderately effective, when in

fact it was very effective with a subgroup

of children. More research needs to be

done to determine which interventions

are most effective for specific risk factors.

Neglected outcomes. Studies also should

address neglected outcomes. Most interventions focus on overt aggressive behavior, with insufficient attention paid to covert antisocial acts. Although physical

aggression is easily observable, most later

delinquency is covert in nature.

Long-term followup. Most studies have not

included long-term followup, even at 1 year.

Without it, long-term maintenance of treatment gains cannot be demonstrated.

Gender. Because the development of antisocial behavior may be different for boys

and girls, gender must be considered in

program design (Wasserman, 1996). Most

interventions are designed with boys in

mind and have been applied only to boys.

When applied to girls, they may be less

effective (Farrell and Meyer, 1997; Kellam

et al., 1998). As a result, designers of prevention programs should consider new

research on female antisocial behavior

(Crick, Bigbee, and Howes, 1996; Crick

and Grotpeter, 1995; Zoccolillo, 1993).

Relating Selection Criteria

and Targeted Outcomes to

Risk Factor Research

Categories of risk factors for delinquency

and violence have been conceptualized in

a variety of ways. Hawkins and Catalano

(1993), for example, define categories of

risk at the levels of community, family,

school, and so on. However, these categories do not readily correspond to the selection criteria or outcomes studied in

prevention research. That is, risk factors

for serious, violent juvenile offending are

not necessarily the outcomes targeted by

preventive interventions. The problem lies

in distinguishing between those factors

used to select children at high risk and

those factors that are themselves targets

of intervention. For example, community

risk factors such as poverty are commonly

used as selection criteria for studies, but

they are often inaccurate indicators of

individual risk and are seldom targeted

for intervention. The opposite tends to be

true with family risk factors. Families are

assumed to have family management problems if they are selected on the basis of

other risk factors, such as the child’s aggressive behavior or poverty.

School and individual risk factors that are

used as selection criteria are often the

focus of intervention. However, targeted

outcomes based on these criteria may not

be linked to offending. For example, social

competency, peer relations, self-control,

ethnic identity, or student-faculty communication have not been proven to contribute to antisocial behavior, nor have they

been proven to be protective factors that

will lessen the risk for antisocial behavior.

Protective factors are not simply the opposite of risk factors.

Some risk factors have not been widely

examined in prevention research. Family

history of problem behavior is an excellent

selection criterion,23 and younger siblings

of delinquents are an obvious, but underaddressed, target group. As discussed

above, ADHD is an important selection

criterion and intervention target, but programs targeting delinquency have yet to

address the disorder systematically.

Practical Issues

Limitations of single-focus preventions.

Antisocial behavior is rarely the result of

a single risk factor.24 Youth live in layered

and complex environments that contain

multiple risk factors at different levels. As

a result, successful approaches to prevention must incorporate components directed at more than one type of risk factor.25

Designers of prevention programs must

consider:

◆ Available institutional resources. For

example, is the school able to run the

program?

◆ The family environment. For example,

will the family become involved? Does

the family have other problems that

need to be addressed?

◆ The child’s chronological age and developmental level. For example, what

interventions are appropriate given the

23 Cadoret, 1991; Patterson, 1984; Rowe and Gulley,

1992; Wasserman et al., 1996.

24 Elliott, Huizinga, and Ageton, 1985; Patterson, Reid,

and Dishion, 1992; Simcha-Fagan and Schwartz, 1986.

25 Coie and Jacobs, 1993; Dodge, 1993; Tremblay et al.,

22 1995. Mayer et al., 1983; Mayer and Butterworth, 1979;

Sulzer-Azaroff and Mayer, 1994.
10

child’s developmental level? Is the child

facing a school transition, such as entry

into a new school?

Antisocial behaviors and the impact of risk

factors vary with a child’s age and development. Transitions between school levels

are important intervention points (Coie

and Jacobs, 1993), partly because they

reconstitute the child’s peer group. At

such transitions, other risk factors, such

as neighborhood influences on the school,

come into play.

Recruiting and retaining participants.

Two practical problems hamper the design

and implementation of research studies

and programs that target serious and violent juvenile offending. The first problem

is the feasibility of recruiting and retaining participants. Although school-based

programs are popular because children

provide a “captive audience,” it is difficult

to involve families in these programs. Outpatient child psychiatry clinics also have

a high rate of missed appointments among

families with antisocial children. Retaining control-group families is even more

difficult.

In a pilot randomized clinical trial in New

York City, Miller and Klein (1996) used a

variety of methods to maintain parent participation. The program paid families for

assessments and for the costs incurred in

attending the clinic, provided food, performed initial assessments in families’

homes, and sent holiday cards to families.

Each family provided the telephone numbers and addresses of two family members

or friends so that families involved in the

program could be contacted, and family

members in both the control and intervention groups received referrals for services.

When appropriate, bilingual interveners

conducted home visits in Spanish. The

study had a low attrition rate of 10 percent

and, using a consumer satisfaction questionnaire (Webster-Stratton, 1989), researchers found that satisfaction among

parents was high.

Identifying necessary components. The

second practical problem is identifying

necessary components. As noted earlier,

multifaceted interventions that target

the development of chronic aggression

are the most effective. Because home

and peer settings establish and maintain

antisocial behavior, interventions that

include parent management training and

a peer component are more successful.

Programs also should enhance academic

skills and provide for the treatment of

conditions such as ADHD. If interventions

take place early in the child’s development

and later during developmental transitions, such as those between school levels,

the child will be better able to generalize

one set of skills across all settings.

Conclusion

Research on the prevention of serious and

violent juvenile offending reveals many

useful lessons:

◆ Successful interventions are those that

address multiple risk factors.

◆ Single-focus interventions are unlikely

to be effective because antisocial behavior emerges from a complex array

of risk factors.

◆ Programs that involve the family will be

more effective than those that do not.

◆ Programs that identify and refer for

treatment children with ADHD or other

disorders will have more powerful, longrange effects than those that do not.

◆ Interventions that are successful with

specific groups of youth may not transfer to a universal setting where fewer

youth exhibit similar problems.

◆ Interventions must have a theoretical

basis and be clearly and concretely described so that they can be systematically evaluated and replicated.

◆ Researchers must consider the child’s

development and larger context, regardless of the chronological age or risk factors involved.

Keeping these lessons in mind, researchers and program planners can design more

effective long-term interventions to prevent serious, violent juvenile offending.

For Further Information

The following publications are available

from the Juvenile Justice Clearinghouse

(JJC). For more information or to order a

copy, contact JJC, 800–638–8736 (phone),

301–519–5600 (fax), puborder@ncjrs.org

(e-mail), www.ojjdp.ncjrs.org (Internet).

◆ Summary of Study Group’s Final

Report. To help communities and practitioners learn more about serious and

violent juvenile offenders, OJJDP released a Bulletin that summarizes the

Study Group’s final report. The 8-page

Bulletin, Serious and Violent Juvenile

Offenders (May 1998), is available (free

of charge) from JJC.

◆ Final Study Group Report. The Study

Group’s final report, Never Too Early,

Never Too Late: Risk Factors and Successful Interventions for Serious and

Violent Juvenile Offenders (Loeber and

Farrington, 1997), is also available (for

a fee) from JJC.

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15

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policies of OJJDP or the U.S. Department of

Justice.

The Office of Juvenile Justice and Delinquency Prevention is a component of the Office of Justice Programs, which also includes

the Bureau of Justice Assistance, the Bureau

of Justice Statistics, the National Institute of

Justice, and the Office for Victims of Crime.

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Acknowledgments

This Bulletin is based on Chapter 10, “The Prevention of Serious and Violent Juvenile

Offending,” by Gail A. Wasserman and Laurie S. Miller (1998), in Serious and

Violent Juvenile Offenders: Risk Factors and Successful Interventions, edited by

Rolf Loeber and David P. Farrington. Thousand Oaks, CA, Sage Publications.

Gail A. Wasserman, Ph.D., is Professor of Clinical Psychology in the Department

of Child Psychiatry in the College of Physicians and Surgeons at Columbia University/New York State Psychiatric Institute. Laurie S. Miller, Ph.D., is Director of the

Institute for Children at Risk at the New York University Child Study Center at the

New York University School of Medicine. Lynn Cothern, Ph.D., is Senior WriterEditor for the Juvenile Justice Resource Center.

Photographs pages 1 and 6 copyright © 1999 West Stock; photographs pages 3,

5, 7, and 8 copyright © 1999 PhotoDisc, Inc.

Webster-Stratton, C. 1991. Annotation:

Strategies for helping families with conduct disordered children. Journal of Child

Psychology and Psychiatry 32:1047–1062.

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Journal of Consulting and Clinical Psychology 66(5):715–30.

Webster-Stratton, C., and Hammond, M.A.

1997. Treating children with early-onset

conduct problems: A comparison of child

and parent training interventions. Journal of Consulting and Clinical Psychology

65:93–109.

Wilson, J.J., and Howell, J.C. 1993. Comprehensive Strategy for Serious, Violent, and

Chronic Juvenile Offenders. Washington, DC:

U.S. Department of Justice, Office of Justice

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Delinquency Prevention.

Yoshikawa, H. 1995. Long-term effects of

early childhood programs on social outcomes and delinquency. Future of Children

5:51–75.

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