Preschool-Based Programs for Externalizing Problems.

Abstract Few mental health initiatives for young children have used classroom programs. Preschool-based efforts targeting externalizing behavior could help prevent conduct disorders. Additional benefits may include improved academic achievement and reduced risk for other mental health difficulties. Programs that target multiple developmental domains are most likely to succeed. However, more research is needed to guide such initiatives, and practical challenges must be addressed. This paper describes an effort to implement and test preschool classroom-based programs aimed at externalizing and academic problems. ********** Preschool-based programs could help prevent externalizing problems, and may also have broad positive side effects, including enhanced academic achievement, reduced risk for other mental health problems, and improved family functioning. These programs are also likely to be an excellent economic investment, reducing societal costs of conduct disorders and their associated difficulties (Schweinhart & Weikart, 1998). However, empirical data justifying such efforts are surprisingly sparse. This paper argues for the importance of early classroom-based programs for externalizing problems. The existing empirical literature on such programs is reviewed. One effort to implement and test such a program is described, with an emphasis on issues in school implementation. Suggestions for future research and practice are offered, including increased consideration of gender and culture. The Importance of Addressing Early Externalizing Problems The broad category of externalizing problems variously described as disruptive behavior, aggression, delinquency, Oppositional Defiant Disorder, or Conduct Disorder affects approximately 10% of children. Externalizing difficulties, in turn, are associated with other problems including substance abuse, family violence, crime, and psychiatric disturbance (Caspi, Moffitt, Newman, & Silva, 1997; Milberger, Biederman, Faraone, & Chen, 1997; Moffitt, Caspi, Dickson, Silva, & Stanton, 1996; Patterson, DeGarmo, & Knutson, 2000). Children raised in poverty are disproportionately affected by externalizing disorders, with higher rates and greater stability of these problems (Qi & Kaiser, 2003; Webster-Stratton & Hammond, 1998). Stressors associated with poverty may exacerbate externalizing problems and impede efforts to seek treatment. In addition, lower-income families may not be able to afford good treatment. In sum, those who need help the most are the least likely to receive it. Efforts to treat externalizing problems have met with discouraging long-term effects. Even the most successful interventions leave at least one fourth of the children with significant problems (Forehand & Kotchick, 2002; Reid, Webster-Stratton, & Hammond, 2003), and long-term maintenance of benefits is the exception rather than the rule (Kazdin, 1993). Earlier intervention may help, because externalizing behaviors begin at a young age for many children who develop lasting problems (Bierman, Coie, & Dodge, 2002; Campbell, Shaw, & Gilliom, 2000; Heller, Baker, Henker, & Hinshaw, 1996; Patterson, Capaldi, & Bank, 1991). Early onset conduct problems are typically stable, increasingly resistant to change, and predictive of future problems (Webster-Stratton, Reid, & Hammond, 2001; White, Moffit, Earls, Robins, & Silva, 1990). Expanded approaches that include broader targets may also improve results. Connections between externalizing problems and other areas of functioning suggest that early intervention efforts should consider the context of problems. In turn, addressing externalizing problems is likely to provide benefits across multiple domains, including children's academic development. Externalizing Problems and Academic Difficulties Mental health problems are generally associated with poor school performance (Hinshaw, 1992a; Tremblay et al. …