By Crystal Phend, Staff Writer, MedPage Today
Published: December 01, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
SEATTLE, Dec. 1 -- Early attention to social development of children from high-crime urban areas may yield long-term benefits for mental and sexual health and educational and economic achievement.
So found J. David Hawkins, Ph.D., and colleagues at the University of Washington here when they followed children taught impulse control, nonaggressive ways of getting what they want, and other life skills in elementary school.
After 15 years of follow-up in the study, the extended intervention group had significantly fewer lifetime sexually transmitted diseases and psychiatric symptoms as adults as well as higher income (P<0.05), the researchers reported in the December issue of Archives of Pediatrics & Adolescent Medicine.
Although these young adults also tended to achieve higher levels of education and have more responsibility at work and in the community, the training did not reduce substance use or criminal behavior.
"Public schools, available to all children in the U.S. beginning at age five or six years, are a potentially powerful setting for preventive intervention," they wrote.
The researchers had previously reported benefits of the intervention in their Seattle Social Development Project in childhood and adolescence.
These findings -- for follow-up at age 27 -- were encouraging because the mid-20s are important years, when individuals adopt adult roles through education and employment, the researchers said.
In their nonrandomized controlled trial, children at 15 Seattle public elementary schools were exposed to a full intervention from first through sixth grade, late intervention in grades five and six only, or no intervention.
The participants were diverse (26% African-American, 22% Asian heritage, and 6% Native American) and frequently from low-income families (56%).
All children in the full-intervention group were from high-crime neighborhoods.
In addition to instruction for the children, their teachers received extra training in instructional methods and in teaching cognitive and social skills.
Their parents were also offered courses on child behavior management skills, supporting their child academically, and reducing risks for problem behaviors, which a minority of parents attended.
For the 598 participants followed through to adulthood, the full intervention significantly improved the composite score on all eight outcome measures at ages 24 and 27 compared with controls (P=0.014).
For the individual outcomes, children given social development training throughout the primary school years had the following effects at age 27 compared with no intervention:
More frequently at or above the median in socioeconomic status (93% versus 84%, P=0.021)
A trend for more responsibility on the job (P=0.088)
Marginally more likely to have more than a high school education (34% versus 22% associate degree, P<0.06, and 20% versus 14% bachelor's degree, P=0.311)
A trend for a higher degree of civic engagement measured by involvement with community groups and volunteerism (P=0.072)
Fewer symptoms of mental health disorders on the disorder criterion index (P=0.008)
Lower prevalence of meeting diagnostic criteria for one or more psychiatric disorders (P=0.027)
Lower likelihood of ever being diagnosed with a sexually transmitted disease (23% versus 35%, P=0.026)
No difference in substance abuse or dependence (P=0.739)
An unexpected trend for higher prevalence of prior-year criminal activity (P=0.081), primarily minor theft (9% versus 4%) and drug selling (8% versus 3%)
These effects were most significant among males and those with a background of childhood poverty.
Most outcomes were consistent with a "dose" effect, the researchers said. The late treatment group fell between the full treatment and control groups for most outcomes, but it did not improve the overall composite measure of social achievement by young adulthood compared with no intervention (P=0.808 to P=0.737).
The researchers noted that the study was limited by its "quasi-experimental" design, geographically limited scope, and heavy reliance on self-reported data from participants.
Primary source: Archives of Pediatrics & Adolescent Medicine
Hawkins JD, et al "Effects of social development intervention in childhood fifteen years later" Arch Pediatr Adolesc Med 2008; 162: 1133-1141.
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