|
...Patterson, 1995), less scientific data available to answer the question of how best to design interventions to prevent or reduce antisocial behavior. One hypothesis that has attracted considerable attention in the literature is that social skills interventions for at-risk adolescents that occur within small groups may be contraindicated or lead to iatrogenic effects (Dishion, McCord, & Poulin, 1999). The purpose of the current study is to provide an empirical test of this hypothesis.
Skills-training programs are predicated on theories that children and adolescents with conduct problems have deficiencies in social skills, anger control, interpersonal problem-solving, and moral reasoning and that remediation of these skills will lead to improved overall functioning and prognosis. By and large, recent research supports the efficacy of such programs (McMahon & Wells, 1998). Skills-training can be provided in small groups of high-risk youth ("pure" or "homogeneous" groups), small groups consisting of both low- and high-risk youths ("mixed" or "heterogeneous" groups), or individual training sessions between a high-risk youth and a therapist. There is a general consensus that the small-group format for skills-training interventions tends to be more efficacious than individual training sessions (Landau, Milich, & Diener, 1998). This is because of the cost-effectiveness of group treatment and the value in providing a social context for the mastery of social and emotional skills (i.e., more opportunities for role-playing activities, modeling, and peer reinforcement of adaptive behavior). It may be counterproductive, however, to aggregate high-risk youths with externalizing problems into pure treatment groups. This concern is based on the "acting out" nature of externalizing problems, combined with the great importance placed on peers during the adolescent stage of development. Some researchers (e.g., Dishion et al., 1999) argue that the deviant peer environment provided in pure treatment groups may interfere with the prosocial skills training process, resulting in the continuation or even exacerbation of conduct problems for the youth involved.
THE IATROGENIC EFFECTS HYPOTHESIS
This argument of possible "iatrogenic" effects of group treatment for adolescent conduct problems has been raised occasionally throughout the history of skills-training programs (e.g., Arnold & Hughes, 1999; Feldman, Caplinger, & Wodarski, 1983; McMahon & Wells, 1998). In fact, the notion of negative group treatment effects for this population is largely accepted, even taken somewhat for granted, by many within the scientific community. For example, Alan Kazdin, a leading figure in the treatment of conduct disorders, was recently quoted as saying, "A number of treatments that harm children are being used; group therapy for behavior disordered children is an absolute no-no. There have been a number of studies that show that if you place these children in groups, those children who receive the treatment do much worse" (Weaver, 2000).
However, only recently has the iatrogenic hypothesis been carefully articulated and the relevant research reviewed (Dishion et al., 1999). In an American Psychologist article, Dishion et al. (1999) examined some of the social developmental and intervention literatures that bear on the popular notion of iatrogenic effects of skills-training treatments that aggregate high-risk youth. Dishion et al. (1999) concluded that there is considerable cause for concern. Specifically, they argued that in treatment groups made up entirely of aggressive, deviant adolescents, there may be more modeling and reinforcement of antisocial behavior than prosocial behavior. They asserted that this, in turn, seems to lead to the further development of conduct problems in youth, both within and outside the treatment group setting (Dishion et al., 1999). The evidence for this negative treatment process and outcome stems primarily from their own research on "deviancy training" and the outcome of their Adolescent Transitions Program intervention study.
Deviancy training refers to "the process of contingent positive reactions to rule-breaking discussions," which Dishion and colleagues argue perpetuates or "trains" deviancy in one adolescent by another (Dishion et al., 1999, p. 756). An example of deviancy training might be an adolescent repeatedly gaining positive peer attention (e.g., expressions of interest, laughter) in response to talking about rebelling against parents, using drugs, or engaging in aggression or violence. Dishion, Spracklen, Andrews, & Patterson (1996) studied this process by analyzing the topics and response patterns of 206 adolescent male friendship dyads during 25-min videotaped discussions. They found that social reinforcement within the dyad (i.e., positive affect or gesture) was strongly associated with conversation topic. For nondelinquent youth dyads, social reinforcement tended to follow normative discussion: for delinquent dyads, the reinforcement occurred more often for deviant, rule-breaking conversation. Furthermore, in follow-up studies of these youth, they found strong relations between the nature of youths' dyadic interactions at age 13-14 years and the rate of problem behaviors reported 2 years later. Boys whose conversations were characterized by deviancy training had a higher probability of substance use initiation, higher self-reported delinquency, and higher self-reported and police-reported violent behavior than dyads characterized by peer reinforcement of normative discussions (Dishion, Capaldi, Spracklen, & Li, 1995; Dishion, Eddy, Haas, Li, & Spracklen, 1997; Dishion et al., 1996).
This body of research seems adequate to suggest that deviancy training may occur within the friendships of high-risk male adolescents. Dishion et al. (1999) went on to suggest that this process also occurs within group skills-training interventions and that it interferes with the therapeutic effectiveness of such interventions. Dishion and Andrews (1995) provided evidence of this effect from the results of the Adolescent Transitions Program (ATP), an intervention aimed at reducing the problem behavior of early adolescents. Participants were middle-school students (mean age = 12 years) who were identified as "high-risk" on the basis of a 10-question screening instrument completed by a parent. Researchers randomly assigned the families of these high-risk adolescents to one of the following conditions: (1) parent-focus group, (2) teen-focus group, (3) both parent- and teen-focus groups, (4) self-directed change (provided intervention materials only), or (5) quasi-experimental, no-treatment control.
Results indicated that there were limited, immediate postintervention benefits to participation in the parent and teen groups (i.e., less coercive family interactions and improved school behavior) and limited long-term benefits to the parent intervention (reduced teen tobacco use). However, there were a few long-term, iatrogenic effects associated with teen participation in the intervention (i.e., either teen-only or teen- and parent-focus groups). These adolescents had higher teacher ratings of externalizing behavior problems, more positive attitudes toward drug use, and more self-reported tobacco use at 1- and 3-year follow-ups (Poulin, Dishion, & Burraston, 2001).
Although the evidence for iatrogenic effects of group intervention sounds convincing at first glance, there are limitations to the conclusions that can be drawn from the Dishion and Andrews (1995) study. Specifically, the iatrogenic effects were limited to a small minority of dependent variables. So, a more conservative interpretation of the Dishion and Andrews study is that there were small positive effects for some variables, small negative effects for others, and no effects for many others. Thus, the case for clinically significant, iatrogenic effects due to peer aggregation in group-based skills-training interventions is far from proven.
In summary, then, the hypothesis put forth by Dishion et al. (1999) of possible iatrogenic effects of all-deviant group skills-training programs for externalizing youth is provocative. If true, it could have far-reaching implications for clinical practice. However, a critical view of the literature cited by Dishion et al. (1999) indicates that the evidence for risk may be overstated. In fact, other researchers have subsequently examined the literature and concluded that it does not support the iatrogenic effects hypothesis (Handwerk, 2000).
A ROLE FOR PROSOCIAL PEERS IN INTERVENTION GROUPS
The deviancy training hypothesis suggests that pure groups of antisocial adolescents may be counterproductive. This raises the question of whether mixed groups of antisocial and prosocial participants would be more effective. That is, perhaps high-risk youths show greater gains in prosocial behavior and reduction in problem behavior if they participate in skills-training curricula alongside socially competent, prosocial youths. This represents the flip side of the deviancy training hypothesis. Youths may experience "prosocial training" as opposed to deviancy training, by way of more peer modeling and reinforcement of adaptive behavior.
We were able to locate only one published study that attempted a direct comparison of mixed versus pure groups for adolescents with conduct problems (Feldman et al., 1983). In "the St. Louis Experiment," a total of 701 boys (age 7-15 years) participated in activity groups of 9-15 members at a local Jewish community center. Boys with conduct problems (n = 263) were recruited from social service agencies. A boy met criteria for study inclusion if both the referral agent and the boy's parent indicated on a checklist that the boy had engaged in at least 21 antisocial behaviors in...
NOTE: All illustrations and photos
have been removed from this article.
More articles from Journal of Abnormal Child Psychology
Peer effects in drug use and sex among college students., June 01, 2005
Looking for additional articles?
Search our database of over 3 million articles.
Looking for more in-depth information on this industry?
Search our complete database of Industry & Market reports by text, subject, publication
name or publication date.
About Goliath
Whether you're looking for sales prospects, competitive information, company
analysis or best practices in managing your organization,
Goliath can help you meet your business needs.
Our extensive business information databases empower business
professionals with both the breadth and depth of credible,
authoritative information they need to support their business
goals. Whether it be strategic planning, sales prospecting,
company research or defining management best practices -
Goliath is your leading source for accurate information.
|
