dren. At the same time, given the magnitude of the program, the potential value of conclusive evidence of its effect, and the availability of rigorous experimental methods, it is surprising that more experimental evaluations have not been conducted.

Several preschool classroom curricula are designed to improve teachers’ behavior management of classrooms by reducing child behavior problems and strengthening children’s social skills or executive functioning (or both). The Promoting Alternative Thinking Strategies (PATHS) curriculum (see Box 6-7) is an example of a curriculum that has been tested in both preschool and elementary school settings.

Elementary, Middle, and Secondary School Interventions
Targeting Child Sexual Abuse

As mentioned earlier, child maltreatment, including sexual abuse, is a potent risk factor for emotional and behavioral problems. Davis and Gidycz (2000) report on a meta-analysis of school-based programs aimed at teaching children to avoid and report sexual abuse. These programs led to significant improvement in child knowledge and skills related to sexual abuse prevention. The most effective programs included four or more sessions, active participant involvement (such as role play), and behavioral skills training. However, none of the studies examined effects on the prevalence of abuse, and it is difficult to draw conclusions about potential downstream effects of these programs on the risk for MEB disorders.

Targeting Problem Behaviors, Aggression, Violence, and Substance Abuse

Many of the target risk factors of preventive interventions are interrelated. In early elementary school, for example, both aggressive and withdrawn behaviors can co-occur, imparting much higher risk than aggressive behavior alone (Kellam, Brown, et al., 1983), and both risk factors are independently linked to concurrent and successive problems in concentration, attention, and poor achievement. Depressive symptoms in this period are also associated with poor achievement (Kellam, Werthamer-Larsson, et al., 1991). Externalizing behavior across different social fields and deviant peer group contact in middle school predict later juvenile arrest and drug use, and much higher levels of risky sexual behavior are seen among those with both internalizing and externalizing problems (Dishion, 2000). The life course of those with multiple problem behaviors is especially negatively affected (Biglan, Brennan, et al., 2004).

A variety of school-based interventions have been designed to address risk and protective factors associated with violence, aggression, antisocial



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