The Use of SMART Design to Construct Adaptive Intervention Strategies for Conduct Problems Prevention

Introduction. This presentation will outline a recently initiated feasibility study utilizing a sequential, multiple assignment, randomized trial (SMART) design for conduct problems prevention within a juvenile diversion context. The SMART will incorporate several preventive intervention components targeting conduct problems along with the use of measures of executive functioning collected prior to and during intervention. The study design will allow for the development of adaptive intervention strategies (AIS) in order to tailor treatment based on response to difference sequences of intervention components. AIS individualize treatment via decision rules that specify how the type or intensity of an intervention should be formulated prior to the beginning of treatment based on youth and family characteristics (e.g., tailoring variables) and/or adjusted over time based on proximal outcomes collected during treatment. AIS are needed in conduct problems prevention to address the heterogeneity of at-risk youth and the variability in response to conventional fixed-type preventive interventions. Executive functioning holds particular promise as a tailoring variable due its role in heterogeneity in individual etiologies for conduct problems and as a mediator in the prevention of conduct problems.

Methods. This feasibility study will enroll high risk youth (10-15 years of age) who have been arrested for status or misdemeanor offenses and referred for pre-court juvenile diversion programming. The SMART design will involve each participant progressing through two stages of intervention using a stepped-care framework. In the first stage participants will be randomized to one of two ‘brief-type’ intervention options, either the youth-focused Teen Intervene-Brief program or the parent-focused Parenting Wisely-Brief program. Responders to either program will be stepped down and monitored over time. Non-responders to either program will be stepped up and randomized to one of two second stage ‘intensive-type’ intervention options that feature either (1) continuation of the first stage option with increased dosage (Parenting Wisely-Expanded or Teen Intervene-Expanded), or (2) switching to the alternative expanded intervention modality. Executive functioning measures will include both ‘hot’ and ‘cool’ performance-based tasks as well as behaviorally-based questionnaires. The development of a practice infrastructure for implementing a SMART design will be outlined.

Conclusion. Preliminary data will be presented, including measures of feasibility and executive functioning and conduct problems characterizing the sample. Finally, methodological considerations in the use of executive functioning as a tailoring variable in the creation of AIS from a SMART will be explored.