Fast Track Effects on Young Adult Externalizing Psychopathology

In 1990, when the Fast Track prevention trial began, scientific findings had highlighted the strong continuity in conduct disorder across the lifespan. Clinical practice debate focused on whether serious conduct disorder could actually be prevented, or would turn out to be a chronic condition. No intervention had successfully prevented adult externalizing psychopathology in a group of early-starting conduct problem children. The goal of the trial, and this presentation, is to test the efficacy of the Fast Track intervention in preventing externalizing psychopathology in young adulthood. 891 early-starting conduct-problem children were identified through multiple-gating screening of 9,594 kindergarteners in three cohorts in 55 high-risk schools in four communities and then randomly assigned by school cluster to a ten-year intervention or control condition. Eight years after intervention ended, condition-blinded adults clinically interviewed participants and knowledgeable peer raters. At selection, the participant mean age was 6.58 years (SD = 0.48); ethnicity = 51% African American, 47% European American, 2% other; and 69% were boys. At age-25 follow-up, 702 participants (81% of those living) and 535 peers provided data. The primary goal of intervention was to develop social competencies in children that would carry them throughout life to prevent externalizing psychopathology in adulthood. Intervention was delivered in groups of about six children, while parents met for behavior management training, with home visiting, peer coaching, reading tutoring, and classroom social-emotional curricula supplements. Manualization and supervision ensured program fidelity. 96% of parents and 98% of children participated during grade 1, and 80% continued intervention through grade 10. At age 25, psychiatric interviews with each participant and a peer knowledgeable about the participant yielded a primary measure of any externalizing psychiatric disorder from either self or peer report. Intent-to-treat logistic regression analyses indicated that 63% of controls displayed at least one externalizing psychiatric disorder, in contrast with 52% of the intervention group (Odds Ratio = .59, p < .01). This pattern also held for self-ratings only as well as peer-ratings only, and in each cohort and site, and for male, female, African American, white, moderate-risk, and high-risk sub-groups. This study provides the first evidence for the efficacy of a comprehensive, long-term intervention in preventing adult externalizing psychopathology among high-risk early-starting children. It supports the hypothesis that conduct disorder can be prevented.