Brief Indexes to Screen Older Children in Need of Preventive Intervention for Substance Use Disorder

Substance use disorder (SUD) etiology is characterized by highly heterogeneous ontogenetic pathways which hinder detection of at-risk youth and complicate the development of efficacious universal prevention programs.  Recent work at the Center for Education and Drug Abuse Research (CEDAR) has aimed to create clinical tools to screen children for overall propensity for SUD, accounting as much as possible for the variability in these equifinality patterns.  Each instrument is grounded in the CEDAR ontogenetic theoretical model.  One foreseen use of these tools is to develop a protocol to screen and refer at-risk well-child patients for individualized prevention that is guided by a youth’s “profile” of SUD risk factors.  This presentation will highlight findings from this line of research using evidence from multiple samples and will describe ongoing efforts to prepare these tools for use in healthcare-based programs.  Psychometric evidence will be presented for each tool, including predictive validity of problem behavior outcomes and tests of measurement equivalence between races/ethnicities.  Two CEDAR screening tools are grounded in the only theoretical orientation to date that accounts for all between-person variance in risk for SUD, behavior genetics.  These two tools are termed the Transmissible and Nontransmissible Liability Indexes (TLI and NTLI, respectively).  In 10- to 12-year-olds, the TLI and NLI have little statistical overlap; excellent internal consistency; and during prospective 10-year follow-ups they predict SUD, risky sex, adulthood antisocial behavior and functioning in work, family and social relationships.  A third CEDAR tool, the Risk Index (RI), is a measure of youths’ propensity for problem behaviors in the short-term future.  A child-report, brief index for 9- to 13-year-olds, the RI consists of items querying diverse risk characteristics such as violence exposure, friends’ conduct problems, peer pressure susceptibility, family conflict, anger coping and depression.  Each RI item statistically predicts level of conduct disorder at, and substance use initiation by, one year later.  The RI has excellent reliability, specificity and sensitivity in two samples of greater-than-average-risk youth.  A recent feasibility study of using the RI and TLI as screening tools during pediatrician well-child check-ups (N=60 patient-parent dyads) demonstrated that the screens were feasible, acceptable, and provided clinical utility.  They were administered by nurses while patients waited for their physician, did not disrupt ‘patient flow,’ and (anecdotally) were acceptable to medical staff.  Nearly all parents stated that if the screening indicated their child needed prevention, they would “definitely” (83.3%) or “probably” (13.3%) seek help from someone who their physician knew could help. Scores on both indexes correlated with substance use, conduct disorder, and health behaviors that pediatricians traditionally promote such as wearing a helmet while riding a bike.  Scores on each of the screening tools also correlated with many of the case-conceptualization parent-report measures that are used with the Family Check-Up, suggesting these screening tools identify families who could benefit from this intervention.