The Administration on Children, Youth and Families (ACYF) and the NIMH have awarded several research grants as the core component of a new young children's mental health research initiative designed to develop and test applications of theory-based research or state-of-the-art techniques for the prevention, identification and/or treatment of children's mental health disorders within a Head Start context. Among these are projects to develop screening tools for identifying behavior problems in preschool children, to test the effectiveness of research-based classroom interventions for very young children with serious disruptive behavior problems, and to assess the mental health needs of this vulnerable population.

School-Age Children

Recent studies have indicated that between 70 and 80 percent of children with diagnosable mental disorders who receive services are served within the school system, primarily by school psychologists and guidance counselors. The NIMH has supported many projects that seek to develop, establish, and improve school-based mental health service delivery systems. These projects range from broad programs intended to enhance the social and problem solving skills of all students, to highly specific programs designed to treat children already showing symptoms of mental health problems. Programs also range from those that intervene at multiple levels, including the child, parents, peers, and teachers, to those that focus solely on the child. For example, research is aimed at developing techniques for teachers to manage disruptive students. Several strong, multi-faceted programs that aim to prevent severe and persistent conduct problems in children have been launched.

The Families and Schools Together (FAST) Track Program is a multi-faceted, multi-year program designed for aggressive children in kindergarten starting at age 6. A four-site study in North Carolina, Pennsylvania, Tennessee, and Washington, the program involves working with the child, the family in their home, and school system, including teachers. Preschool children at high risk were identified at 55 different schools. These children were randomly assigned for intervention or no intervention.

The children initially enrolled in the study are now young adolescents. An evaluation of FAST TRACK indicated that by the third grade, students who took part in the program showed less oppositional and aggressive behavior and were less likely to require special education services than students who did not take part.

The Linking the Interests of Families and Teachers (LIFT) Program (in Oregon) is a 10-week intervention created for children and families who are at risk for the development of conduct problems due to residence in neighborhoods characterized by high rates of juvenile delinquency. The LIFT Program is a multi-component intervention that includes parent training, social skills training, a playground behavioral program, and regular communication between teachers and parents. Following program participation, students engaged in significantly less aggressive behaviors on the playground, parents demonstrated fewer negative behaviors during family problem-solving activities, and teachers reported improved student social behavior and peer interactions. Three years following the intervention, students who received the program were less likely to engage in consistent alcohol use, less likely to have troublesome friends, and less likely to have been arrested for the first time than students who did not receive the program. Students were also less likely to demonstrate inattentive, impulsive, overactive, and disruptive behaviors in the classroom than students who did not receive the program.

Programs have also been initiated which seek to enhance the skills and knowledge of all children in order to decrease their risk of future emotional and behavioral problems. NIMH has sponsored the Promoting Alternative Thinking Strategies (PATHS) Curriculum, based in Washington state, which teaches children about self-control, understanding emotions, and problem solving. The PATHS curriculum has been evaluated using students in both regular education and special education classrooms. Students who received the PATHS curriculum demonstrated better knowledge of emotions than children who did not receive the curriculum. This emotional knowledge is thought to underlie the development of necessary social skills such as friendship development and maintenance, anger management, conflict resolution, and appropriate problem solving.

Development of Depression

NIMH research is investigating promising and successful interventions to prevent and treat adolescent depression, which often coexists with conduct problems, a combustible mix that can result in violence, both against self and others. Several NIMH projects focus on determining whether cognitive therapy techniques that have been found to be effective for treating depression in adults can be applied to prevent depression in adolescents. Such research tests, among other things, the effects of after-school programs, which are based on cognitive therapy and social problem-solving techniques and delivered by school staff. Findings from this type of research are mixed, with more intensive interventions appearing to have at least initial effects of reducing or preventing depressive symptoms. Additional work is needed to determine the optimal length and intensity of interventions as well as approaches for sustaining their effects.

For example, the Coping with Stress Course was designed to prevent the onset of depressive disorders among adolescents who report high levels of depressive symptoms. With programs in Oregon, Maryland, and Ohio, this group course teaches adolescents cognitive skills to identify and challenge negative or irrational thoughts and beliefs that may contribute to the development of depression. Evaluation showed that the course was successful in reducing the number of cases of depressive disorder among adolescents at risk. In fact, twice as many students in the no-treatment group developed a depressive disorder than in the treatment group. Students in the treatment group also reported fewer depressive symptoms and better adjustment than students in the untreated group. However, with the passage of time, differences between the treatment and no-treatment groups decreased.