ADOLESCENT TRANSITIONS PROGRAM (ATP)

Principal Investigator: Thomas J. Dishion

Level of Intervention: Indicated

Target Population: High-risk adolescents & their families.

References: Andrews, Soberman, & Dishion, 1995; Dishion & Andrews (1995); Dishion, Andrews, Kavanagh, & Soberman (1996); Irvine, Biglan, Smolkowski, Metzler, & Ary (in press).

Theory (Risk & Protective Factors Targeted): The Adolescent Transition Project is based on an ecological model of antisocial behavior (Patterson, Reid, & Dishion, 1992). Early adolescence is considered an important time period to target with preventive interventions if signs of antisocial behavior are present because this pattern of behavior is an antecedent to many other adolescent problems (e.g. delinquency and substance use). Certain patterns of parenting practices contribute to children’s antisocial behavior and perpetuate the problem over time (Dishion, French, & Patterson, 1995). Based on work of Patterson and colleagues (Patterson, 1992; Patterson et al., 1992), it is clear that coercive parenting is associated with child antisocial behavior. These children often exhibit similar behavior problems at school and experience academic failure and rejection by peers. The combination of punitive parenting practices, a lack of monitoring, and school problems often results in the child disengaging from the school community and being drawn towards associations with deviant peers.

Description of Intervention:

Teen Focus
This component of the program was aimed at developing the self-regulation of the teens in order to reduce problem behavior. The lessons focused on improving the adolescents’ ability to set goals, identify small steps towards goals, develop peer support, set personal limits, and engage in problem solving. The curriculum was presented in a group format over 12 weekly, 90-minute, sessions. Presentations and videotapes were utilized to model skills and tokens were used to reinforce behavior in the group. Each group served 8 adolescents. Parent-child activities were sometimes included as part of skill development exercises.

Parent Focus
This component was a step-wise, skill-based curriculum designed to improve parent management skills based on the work of the OSLC (e.g. Patterson et al., 1992). Parents were encouraged to foster and reinforce their adolescent’s prosocial behavior, set appropriate limits, and engage in problem solving with the teen. The curriculum was conducted through group sessions (90 minute to two hours long) held weekly for 12 weeks. Group leaders also conducted three individual consultations with each family to tailor skills and discuss family issues. Each group served 8 families (8-16 participants in a group). Skills were discussed and practiced in the group setting and then tried at home. The next week parents reported on their attempts to use the skill and discussed any problems encountered.

Parent and Teen Focus
In the combined groups, peer consultants were used to bridge discussions between adolescents and parents.

Self-Directed Control
Subjects in the control condition received intervention materials in the form of 6 newsletters and 5 videotapes.

Research Subjects: The sample consisted of 158 families with adolescents between the ages of 10 and 14 (83 boys and 75 girls) who were primarily Caucasian (95%) and low-income though there was some variability in SES and education. The families were self-referred and became aware of the program through a variety of sources including advertising and referrals through school counselors. Parents were asked to participate in a telephone interview to assess their adolescent’s behavior. The screening consisted of items regarding 10 risk areas identified in risk-factor research by Bry and colleagues (Bry, McKeon, & Pandina, 1982). Subjects were eligable for participation if their parent endorsed four or more risk factors. Only 50% of the families that participated in the telephone had an adolescent that qualified to be in the program.

Research Design: Subjects were randomly assigned to one of 4 conditions: 1) Parent focus, 2) Teen focus, 3) Parent & Teen focus, 4) Self-Directed materials only. A quasi-experimental control group was also recruited that consisted of 39 (17 boys, 22 girls) subjects. Pre-intervention comparisons revealed no significant differences between groups in age or level of symptomatology (CBCL).

Outcomes: No statistically significant differences in retention rates by condition at termination or follow-up. The two control groups were collapsed as analyses revealed no significant differences between the two groups at post-intervention or follow-up.

Post-Test:
Observations of family problem-solving indicated that teens and parents in the Parent Focus group (p<.05), the Teen Focus group (p<.05), and the Parent and Teen (p<.05) intervention groups exhibited less negative engagement compared to controls. Parents of adolescents in all groups reported significant reductions of home problem behavior (CBCL externalizing score) at termination, so no intervention effects were found. School behavior problems (Teacher CBCL externalizing score) were marginally reduced (p<.06) in families assigned to parent interventions (parent-focus or combined group) compared to the control conditions.

Follow-up (1 year):
Observations were not conducted as part of the follow-up assessment. Parents of adolescents in all groups reported significant reductions of home problem behavior (CBCL externalizing score) at follow-up, so no intervention effects were found. Adolescents in the Teen focus group exhibited significantly higher levels of school problem behavior (Teacher CBCL externalizing score) than adolescents in the control group (p<.05).

Replication: Irvine et al. (in press) conducted a randomized trial replication of ATP with 8 small, community samples in Oregon using non-mental health clinicians as group leaders. Subjects were students referred by schools or service agencies based on the Teacher Risk Screening Instrument (Soberman, 1994), a measured adapted by OSLC from the work of Bry and his colleagues (Bry, McKeon, & Pandina, 1982; Bry, Pedraza, & Pandina, 1988). The sample consisted of a total of 303 families and the target children were 61.1% male and 38.9% female. The average age of the target children was 12.2 years (SD = 1.1) and the majority of the subjects were Caucasian (87.5%). Families were randomly assigned to the Parent Focus component of the original ATP program or a wait-list control. Program leaders received extensive training to prepare them to conduct the ATP sessions and then additional supervision while they were implementing the program. Despite substantial attrition at follow-up, parents that dropped out were only significantly different than those who remained in the intervention on one measure across all time points. No interactions were found between treatment condition and attrition on Time 1 variables. The results of latent growth curve modeling analyses indicated that according to parent’s reports on the Parent Daily Report (PDR; Patterson, 1974; Reid & Patterson, 1976; Chamberlain & Reid, 1987) and the Child Behavior Checklist (CBCL; Achenbach, 1991), children’s externalizing behavior was significantly reduced after their parents participated in the ATP program. The authors conducted additional analyses on a subset of "high attending" families and found that for parents who received four or more sessions of ATP there was a clear and moderate-sized effect of treatment on parent-reported externalizing behavior.

Strengths & Limitations: The Adolescent Transition Program is a preventive intervention that targets both at-risk adolescents and their families to prevent further escalation of problem behaviors. The program draws on years of research conducted at the OSLC on the developmental model of antisocial behavior and skills training programs for improving parenting practices associated with child problem behavior. In the original evaluation positive program effects were found on observations of parent-child interactions for families in all treatment groups, but iatrogenic effects were found for youth who participated in the Teen focus only group. For these subjects, teacher ratings of externalizing behavior indicated significant increases at follow-up. The authors hypothesized that the structure of this group may have inadvertently fostered the development of deviant associations between the adolescents and contributed to the counter-intuitive findings. There is some recently published research to suggest positive program effects for parent ratings of externalizing behavior when the Parent Focus component of the ATP program is utilized (Irvine et al., in press).

All ATP sessions are based on structured curricula that are accompanied by videotape presentations (Dishion, Kavanagh & Soberman, in press). Unfortunately, neither the original ATP program, or the replication, included any measures to assess program fidelity. In terms of dosage, percentages for families that attended sessions were provided in the original evaluation, but breakdowns in terms of actual number of sessions attended were not provided. In the replication training efforts were described in great detail but training was not mentioned in the original evaluation. Twenty-four group leaders (range of degrees and background experience that would be expected in small community) were recruited in the replication study, and each taught the 12-session program approximately 2.5 times. Each leader agreed to participate in bi-weekly staff review session during the duration of the program but leaders also received extensive training prior to the intervention. The research staff provided workshops, supervision, and phone consultations to program leaders over the four years of the intervention.

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