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Intervention

Early Risers is a multicomponent, high-intensity, competency-enhancement program that targets elementary school children (ages 6 to 10) who are at high risk for early development of conduct problems, including substance use (i.e., who display early aggressive, disruptive, or nonconformist behaviors). Most of the original participants were white and resided in semirural communities. Subsequent replications have involved African-American children from economically disadvantaged urban communities.

The program is based on the premise that early, comprehensive, and sustained intervention is necessary to target multiple risk and protective factors. Early Risers uses a full-strength intervention model with two complementary components to move high-risk children onto a more adaptive developmental pathway. Interventions include

• Parent education and skills training
• Proactive parent–school consultation
• Child social skills training and strategic peer involvement
• Reading and math instruction and educational enrichment activities
• Family support, consultation, and brief interventions to cope with stress
• Contingency management of aggressive, disruptive, and noncompliant behavior

The enhanced competence gained through the program leads to the development of positive self-image, independent decision-making, healthy problem-solving, assertive communication, and constructive coping. Once acquired, these attributes and skills collectively enable youths to resist personal and social forces that encourage early substance use and potential abuse and dependency.

Evaluation

The intervention was tested using a multiple time-series design involving a baseline assessment and three annual assessments thereafter. Children were screened for risk (aggressive behavior) during kindergarten and randomly assigned (nested within schools) to either the program or no-program (control) conditions. Eighty-two percent of the participants completed the 3-year prevention trial. Rate of attrition and characteristics of those who failed to complete the trial did not differ for program and control groups. Outcome variables were specified that corresponded to four global competence domains (i.e., academic competence, social competence, self-regulation problems, and parent investment), each of which included several specific skill domains.

Outcome

High-risk children whose parents received 50 percent or more of recommended FLEX home visiting contact time showed higher rates of improvement on academic achievement, lower rates of attention/concentration problems, and greater rates of improvement in social skills and overall social competence. Compared with high-risk control participants, high-risk program participants made significant improvements in numerous areas, including

• Academic achievement. High-risk children receiving the program showed significant improvement in rate of academic achievement, with this effect primarily accounted for by gains in basic reading skills. This effect held true for boys and girls.
• Self-regulation. Both program and control children showed reductions in self-regulation problems. However, those program children with the highest level of aggressive behavior showed significant reductions in behavioral problems compared with their high-aggressive control counterparts.
• Social competence. High-risk children receiving the program made significant gains in social skills, social adaptability, and leadership following 3 years of intervention.

Parents of children with the highest level of aggressive behavior, who received 50 percent or more of recommended FLEX contact time, reported improved investment in their child and less personal distress.

Endorsements

• SAMHSA: Model Programs

References

August, Gerald J., Elizabeth A. Egan, George M. Realmuto, and Joel M. Hektner. 2003. “Parceling Component Effects of a Multifaceted Prevention Program for Disruptive Elementary School Children.” Journal of Abnormal Child Psychology 31:515–27.

August, Gerald J., Joel M. Hektner, Elizabeth A. Egan, George M. Realmuto, and Michael L. Bloomquist. 2002. “The Early Risers Longitudinal Prevention Trial: Examination of 3-Year Outcomes in Aggressive Children With Intent-to-Treat and As-Intended Analyses.” Psychology of Addictive Behaviors 16:27–39.

August, Gerald J., George M. Realmuto, Joel M. Hektner, and Michael L. Bloomquist. 2001. “An Integrated Components Preventive Intervention for Aggressive Elementary School Children: The Early Risers Program.” Journal of Consulting and Clinical Psychology 69:614–26.

August, Gerald J., George M. Realmuto, Ken C. Winters, and Joel M. Hektner. 2001. “Prevention of Adolescent Drug Abuse: Targeting High-Risk Children With a Multifaceted Intervention Model—The Early Risers ‘Skills for Success’ Program.” Applied and Preventive Psychology 10:135–54.

Contact

Gerald J. August, Ph.D.
Division of Child and Adolescent Psychiatry
2450 Riverside Avenue, F256/2B West
Minneapolis, MN 55454–1495
Phone: (612) 273-9711
Fax: (612) 273-9779
E-mail: augus001@tc.umn.edu

Technical Assistance Provider

Gerald J. August, Ph.D.
Division of Child and Adolescent Psychiatry
2450 Riverside Avenue, F256/2B West
Minneapolis, MN 55454–1495
Phone: (612) 273-9711
Fax: (612) 273-9779
E-mail: augus001@tc.umn.edu