Putting brain science back on the streets of Los Angeles

That their adolescent children might fall in with the ‘wrong crowd’ is among the worst fears of many parents. Falling or not quite falling is the stuff of movies and and the pivotal moment in countless life histories. But before research specialist and clinical psychologist Tom Dishion got to work, the underlying human dynamics were little understood by science.

What marks Dishion’s career apart is the application of medical science to policy and practice. The Child and Family Center which he founded at the University of Oregon in 2000 is known not only for its significant contributions to prevention science but also for its clinical work.

It offers assessment, diagnosis, referral, and intervention services for children aged two to 17, and also provides a range of low-cost services for children and teenagers experiencing difficulties at school, home, or both. True to his training at the Oregon Social Learning Centre, where he was based between 1978 to 2000, Dishion ensures that interventions are family centered.

One way to portray the range of his preoccupations is through his studies. Over 100 articles and books range from cutting edge research insights from Magnetic Resonance Imagining (MRI) into the effect on the adolescent brain of drug use, to an acute involvement in program development: he is author of two books on family-centered approaches to healthy adolescence.

He is perhaps best known for his work with colleagues at the Oregon Social Learning Center on the dynamics behind escalations into adolescent substance use, delinquency, and violence. He has explained how adolescents who behave badly are drawn to each other, and then ‘talk up’ antisocial conduct. Those who question the wisdom of placing delinquent youth in groups need look no further for supporting evidence than Dishion’s writings.

But for many parents and young people, what stands out from this combination of interests is his ability to bridge the gap between clinical data and the clutter of everyday life by translating the science into practical advice.

“Many children experiment with delinquency,” he explains. “Befriending someone whom parents’ consider a bad influence is one way teenagers experiment. Telling your child that they are doing wrong will often make matters worse. Better to let things ride and see if it turns into a potentially serious problem. In most cases it won’t.

“But if you tell your child not to hang out with someone, you’re fighting a losing battle. Teenagers are rightfully proud of their new-found abilities to think about complex social and personal problems. Much better to talk in an adult way about the specific behaviors that will get in the way of future development.”

Tom Dishion should know about group behavior. Born and raised in a tough section of a Los Angeles neighborhood he learned to negotiate a way around gangs and between more and less productive behavior avenues.

In 1978, after completing a degree in Philosophy from the University of California in St Barbara, he met Jerry Patterson who was working alongside John Reid to set up what became the Oregon Social Learning Center, the vehicle for a series of breakthroughs on family functioning and child development.

Patterson taught Dishion the importance of direct observation. As Dishion explains, “Jerry showed me how people get caught up in relationship dynamics that are bigger than themselves and that they struggle to control. And more important than that, I learned that studying behavior is a means of designing interventions.”

He worked at the Oregon Center until the opportunity arose in 2000 to found and lead the Child and Family Center. “I enjoyed my collaborations at Oregon Social Learning Center but as a not-for-profit organization there were challenges. It was difficult to engage with students and the constant writing of grants and raising funds when I had young children began to drain me”.

As well as offering security, the Child and Family Center allows Dishion to bring together his passions: to undertake high quality research, teach and learn from his doctoral students, and offer clinical services. He is one of very few elite scientists who work directly with children and families. The clinical work takes up as much of a third of his working week.

From this continuous engagement Dishion highlights two particularly promising avenues for improving the lives of children and their families. Methods such as fMRI and high density EEG imaging make it possible to see inside the brain. Whereas previously it was only possible to hypothesize on neural mechanisms, such as self-regulation, reasonably good empirical data can now be collected.

The second line of his enquiry, also to be explored in his Bennett Lecture, is about improving assessment. The Family Check-up developed with Elizabeth Stormshak, Kate Kavanagh and others is based on an ecological approach to family problems. Clinicians are looking for a precise calculation of what is happening to the child, but families want clinicians to listen to their perceptions of their needs. Scientists remind us that reliable data takes time to collect; the need for help far outstrips supply of prevention and treatment; families want a rapid response.

The Family Check-up tries to reconcile all these pressures. Assessment is brief, and, in many cases so too is the intervention – 80 minutes on average for low risk groups. The starting point is an interview, followed by a small battery of reliable assessment measures, followed by feedback to the family that allows them to compare the conclusion with their own view of the world. A series of visual profiles lets the family to see how it is doing in relation to others in similar circumstances.

Experimental evaluation of the Family Check-up and brief intervention that follows is suggesting promising results, particularly with respect to early onset drug use and higher parental monitoring.

Dishion is evolving these approaches at the Child and Family Center, often working with poor families, many lacking health insurance. As with all prevention scientists interested in translating evidence to policy and practice, the challenge for Dishion is finding ways of taking these advances to scale. Maybe in time, the children in the poor neighborhoods of Los Angeles where he started out will become routine beneficiaries.