The needs of children who have displayed persistently poor behavior from a very young age are an obvious target for early intervention programs as well as a severe test of their effectiveness. For the most part, efforts by practitioners, policy makers and prevention scientists have not had much long-term success.

However, continuing evaluation of a program called Fast Track [1] by a coalition of US universities - Duke, Pennsylvania State, Washington and Vanderbilt - offers signs of hope.

Fast Track has already proved itself capable of changing the trajectories of seriously troubled young people and it continues to report successes with high-risk children, regardless of their gender or ethnicity. So why does it excel where so many others falter?

Program developers from the The Conduct Problems Prevention Research Group (CPPRG) believe that other attempts are flawed for being too narrow and too brief. Writing in the Journal of the American Academy of Child and Adolescent Psychiatry, Karen Bierman and colleagues explain the drawbacks.

Some programs that focus on peer relationships or parenting or social and academic skills have demonstrated short term successes but on the whole the benefits diminish as the child gets older, they say.

Fast Track on the other hand aims to tackle all three aspects of children’s lives throughout a critical decade of their development, delivering services during the junior years (6-10) and again during adolescence (11-15 years).

The underlying logic has its roots in a developmental theory that emphasizes interaction between multiple influences.

So to take the example of a child from a low income family where marital conflict and instability have given rise to inconsistent parenting. Fast Track rationale suggests that such a child, particularly one with an impulsive or difficult temperament, is more likely to start school with adjustment problems which may lead to him or her becoming disruptive and aggressive at school, perhaps influenced by similarly troubled children.

As a result of the same chain of possibilities, such a child may start to experience rejection from parents, other peers and also receive less support from teachers. All this has a consequence for academic progress and can lead to serious long-term conduct problems and risky behaviors.

Taking these factors into account, Fast Track screens all pre-school age children and collates parent and teacher ratings. Children selected for the program are those at particularly high risk (the top 15% of poor behavior).

Once enrolled, they attend social skill training groups, academic tutoring and receive mentoring as well, as participating in PATHS, a curriculum designed to improved social and emotional health. These activities are delivered at home, but families also receive home visits by teachers, in order to improve parents problem-solving skills, self-confidence and capacity to manage family life more effectively.

In 1991, 1992 and 1993 over 800 children and their families were selected to participate in the first randomized controlled trial of Fast Track. Initial results were promising: by the age of ten the Fast Track children had significantly improved home circumstances and better social and emotional skills.

Another follow-up last year suggested that the intervention had a statistically significant impact by preventing the development of clinically-defined behavioral problems such as conduct disorder and anti-social behavior. These effects can be observed right through to grade 9. Conduct disorder cases were down by 75%, ADHD by 53% and all externalizing psychiatric disorders by 43%.

• See: Conduct Problems Prevention Research Group (2007) “Fast Track Randomized Controlled Trial to Prevent Externalizing Psychiatric Disorders: Findings From Grades 3 to 9”, Journal of the American Academy of Child and Adolescent Psychiatry, 46, 10, pp. 1250-1262.