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Sheppard Kellam: Early is better: Prevention in early childhood can reduce drugs and crime later

Early is better: Prevention in early childhood can reduce drugs and crime later

Sheppard Kellam, M.D.
Johns Hopkins University

An important early risk factor for later illicit drug abuse and crime is failure to adapt as early as the first grade of school to the classroom social task demands.  These include paying attention and being able to concentrate, learning not to be disruptive or physically aggressive, developing good relationships with other children and learning the subject matter. A poor start at these tasks as early in school as first grade greatly increases the risk later school dropout, drug abuse, early entrance into crime and risky sex and incarceration in adolescence and well into adulthood. The discovery of these early risk factors has meant developing and testing prevention programs prior to and during the start of school and into early adolescence. More tested and effective prevention programs are now available for higher risk mothers during pregnancy, for higher risk pre-school children and families, and other times of transition over the continuing life course. One program is named the Good Behavior Game (GBG) and is implemented by the first grade teacher to the entire classroom. After the first few weeks of 1st grade, all children are assigned to three teams each team with children with different levels of adapting to the student role. The GBG is played when the teacher announces” we are playing the game” which means teams obey classroom rules during this specified time. All teams can “win” by following classroom rules with less than a specified number of broken rules, but if one or more children commit more, the team is not rewarded. The teacher and the children systematically “play the game”, three times a week early in the year with systematic increases in frequency over the year. Over the course of the first grade year the team’s rewards evolve from small concrete to more mature activities. Such “universal” programs directed at total populations, are the first prevention level and can be integrated in a life course human services system starting early with universals. We implemented and systematically tested the impact of GBG in first grade in large numbers of schools and first grade classrooms in partnership with the Baltimore City Public School System and the families, and with follow-up into early adulthood. The impact showed significant reductions among males in drug abuse disorders, violence and incarceration, early and risky sex, tobacco addiction and school failure as well as reduction in suicide attempts. Early aggressive behavior was more common among males who were much more likely to have had difficulty with the core social tasks in first grade. While much was accomplished with GBG among males with the early universal prevention into first grade classrooms, those who needed more became identified by their responses to GBG. The results from prevention programs like GBG, including others with benefit among females, could provide a base for a system of early prevention backed up by more specialized prevention and treatment over the
life course.