Interventions need to address the childs environment

A general dissatisfaction with the impact of providing information (health education) has led to a more interactive or skills-building approach. Until recently, attempts to engage children individually in order to develop relevant skills have not been very successful (but see Selman et a/.(22)). Most attempts at prevention have focused on parents and parenting. The reason is that it is the child's family that provides close personal relationships within which psychosocial maturation is promoted. It is also the principal immediate environment in early development and the medium through which more distal environmental adversities are transmitted. There is now good evidence that parent management training can both reverse and prevent emotional and behavioural disorders in childhood, and it has been suggested that they may also promote adult mental health in the longer term. (23> Typically, parents are taught to recognize and intervene to correct problem behaviours in their children, according to social learning principles—this can be done in a community rather than a clinic setting—and how to implement various procedures in their home to reduce conflict with their children and promote their prosocial behaviour. A popular variant is to use videotaping to provoke discussion in parent groups. Gains are greatest for families with fewer risk factors, but gains can be maintained for years if treatment is sufficiently prolonged, 50 hours rather than 10 hours or so. (14)

It is not uncommon to combine parent management training with social skills training for children. Tremblay et a/.(24) were able to show that this combination, delivered over a 2-year period to disadvantaged and disruptive kindergarten boys and their families in Montreal, reduced delinquency behaviours and substance misuse at age 15.

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