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Preventing Youth Internalizing Symptoms Through the Familias Unidas Intervention: Examining Variation in Response.

ABSTRACT: Prevention programs that strengthen parenting and family functioning have been found to reduce poor behavioral outcomes in adolescents, including substance use, HIV risk, externalizing and internalizing problems. However, there is evidence that not all youth benefit similarly from these programs. Familias Unidas is a family-focused intervention designed to prevent substance use and sexual risk among Hispanic youth and has recently demonstrated unanticipated reductions in internalizing symptoms for some youth. This paper examines variation in intervention response for internalizing symptoms using individual-level data pooled across four distinct Familias Unidas trials: (1) 266 eighth grade students recruited from the general school population; (2) 160 ninth grade students from the general school population; (3) 213 adolescents with conduct, aggression, and/or attention problems; and (4) 242 adolescents with a delinquency history. Causal inference growth mixture modeling suggests a three-class model. The two largest classes represent youth with low (60 %) and medium (27 %) internalizing symptoms at baseline, and both intervention and control participants show reductions in internalizing symptoms. The third class (13 %) represents youth with high levels of baseline internalizing symptoms who remain at steady levels of internalizing symptoms when exposed to the intervention, but who experience an increase in symptoms under the control condition. Female gender, low baseline levels of parent-adolescent communication, and older age were associated with membership in the high-risk class. These synthesis analyses involving a large sample of youth with varying initial risk levels represent a further step toward strengthening our knowledge of preventive intervention response and improving preventive interventions.

SUBMITTER: Brincks A

PROVIDER: S-EPMC5164973 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Preventing Youth Internalizing Symptoms Through the Familias Unidas Intervention: Examining Variation in Response.

Brincks Ahnalee A Perrino Tatiana T Howe George G Pantin Hilda H Prado Guillermo G Huang Shi S Cruden Gracelyn G Brown C Hendricks CH

Prevention science : the official journal of the Society for Prevention Research 20180201 Suppl 1

Prevention programs that strengthen parenting and family functioning have been found to reduce poor behavioral outcomes in adolescents, including substance use, HIV risk, externalizing and internalizing problems. However, there is evidence that not all youth benefit similarly from these programs. Familias Unidas is a family-focused intervention designed to prevent substance use and sexual risk among Hispanic youth and has recently demonstrated unanticipated reductions in internalizing symptoms f ...[more]

PMID: 27318951

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Project description:BackgroundPrevention is essential to reduce the development of symptomology among children and adolescents into disorders, thereby improving public health and reducing costs. Therefore, easily administered screening and early assessment methods with good reliability and validity are necessary to effectively identify children's functioning and how these develop. The Brief Problem Monitor (BPM) is an instrument designed for this purpose. This study examined the psychometric properties of the Norwegian version of the BPM parent (BPM-P) and teacher (BPM-T) versions, including internal reliability and construct validity at assessing children with internalizing problems.MethodsBaseline data were collected from a national randomized controlled intervention study. Children aged 8-12 years with self-reported symptoms of anxiety and/or depression with one standard deviation above a chosen population's mean were included in this study. Teachers (n = 750) and parents (n = 596) rated children using the BPM-T and BPM-P, respectively. Internal consistency was measured using Cronbach's alpha, and multi-informant agreement between the BPM-P and BPM-T was measured using Spearman's correlations. Construct validity was assessed via confirmatory factor analysis.ResultsInternal consistency was good throughout all domains for both the BPM-P and BPM-T, with a Cronbach's alpha ranging from .763 to .878. Multi-informant agreement between the parents and the teacher was moderate on the externalizing, attention, and total scales and low on the internalizing scale. The model fit for the three-factor structure of the BPM was excellent for the BPM-P and good for the BPM-T.ConclusionsInternal consistency was good, and the original three-factor solution of the BPM-P and BPM-T was confirmed based on our sample of school children at-risk for emotional problems. These promising results indicate that the BPM may be a valid short assessment tool for measuring attentional, behavioral, and internalizing problems in children. Trial registration in Clinical Trials: NCT02340637; June 12, 2014.

Project description:BackgroundInternalizing disorders such as anxiety and depression are common psychiatric disorders that frequently begin in youth and exhibit marked heterogeneity in treatment response and clinical course. Given that symptom-based classification approaches do not align with underlying neurobiology, an alternative approach is to identify neurobiologically informed subtypes based on brain imaging data.MethodsWe used a recently developed semisupervised machine learning method (HYDRA [heterogeneity through discriminative analysis]) to delineate patterns of neurobiological heterogeneity within youths with internalizing symptoms using structural data collected at 3T from a sample of 1141 youths.ResultsUsing volume and cortical thickness, cross-validation methods indicated 2 highly stable subtypes of internalizing youths (adjusted Rand index = 0.66; permutation-based false discovery rate p < .001). Subtype 1, defined by smaller brain volumes and reduced cortical thickness, was marked by impaired cognitive performance and higher levels of psychopathology than both subtype 2 and typically developing youths. Using resting-state functional magnetic resonance imaging and diffusion images not considered during clustering, we found that subtype 1 also showed reduced amplitudes of low-frequency fluctuations in frontolimbic regions at rest and reduced fractional anisotropy in several white matter tracts. In contrast, subtype 2 showed intact cognitive performance and greater volume, cortical thickness, and amplitudes during rest compared with subtype 1 and typically developing youths, despite still showing clinically significant levels of psychopathology.ConclusionsWe identified 2 subtypes of internalizing youths differentiated by abnormalities in brain structure, function, and white matter integrity, with one of the subtypes showing poorer functioning across multiple domains. Identification of biologically grounded internalizing subtypes may assist in targeting early interventions and assessing longitudinal prognosis.

Dataset Information

Preventing Youth Internalizing Symptoms Through the Familias Unidas Intervention: Examining Variation in Response.

Publications

Preventing Youth Internalizing Symptoms Through the Familias Unidas Intervention: Examining Variation in Response.

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