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Helping Adolescents at Risk

Guilford Publications

Chapter One

Sixteen-year-old Michael has just ended a stay in a juvenile detention center. Arrested twice-once for breaking and entering and once for an assault that followed a night of heavy drinking-Michael has problems other than his encounters with the legal system. He attends high school erratically and no doubt will soon drop out entirely. He smokes almost a pack of cigarettes a day and smokes marijuana frequently. Recently he has begun to experiment with harder drugs. Now, Michael has another surprise in store for him-his girlfriend is pregnant and she plans to tell him this as soon as she sees him after his release.

We have written this book for Michael and for the many other young people headed for deeply troubled lives. Research has helped us understand much about young people with multiple behavior problems and the cost of their actions to themselves and society. Research and clinical work have also helped us to identify numerous promising strategies to work with these multiproblem youth and to begin to reduce the number of teens who end up on a downward spiral. In this book, we lay out what we know about these young people. Our goal is to demonstrate actions that are more effective in order to alter the destructive path these children travel.

The existence of a small group of multiproblem youth has been clear, at least since Jessor and Jessor (1977) first described the phenomenon of deviance-prone youth. However, despite literally hundreds of studies showing that delinquency, substance use, and high-risk sexual behavior co-occur, the implications of this phenomenon for policy, practice, and research are not clear. They have been unclear because no one has brought all this information together and spelled out its significance for research and practice. Prevention and treatment strategies typically focus only on a subset of problems. For example, we have programs to prevent academic failure, but we know little about whether these programs can prevent delinquency or drug abuse. In addition, we know that the family, schools, peers, and the community may (either positively or negatively) influence what happens to these teens. For example, with protective factors, such as a stable home life, involved parents, and teachers at school who never give up, even a teen beginning to get involved in problematic behavior can pull out of the downward spiral. Yet, when the child's father abandons the family, the mother works two jobs, and the child's acting out in school lands him or her in the principal's office more often than not, avenues narrow for the opportunity to resist the negative pull. We know that influences on the development of the multiproblem pattern begin while the child is still in the womb. Obviously, the time to intervene is when the potential for the developmental of problems is in its infancy. Despite our knowledge, we have not instituted widespread comprehensive, evidence-based approaches geared to deal with these problems before they lead to a cascade of increasingly destructive behavior patterns.

In Chapter 2, we document the extent to which multiproblem youth account for a large proportion of the occurrence of serious antisocial behavior, risky sexual behavior, drug and alcohol misuse, and tobacco use. In that chapter, we also show how multiple behavior problems lead to many problematic outcomes such as suicide and unwanted pregnancy. In Chapter 3, we show how to estimate the social costs attributable to the behavior of multiproblem youth. In Chapter 4, we identify the major factors that influence young people to develop these problems. Chapters 5-8 describe empirically evaluated interventions shown to reduce one or more of the problems that concern us. Chapter 5 focuses on interventions that target preadolescent influences on the development of multiple problem behaviors. It documents numerous strategies to follow for prevention of these problems and to promote successful adolescent development. Chapter 6 describes interventions designed to prevent problem behaviors among all adolescents. Chapters 7 and 8 describe interventions focused on helping adolescents who are already showing signs of problematic behavior. The final chapter examines issues involved in applying these scientific findings to help communities develop programs and policies to help not only youths in trouble but also those headed in that direction.

ADOLESCENT PROBLEM BEHAVIORS

We have chosen to focus on five adolescent problem behaviors: antisocial behavior (including aggressive social behavior and more serious acts such as stealing and assault), cigarette smoking, alcohol and drug misuse, and sexual behavior that risks pregnancy or disease. We chose these behaviors for several reasons. First, they represent the five most costly problems our society faces. Second, young people who engage in any one of these problem behaviors are highly likely to engage in the others. Third, many of the same biological and environmental factors influence the development of each these problems. Fourth, many of the prevention and treatment interventions previously developed have an impact on more than one of these problems. It is clear to us, therefore, that our society's efforts to lower the rates and costly consequences of each of these problems will benefit from comprehensive and coordinated strategies that simultaneously address the entire set of problems.

Most typical adolescents engage in some of these behaviors to some extent. For example, the majority of adolescents report committing some form of delinquent behavior at some point in their adolescence (Elliott, Huizinga, & Menard, 1989). Similarly, by the age of 17, 70-75% of adolescents drink alcohol, 25% have smoked marijuana, and 80% have engaged in sexual intercourse (Huizinga, Loeber, & Thornberry, 1993). Although we may argue about the desirability of these behaviors in any form, we would all have to concur that, at serious levels, these behaviors are deeply problematic for everyone concerned and can only lead to more difficulties. Therefore, we focus on types of behavior that most would agree are problematic because of the serious consequences they can and often do produce.

We call youth who engage in two or more of these behaviors "multiproblem youth." Because large numbers of youth begin to engage in these serious behavior problems only after they reach adolescence, our primary focus is on children between the ages of 11 and 18, although we look also at early precursors of these problems and the corresponding prevention strategies for use with younger children.

Serious Antisocial Behavior

Antisocial behavior consists of aggressive and criminal acts. The most serious forms of antisocial behavior are so-called index crimes, identified by the FBI as murder, aggravated assault, sexual assault, gang fights, car theft, theft of something worth more than $50, breaking and entering, or strong arming someone (Elliott et al., 1989). In addition, antisocial behavior is generally defined to include less severe delinquent offenses, such as buying stolen goods; carrying a hidden weapon; stealing something worth less than $5; prostitution; selling marijuana; hitting a teacher, parent, or student; disorderly conduct; selling hard drugs; joyriding; stealing something worth $5 to $50; and panhandling (Elliott...