Research of Note for May 2004

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There is good news and bad news this month: an analysis of two comprehensive programs aimed at helping urban youth avoid risky behaviors, interesting data on efforts to reunite foster children with their families, and frightening new research on how TV viewing might be linked to attention deficit disorder.

Programs That Attack Risky Behaviors

Effects of Two Prevention Programs on High-Risk Behaviors Among African American Youth
Brian Flay, D.Phil.; Sally Graumlich, Ed.D.; Eisuke Segawa, Ph.D.; and colleagues.
Archives of Pediatrics and Adolescent Medicine, Vol. 158, April 2004, pgs. 377-384.
Available from Flay at or Health Research and Policy Centers, University of Illinois at Chicago, 850 W. Jackson Blvd., # 400, Chicago, IL 60607.

This new study of two programs serving youth in Chicago is a good example of the successes and shortcomings of programs designed to help inner-city youth.
The Aban Aya Youth Project, which was designed by health and mental health professionals at the University of Illinois at Chicago, developed and ran two school-based programs targeting a wide range of risk behaviors: violence, provoking behavior, substance use, school delinquency, and sexual intercourse.
Researchers surveyed 668 fifth-grade children in 12 schools in 1994, and just over half of them (339) participated through 1998.

Some were put in a “social development” program designed to build self-esteem and empathy, manage stress and anxiety, develop interpersonal relationships, resist peer pressure and develop problem-solving skills. The program developed a classroom curriculum based in part on the New Haven Social Development Program, the Youth AIDS Prevention Project and other prevention curricula.

The other intervention included the same curriculum but also offered schoolwide and communitywide activities: a parent support group; a youth support program; and a task force of youth, parents, community advocates and school personnel to propose changes in school policy, strengthen school-community liaisons and solicit community organizations to conduct activities.

A control group curriculum included some of the same skills, such as decision-making and problem-solving, but focused on health care, nutrition and exercise.
The curricula for all three programs included 16 to 21 lessons each year for four years. Many of the youths moved and did not stay for all four years, so the data were analyzed for any youth who was in the program at least from the beginning to the end of fifth grade.

Because the authors are writing about a program they designed, it is perhaps not surprising that the Archives article focuses on the positive, even when the results showed that the number of youth engaging in risk behaviors increased every year in each of the three groups.

The good news is that the boys in the intervention programs did not increase their problem behaviors as much as the youth in the control group. For example, while negative behavior scores increased by 74 percent for boys in the control group, they rose by only 13 percent in the community group and 36 percent in the social development group. The community group had more negative behaviors before the intervention started, so that its scores at the end of the program were almost identical to those of the social development group.

The programs had no impact on girls, who tended to have fewer problems than boys each year but, like the boys, engaged in more risk behaviors each year from fifth grade through eighth grade.

The researchers admit that the control group was not really a control group, because it participated in a program that helped develop problem-solving skills and may therefore have also reduced problem behaviors. They speculate that the girls did not benefit as much because they did not have major behavior problems to begin with, but they also acknowledge that the programs may not have been as well-suited to the interests of girls. They also remind us that some of the youths were only in the program one year, which could weaken its impact.

All these caveats are true. On the other hand, these programs represented a long-term, comprehensive effort to improve the lives of inner-city boys and girls, and it is distressing that they did not help the girls. And although risky behaviors tend to increase with age, it is disappointing that the program did not have a more positive impact on the boys. Does the curriculum need to be changed for girls? Should efforts to improve self-esteem focus on self-efficacy instead? Are the problems in the homes and neighborhoods so pervasive that the most that school-based and school/community efforts can hope for is to hold down increases in risky behavior?

This article can’t answer those questions, but it’s important to keep developing and evaluating programs to find out what works.

Which Families Can Be Reunited?

Family Reunification
Fred Wulczyn, Ph.D., M.S.W.
“Children, Families, and Foster Care,” The Future of Children, Winter 2004, pgs. 95-113.
Available free at

This issue of The Future of Children covers foster care, including safety and stability, adoption and guardianship, kinship care, older children, and the much-debated topic of family reunification. The family reunification article is more research-based than most of the other articles and is the focus of this Research Watch.

Most foster care placements end with the children returning to their biological parents. But surprisingly little research has been conducted to determine how often that reunification is successful for the child, and whether success can be predicted.

The article quotes one study showing the importance of the quality of case plans, assessments, family engagement and compliance, service coordination before and after reunification, and monitoring of the reunification. Most of the article focuses on a data set of 1.3 million foster children in 12 states who were followed for up to 10 years after leaving foster care. The Multi-state Foster Care Data Archive includes children in Alabama, California, Illinois, Iowa, Maryland, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio and Wisconsin – states that account for 55 percent of children in foster care in the United States.

Researchers found that approximately half of the children placed in foster care between the ages of 1 and 17 were reunified with their parents. The percentage is closer to one-third for infants who were under 1 year old when first placed in foster care, while almost 40 percent of those infants were adopted. Another 10 percent were placed with family members.

Approximately 20 percent of the children first placed in foster care between the ages of 1 and 5 are adopted, as are just under 10 percent placed between 6 and 12 years old.

Race and ethnicity influence whether a child will be reunified with the parents, adopted or placed elsewhere. Whites are slightly more likely to be reunified than children of other races and ethnicities, and less likely to be adopted. African-Americans are somewhat less likely to be reunified, compared with other groups (although more than 40 percent are reunified), and slightly more likely to be adopted (more than 20 percent) or placed with a relative (more than 10 percent). The differences are small and do not support the conventional wisdom about which children are “adoptable.”

Reunification is more likely to take place after a short placement in foster care, than after a long placement. For example, 28 percent of children who leave foster care within a year are reunified with their parents, compared with 16 percent of those who leave during their second year in care, and 10 percent of those who leave during the third year.

Unfortunately, the data also show that 28 percent of the kids who are reunified with their families return to foster care within 10 years, and most of those return within one year.

The researchers raise important questions about how little is known about reunification. In addition to not knowing what strategies would help reunification succeed, little is known about whether reunification truly is a successful outcome for most children. For example, a small study in San Diego found that children who were reunified were more likely to engage in risky behaviors and had more behavior problems than those who stayed in foster care.

The bottom line: We don’t know as much about reunification as we should.

Does Early TV Viewing Cause ADHD?

Early Television Exposure and Subsequent Attentional Problems in Children
Dimitri Christakis, M.D., M.P.H.; Frederick Zimmerman, Ph.D.; David DiGiuseppe, M.Sc.; and Carolyn McCarty, Ph.D.
Pediatrics, Vol. 113, No. 4, April 2004, pgs. 708-713.
Available free at

For adults working with children, one of the big questions in recent years has been the apparent epidemic of attention deficit disorder with hyperactivity (ADHD). Why are there so many kids with this diagnosis compared with 40 years ago? Could it merely be that we are recognizing a problem that used to be undiagnosed, or is there a real increase in this disorder? If so, why?
This new study, linking TV viewing and ADHD, took me by surprise. It raises important issues for all youth workers, child care workers and parents. But it must be read carefully. The headlines are misleading.

A huge pile of research indicates that watching TV is linked with negative behaviors in children, and I have been concerned about the negative influences of TV on kids’ attitudes and behavior since I conducted research on elementary school children in 1978. But, like most psychologists, I thought the problem was that children were “learning” bad things from what they watched. I never thought about the impact on the “wiring” of the developing brain, which is the premise of this study.

The researchers point out that, compared with the pace of real life as experienced by young children, TV can portray “rapidly changing images, scenery, and events.” It is very interesting to children, but may be overstimulating as well. Pediatricians warn against TV viewing for children under the age of 2, but TV is a convenient babysitter, and young children are exposed to it in most homes and many family day care centers.

This article in Pediatrics is based on data from the National Longitudinal Survey of Youth (NLSY) 1979, which started with a nationally representative sample of more than 12,000 youth who were between the ages of 14 and 22 in 1979. The participants have been interviewed every other year since then. Starting in 1986, more than 11,000 children born to the women in the original study were also included. This article is based on a study that followed more than 2,500 of those children, starting from ages 1 or 3 to age 7.

Starting in 1990, mothers were asked the number of hours of TV their children watched on typical weekdays and weekends. Half of the children were male, and 57 percent were white.

The children watched an average of 2.2 hours of TV every day at age 1 and 3.6 hours at age 3. However, the range of TV viewing was skewed, especially for 1-year-olds, with almost half the moms reporting that their infants watched TV less than one hour per day and about 10 percent reporting that their infants watched five hours or more per day.

Ten percent of the children had attention problems at age 7, based on the hyperactivity subscale of the Behavior Problems Index. This subscale consists of five questions about having difficulty concentrating, being easily confused, impulsive and restless, and having obsessions. Although not the same as a diagnosis, these questions are from the Child Behavior Checklist, and other studies show that most children with these reported problems are diagnosed with ADHD.

Because parents who allow young children to watch many hours of TV each day may have other shortcomings, the researchers controlled for prenatal substance abuse, gestational age of the child, the mothers’ mental health and socioeconomic status.
Even when those traits were statistically controlled, infants and toddlers who watched more TV were more likely to have attention problems at age 7.

The children who had attention problems watched only a little more TV than the other children, on average. But some children watched eight or more hours of TV each day, and the results of the extremes of TV viewing are startling. For each additional three hours of daily TV viewing, a child was 28 percent more likely to have attention problems.

One shortcoming of the study is that TV viewing was estimated by the mothers, who might have been inaccurate or less than candid. Likewise, mothers who let their young children watch excessive amounts of TV could be neglectful or have other traits that were not statistically controlled.

Another problem is that the type of TV programs viewed was not evaluated. This study couldn’t determine whether some TV programs were more strongly associated with attention problems than others. But four-plus hours of TV each day is probably not good for infants’ and toddlers’ brain development, no matter what the programs are.

Diana Zuckerman, Ph.D., is president of the National Center for Policy Research for Women and Families. Contact: