Preventive Sessions After Divorce Protect Children into Teens

Divorcing families who participated in a prevention program markedly reduced the likelihood of their children developing mental disorders as adolescents, say NIMH-funded scientists. Structured group sessions for mothers and children later halved rates of mental disorders in the teen years, among other benefits, in the first study to document long-term effects of such preventive interventions using a randomized experimental trial.

Prevalence of mental disorders rose to 23.5 percent among teens in families that did not receive active interventions, compared to only 11 percent in families who received the most comprehensive intervention. The program also reduced acting out, drug and alcohol use and sexual promiscuity. Drs. Sharlene Wolchik, Iwin Sandler, and colleagues at Arizona State University, Tempe, report on their 6-year follow-up of 218 families in the October 16, 2002 Journal of the American Medical Association.

About 1.5 million children experience the divorce of their parents each year - ultimately 40 percent of all children. While most adapt well, 20-25 percent suffer significant adjustment problems as teenagers. The negative impact often persists into adulthood, resulting in nearly twice the normal prevalence of mental health problems and impaired educational attainment, socioeconomic and family well-being.

"The skills training program's breadth of effect cut across multiple mental health, substance use and sexual behavior problems," said Sandler. "It reduced the 1-year prevalence of mental disorder in these teens by 50 percent, boosting their chances of avoiding serious mental health problems by more than four-to-one."

The divorcing families, with children then age 9-12, were randomly assigned to one of three preventive interventions for mothers and their children, conducted in the Phoenix area New Beginnings Program in l992-l993:

Mother Program -- 11 group sessions in which two clinicians focused on improving the mother-child relationship, discipline, increasing father's access to the child, and reducing conflict between the parents. Each mother also had two structured individual sessions.

Mother Plus Child Program -- the mother program, plus 11 structured group sessions for children, designed to improve coping, the mother-child relationship, and reduce negative thoughts. Based on social-cognitive theory, the children learned to label feelings, solve problems, and to reframe their thinking in a positive way in dealing with the stress of divorce.

Literature Control condition - mothers and children each received three books on divorce adjustment.

After 6 years, the researchers followed up 91 percent of the families, whose children then averaged nearly 17 years old. Eighty percent of the teens were living with their mothers. The two active interventions led to more favorable outcomes than the control condition for all problems assessed. Effects proved greatest for children who entered the study with the most problems. Although the Mother and Mother Plus Child Programs finished in a statistical dead heat overall, each showed certain strengths.

When evaluated 6 months after the trial, children who had started out at highest risk of externalizing problems - aggression, hostility - had benefited from the Mother Program and the Mother Plus Child Program. At the six-year follow-up, the Mother Program also led to significantly less alcohol, marijuana, and other drug use for those who were initially at higher risk. Teens who had been in the Literature Control condition had more than twice as many sexual partners as those exposed to the Mother Plus Child Program. Again, the latter group also showed a significantly reduced 1-year prevalence of mental disorders; the odds of Literature Control condition teens having a mental disorder diagnosis were 4.50 times higher.

"The impact of the programs on reducing externalizing problems is especially noteworthy," said Wolchik. "Children of divorce are at high risk for these problems, which have high individual and social costs. Skill-building programs to help mothers and children during difficult times can have a long-term positive impact."

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