The Bully: Types Of Prevention
If we all know that an ounce of prevention is worth a
pound of cure, why aren't preventive measures more
common? In some cases it is not clear what steps are
needed to achieve the goal of prevention, and in others
society does not seem willing or able to take the needed
steps.
Prevention can take place on three levels. Primary
prevention is concerned with the reduction of new
cases of mental or physical disorder in a given population.
Scientific information about cause and effect is
very important in primary prevention. For example,
knowledge of the possibility of harm to the unborn
child has persuaded many women not to smoke or drink
during pregnancy. Physicians are much more careful
about prescribing medication for pregnant women because
of information linking even seemingly harmless
drugs with birth defects. Psychologists are conducting
research on ways to discourage children from beginning
to smoke cigarettes (Flay and others, 1985). Another
example of primary prevention is premarital counseling.
Marital problems and divorce are highly correlated with
maladaptive behavior. Premarital counseling is aimed at
encouraging couples to anticipate any problems and to
develop ways of coping with them before marriage.
The aim of secondary prevention is to reduce the
duration, intensity, and disability of an existing abnormal
condition. For example, if a child with phenylketonuria
(PKU) is identified early, a special diet can prevent
serious retardation. Enrichment programs for
infants from homes where little stimulation is available
can improve children's intellectual functioning and their
level of achievement in school.
Whereas secondary prevention refers to the diagnosis
and treatment of disorders as soon as possible, tertiary
prevention is aimed at reducing the impairment
that may result from a given disorder or event. This is
achieved through rehabilitation and re-socialization. For
example, behavioral therapy for a hyperactive child may
help him or her become more attentive in school and
more accepted by other children. Counseling or group
therapy after a traumatic event such as the death of a
spouse or a rape may provide the social supports that
reduce a person's vulnerability to stress.
Preventive measures have been developed in many
cases in which biophysical factors are known to cause
maladaptive behavior. However, the effects of detrimental
social factors have frequently been ignored or neglected.
It is much easier to detect and control the effects
of an enzyme deficiency in newborn infants than it
is to detect and control the pervasive influence of poverty
and racism. But ignoring these causes and correlates
of maladaptive behavior will not decrease their influence.
When prevention methods are successful, risk factors
that lead to abnormal behavior are reduced or eliminated.
In general, priority in efforts to achieve prevention
is given to serious conditions that have high rates
of incidence, and for which effective methods are available.
For example, one of the most serious and prevalent
maladaptive behaviors of childhood is juvenile delinquency.
Delinquent behavior seems to have many
causes, ranging from poor living conditions to a psychopathic
or antisocial personality disorder to psychosis. It
is sobering to realize that one out of nine children will
be referred to juvenile court for an act of delinquency
before his or her eighteenth birthday and that perhaps
one-third of all cases of delinquency involve repeat offenders.
Obviously, not all delinquents are arrested for
their crimes. Thus, when juveniles are asked about their
delinquent activities, the percentage of young people
who have been involved in delinquency becomes even
higher. Some of the following conditions have also been
identified with delinquency.
1. Poor physical and economic conditions in the home
and neighborhood.
2. Rejection or lack of security at home.
3. Exposure to antisocial role models within or outside
the home, and antisocial pressures from peer-group
relationships.
4. Lack of support for social achievement in school.
5. The expectation of hostility on the part of others.
Juvenile delinquency can be approached at different
levels of prevention. Primary prevention often takes
the form of programs aimed at improving living conditions
and school achievement. Sometimes primary prevention
comes about more informally. There is some
evidence that if children growing up in high-crime areas
have a positive figure to copy or model themselves after,
their behavior may be more influenced by that person
than by their antisocial peers. The value of a model is
shown in the following example.
Caesar and Richard are two brothers who lived in
a high-crime community. Neither has become delinquent.
Talking with them gives us some clues to why
this is so. Caesar has had one year of community college.
He quit because he had to support the family, but
at present he is unemployed. He spends his time with
gang members but does not participate in their antisocial
activities. He thinks he is able to do this because
the others admire him for his skill at restoring old cars.
This admiration makes it possible
for him to know them without participating in their activities,
to dress differently, and to see himself as a potentially
achieving person who will contribute to the
community. Caesar attributes his goals and behavior to
his efforts to be like an older, retired gang member,
Hood.
Hood's been through it all. He's lived here all his
life-he Js done time-he Js been a user but now he Js
clean. He is harassed by the cops so much that he had
to get a letter from a judge saying that he was clean
and that he should be left alone. He helps all of us in
the barrio. He tells it like it really is Js takes us to the
ballgame) helps raise money for bail) whatever. He
does it all for nothing. Not even teachers and
counselors work for nothing.
-(Aiken and others, 1977, p. 217)
Richard, a younger boy, thinks Caesar, his older
brother, was instrumental in the development of his
own pro-social behavior.
My mother told my brother when my father left that
he was responsible for me) she wasn't. My brother
counseled me) looked out for me) and told me what to
do. He told me never to steal-that if I wanted
something to come to him and he'd. try to get it for
me or see if I could earn it. If my brother thought
that I was getting into trouble) he would probably
kick my butt.
-(Aiken and others, 1977, p. 217)
Richard is classified as a slow learner in school and
has problems in math and reading. But he has learned
how to repair bicycles and sees this as a way to gain
status in the community.
Some adolescents develop their own cognitive
mechanisms to help them resist peer pressure. Linda
Carmichael, who lived in a Chicago tenement inhabited
by winos, junkies, and petty hustlers, went to college.
Linda wants to get out of the ghetto.
This is how she described the cognitions that
helped her keep on her track when her peers sneered
and when she ''wanted to be out partying and goofing
off like everyone else": "I'd start thinking about all those
people on the street with nothing to look forward to
and where would I be without school. That kept me
going" (Goldman and Williams, 1978, p. 34)
Secondary prevention programs concentrate on
young people who have shown early signs of delinquency.
An example of this approach is a project aimed
at rehabilitating pre-delinquent boys in a homelike setting
(Kirigin and others, 1982). This project focuses
not only on teaching social and vocational skills but also
on helping boys to behave less impulsively. The project
has been carried out at Achievement Place, a group
home in Lawrence, Kansas, for 12- to 14-year-old boys
who have committed minor nonviolent offenses (such
as theft or truancy) but seem to be on the road to more
serious crimes. House-parents at Achievement Place
identify target behaviors and employ token reinforcement
systems to strengthen pro-social tendencies. The
emphasis is on social and academic skills as well as on
self-care.
Sometimes changing delinquent behavior might
be classified as tertiary prevention. For example, the
youth might be involved in seriously maladaptive behavior.
For instance, a 14-year-old boy was referred to a
therapist by the court because he had set several large
grass fires that had endangered houses. He could not
explain his behavior, and neither could his parents since
he had always behaved responsibly at home.
The boy's family was seen for six family-therapy
sessions. These sessions revealed that
the family could not discuss problems openly but
tended to communicate non-verbally. Several recent family
crises had caused tension. The father seemed to handle
his unhappiness by withdrawing from the family
into club activities. The son seemed to express his anger
at family problems by setting fires. Once they began to
meet in therapy sessions and these problems became evident,
all of the family members were able to change
their behavior. One year later there had been no more
fire-setting (Eisler, 1972).
At all levels of prevention, the problems of delinquency
and the therapeutic treatment of delinquents are
far from solved. The number of delinquents who go on
to commit more antisocial acts is high. Different approaches
work best with different types of cases, but as
yet all methods produce more misses than hits. Understanding
delinquency requires a better grasp of the variables involved in the
interaction between the person
and the situation.
Sites of Prevention
In this chapter we are especially interested in research
that is relevant to the prevention of maladaptive behavior.
Where data are lacking, we speculate about the use
of social experimentation. We do not attempt a comprehensive
analysis of all the components of a complex social
structure; instead, we direct our attention toward
three areas that definitely affect the growth and development
of children and adults: the family, the school,
and the community.
The Family
Parents are important because of the genes they contribute
and the environment they provide for their children.
This environment begins in the uterus during the 9 months
before birth. Whatever can improve prenatal
care and thus reduce the incidence of premature birth
and other foreseeable difficulties might help reduce several
types of problems, such as low intelligence. Improved
prenatal and neonatal care can be expected to
reduce brain damage, which, among other conditions, is
related to certain types of epilepsy.
From the standpoint of prevention, the family is
important because much of the child's earliest learning
and development takes place within the family setting.
Parents' ideas about child-rearing and the growing-up
process make important contributions to the day-to-day
environment of children.
One of the most common observations of clinicians
who specialize in treating childhood disorders is that
treating the child is not enough. The parents are usually
part of the problem. The following are some extreme
examples: Children of psychotic parents are slow in defence.
Some well-intentioned, overly conscientious parents worry
too much about what children need early in life to lay the
groundwork for a good life later. On the other hand, there are
parents who do not devote enough attention to their children's needs.
Developing speech and bladder control, have more eating
and sleeping problems, and are more likely to be delinquent
than other children. Alcoholic parents have a disproportionately
large number of hyperactive children,
and alcoholic mothers are over represented among mothers
of babies with low birth weight and low IQs. There
is also a relationship between criminality in parents and
delinquency in their children. Children who have been
physically abused, malnourished, and neglected by their
parents are more prone to various forms of maladaption
than other children. Under certain circumstances even
"normal" parents-that is, parents who are not obviously
disturbed-can have negative effects on their
children's development.
pound of cure, why aren't preventive measures more
common? In some cases it is not clear what steps are
needed to achieve the goal of prevention, and in others
society does not seem willing or able to take the needed
steps.
Prevention can take place on three levels. Primary
prevention is concerned with the reduction of new
cases of mental or physical disorder in a given population.
Scientific information about cause and effect is
very important in primary prevention. For example,
knowledge of the possibility of harm to the unborn
child has persuaded many women not to smoke or drink
during pregnancy. Physicians are much more careful
about prescribing medication for pregnant women because
of information linking even seemingly harmless
drugs with birth defects. Psychologists are conducting
research on ways to discourage children from beginning
to smoke cigarettes (Flay and others, 1985). Another
example of primary prevention is premarital counseling.
Marital problems and divorce are highly correlated with
maladaptive behavior. Premarital counseling is aimed at
encouraging couples to anticipate any problems and to
develop ways of coping with them before marriage.
The aim of secondary prevention is to reduce the
duration, intensity, and disability of an existing abnormal
condition. For example, if a child with phenylketonuria
(PKU) is identified early, a special diet can prevent
serious retardation. Enrichment programs for
infants from homes where little stimulation is available
can improve children's intellectual functioning and their
level of achievement in school.
Whereas secondary prevention refers to the diagnosis
and treatment of disorders as soon as possible, tertiary
prevention is aimed at reducing the impairment
that may result from a given disorder or event. This is
achieved through rehabilitation and re-socialization. For
example, behavioral therapy for a hyperactive child may
help him or her become more attentive in school and
more accepted by other children. Counseling or group
therapy after a traumatic event such as the death of a
spouse or a rape may provide the social supports that
reduce a person's vulnerability to stress.
Preventive measures have been developed in many
cases in which biophysical factors are known to cause
maladaptive behavior. However, the effects of detrimental
social factors have frequently been ignored or neglected.
It is much easier to detect and control the effects
of an enzyme deficiency in newborn infants than it
is to detect and control the pervasive influence of poverty
and racism. But ignoring these causes and correlates
of maladaptive behavior will not decrease their influence.
When prevention methods are successful, risk factors
that lead to abnormal behavior are reduced or eliminated.
In general, priority in efforts to achieve prevention
is given to serious conditions that have high rates
of incidence, and for which effective methods are available.
For example, one of the most serious and prevalent
maladaptive behaviors of childhood is juvenile delinquency.
Delinquent behavior seems to have many
causes, ranging from poor living conditions to a psychopathic
or antisocial personality disorder to psychosis. It
is sobering to realize that one out of nine children will
be referred to juvenile court for an act of delinquency
before his or her eighteenth birthday and that perhaps
one-third of all cases of delinquency involve repeat offenders.
Obviously, not all delinquents are arrested for
their crimes. Thus, when juveniles are asked about their
delinquent activities, the percentage of young people
who have been involved in delinquency becomes even
higher. Some of the following conditions have also been
identified with delinquency.
1. Poor physical and economic conditions in the home
and neighborhood.
2. Rejection or lack of security at home.
3. Exposure to antisocial role models within or outside
the home, and antisocial pressures from peer-group
relationships.
4. Lack of support for social achievement in school.
5. The expectation of hostility on the part of others.
Juvenile delinquency can be approached at different
levels of prevention. Primary prevention often takes
the form of programs aimed at improving living conditions
and school achievement. Sometimes primary prevention
comes about more informally. There is some
evidence that if children growing up in high-crime areas
have a positive figure to copy or model themselves after,
their behavior may be more influenced by that person
than by their antisocial peers. The value of a model is
shown in the following example.
Caesar and Richard are two brothers who lived in
a high-crime community. Neither has become delinquent.
Talking with them gives us some clues to why
this is so. Caesar has had one year of community college.
He quit because he had to support the family, but
at present he is unemployed. He spends his time with
gang members but does not participate in their antisocial
activities. He thinks he is able to do this because
the others admire him for his skill at restoring old cars.
This admiration makes it possible
for him to know them without participating in their activities,
to dress differently, and to see himself as a potentially
achieving person who will contribute to the
community. Caesar attributes his goals and behavior to
his efforts to be like an older, retired gang member,
Hood.
Hood's been through it all. He's lived here all his
life-he Js done time-he Js been a user but now he Js
clean. He is harassed by the cops so much that he had
to get a letter from a judge saying that he was clean
and that he should be left alone. He helps all of us in
the barrio. He tells it like it really is Js takes us to the
ballgame) helps raise money for bail) whatever. He
does it all for nothing. Not even teachers and
counselors work for nothing.
-(Aiken and others, 1977, p. 217)
Richard, a younger boy, thinks Caesar, his older
brother, was instrumental in the development of his
own pro-social behavior.
My mother told my brother when my father left that
he was responsible for me) she wasn't. My brother
counseled me) looked out for me) and told me what to
do. He told me never to steal-that if I wanted
something to come to him and he'd. try to get it for
me or see if I could earn it. If my brother thought
that I was getting into trouble) he would probably
kick my butt.
-(Aiken and others, 1977, p. 217)
Richard is classified as a slow learner in school and
has problems in math and reading. But he has learned
how to repair bicycles and sees this as a way to gain
status in the community.
Some adolescents develop their own cognitive
mechanisms to help them resist peer pressure. Linda
Carmichael, who lived in a Chicago tenement inhabited
by winos, junkies, and petty hustlers, went to college.
Linda wants to get out of the ghetto.
This is how she described the cognitions that
helped her keep on her track when her peers sneered
and when she ''wanted to be out partying and goofing
off like everyone else": "I'd start thinking about all those
people on the street with nothing to look forward to
and where would I be without school. That kept me
going" (Goldman and Williams, 1978, p. 34)
Secondary prevention programs concentrate on
young people who have shown early signs of delinquency.
An example of this approach is a project aimed
at rehabilitating pre-delinquent boys in a homelike setting
(Kirigin and others, 1982). This project focuses
not only on teaching social and vocational skills but also
on helping boys to behave less impulsively. The project
has been carried out at Achievement Place, a group
home in Lawrence, Kansas, for 12- to 14-year-old boys
who have committed minor nonviolent offenses (such
as theft or truancy) but seem to be on the road to more
serious crimes. House-parents at Achievement Place
identify target behaviors and employ token reinforcement
systems to strengthen pro-social tendencies. The
emphasis is on social and academic skills as well as on
self-care.
Sometimes changing delinquent behavior might
be classified as tertiary prevention. For example, the
youth might be involved in seriously maladaptive behavior.
For instance, a 14-year-old boy was referred to a
therapist by the court because he had set several large
grass fires that had endangered houses. He could not
explain his behavior, and neither could his parents since
he had always behaved responsibly at home.
The boy's family was seen for six family-therapy
sessions. These sessions revealed that
the family could not discuss problems openly but
tended to communicate non-verbally. Several recent family
crises had caused tension. The father seemed to handle
his unhappiness by withdrawing from the family
into club activities. The son seemed to express his anger
at family problems by setting fires. Once they began to
meet in therapy sessions and these problems became evident,
all of the family members were able to change
their behavior. One year later there had been no more
fire-setting (Eisler, 1972).
At all levels of prevention, the problems of delinquency
and the therapeutic treatment of delinquents are
far from solved. The number of delinquents who go on
to commit more antisocial acts is high. Different approaches
work best with different types of cases, but as
yet all methods produce more misses than hits. Understanding
delinquency requires a better grasp of the variables involved in the
interaction between the person
and the situation.
Sites of Prevention
In this chapter we are especially interested in research
that is relevant to the prevention of maladaptive behavior.
Where data are lacking, we speculate about the use
of social experimentation. We do not attempt a comprehensive
analysis of all the components of a complex social
structure; instead, we direct our attention toward
three areas that definitely affect the growth and development
of children and adults: the family, the school,
and the community.
The Family
Parents are important because of the genes they contribute
and the environment they provide for their children.
This environment begins in the uterus during the 9 months
before birth. Whatever can improve prenatal
care and thus reduce the incidence of premature birth
and other foreseeable difficulties might help reduce several
types of problems, such as low intelligence. Improved
prenatal and neonatal care can be expected to
reduce brain damage, which, among other conditions, is
related to certain types of epilepsy.
From the standpoint of prevention, the family is
important because much of the child's earliest learning
and development takes place within the family setting.
Parents' ideas about child-rearing and the growing-up
process make important contributions to the day-to-day
environment of children.
One of the most common observations of clinicians
who specialize in treating childhood disorders is that
treating the child is not enough. The parents are usually
part of the problem. The following are some extreme
examples: Children of psychotic parents are slow in defence.
Some well-intentioned, overly conscientious parents worry
too much about what children need early in life to lay the
groundwork for a good life later. On the other hand, there are
parents who do not devote enough attention to their children's needs.
Developing speech and bladder control, have more eating
and sleeping problems, and are more likely to be delinquent
than other children. Alcoholic parents have a disproportionately
large number of hyperactive children,
and alcoholic mothers are over represented among mothers
of babies with low birth weight and low IQs. There
is also a relationship between criminality in parents and
delinquency in their children. Children who have been
physically abused, malnourished, and neglected by their
parents are more prone to various forms of maladaption
than other children. Under certain circumstances even
"normal" parents-that is, parents who are not obviously
disturbed-can have negative effects on their
children's development.