Several programs for adolescent substance abuse are reportedly """"""""effective"""""""" for a significant number of participants; however, there is invariably a substantial subgroup that does not respond favorably. It is critical that underlying mechanisms for these differences are identified in order to improve prevention efficacy. Integrity of executive cognitive function (ECF) and its modulation of emotional arousal levels may represent significant dimensions of regulatory processes related to risk for substance abuse (Dawes et al., 2000) and may play a principle role in differential responses to programming. ECF and its physiological corollaries (e.g., skin conductance response [SCR]) are subserved by the brain's prefrontal cortex and its limbic circuitry to regulate behavioral inhibition, sensitivity to rewards and penalties, and decision-making. Deficits in ECF and SCRs have been associated with a variety of behavioral disorders, including substance abuse. The premise behind the proposed study is that differences in these neurocognitive-emotive processes also contribute to differential responses to preventive interventions. Thus, the goal of this study is to identify specific underlying neurocognitive components of psychosocial risk factors related to adolescent drug abuse and to assess their moderating effects on ability to process prevention materials under laboratory conditions. This study will be conducted in collaboration with the ongoing preventive intervention study at Johns Hopkins University Prevention Intervention Research Center (JHU PIRC) within the Baltimore City Public Schools. Longitudinal data (8 years) will be provided on intelligence, school achievement, and risk behaviors. An initial """"""""extreme groups validity"""""""" assessment of ECF and SCR measures will be conducted by selecting ninth graders participating in the JHU study; one group with high levels of delinquency and drug abuse and the other without any. Adolescents will receive a general neuropsychological test, three developmentally appropriate ECF tasks, and simultaneous monitoring of SCR. The selected ECF tasks measure risky decision-making, sensitivity to consequences, and impulsivity which are conceptually consistent with the phenomenology of drug abuse and shown in neuroimaging studies to activate the prefrontal cortex. These well-tested protocols have been adapted to the students' developmental stage. The concurrent validity and predictive value of these measures will be assessed with respect to psychosocial and behavioral factors (i.e., risk behaviors in the 9th and 10th grades) measured by the JHU study. In a separate session, subjects will be presented with videotaped stimulus materials from a prominent preventive intervention, the Positive Adolescent Choices Training (PACT), developed specifically for high-risk, minority, inner-city children. PACT features interactive exercises guided by videotaped role plays, and has been shown to reduce behaviors related to substance abuse (e.g., antisocial behavior, aggression, risk-taking, poor decision- making, and school-related problems) (Hammond and Yung, 1991). Students will be randomly assigned to two groups; one will be exposed to these materials by a facilitator and then presented with a series of vignettes reflective of real-life situations involving behavioral choices, and the other will not. Instrumentation will be used to assess decision-making skills that are potentially affected by the curriculum. Previously tested ECF and SCRs will be related to experimental performance to determine whether cognitive and physiological responses are predictive of performance. The high-risk group is expected to generate lower ECF and SCRs, and these responses will moderate effects of the experimental stimuli on decision-making. Thus, this experiment extends beyond assessment of correlational relationships between neurological function and behavior; it invokes ECF and SCRs in the context of real-life situations where choices made are affected by the ability of subjects to process prevention materials. This study will provide valuable insights for developing preventive interventions, individualized according to underlying pathology, for adolescents who tend to be refractory to standard treatments.
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| Fishbein, Diana H; Hyde, Christopher; Eldreth, Diana et al. (2006) Neurocognitive skills moderate urban male adolescents' responses to preventive intervention materials. Drug Alcohol Depend 82:47-60 |
| Paschall, Mallie J; Fishbein, Diana H; Hubal, Robert C et al. (2005) Psychometric properties of virtual reality vignette performance measures: a novel approach for assessing adolescents' social competency skills. Health Educ Res 20:61-70 |
| Hubal, Robert C; Deterding, Robin R; Frank, Geoffrey A et al. (2003) Lessons learned in modeling virtual pediatric patients. Stud Health Technol Inform 94:127-30 |
