Prevention Science [PREV] pp654-prev-454095 October 14, 2002 12:39 Style ﬁle version Nov. 04, 2000
Prevention Science, Vol. 3, No. 4, December 2002 (
Early Identification of Children At Risk
for Costly Mental Health Service Use
Kenneth A. Dodge,
E. Michael Foster,
and Conduct Problems Prevention Research Group
Children and adolescents with serious and persistent conduct problems often require large
public expenditures. Successfully diverting one high risk child from unfortunate outcomes may
result in a net savings to society of nearly $2 million, not to mention improving the life of that
child and his or her family. This ﬁgure highlights the potential of prevention, which often rests
on the ability to identify these children at a young age. This study examined the ability of a short
conduct-problems screening procedure to predict future need for mental health assistance,
special education services, and the juvenile justice system during elementary school ages. The
screen was based on teacher and parent report of child behavioral habits in kindergarten,
and was used to identify children as either at risk or not at risk for behavioral problems.
Service outcomes were derived from a service-use assessment administered to parents at the
end of the sixth grade, while special education information was gathered through a survey
of school records. Study participants (463 kindergarten children; 54% male, 44% African
American) were from economically disadvantaged neighborhoods in four diverse communities
across the United States. Results indicated that, while controlling for demographic background
variables, the risk indicator strongly predicted which children would require services related
to conduct disorder or behavioral/emotional problems. Additional analyses revealed that the
dichotomous high risk indicator was nearly as strong as the continuous screening variable in
predicting the service-use outcomes, and that the screening of both parents and teachers may
not be necessary for determining risk status.
KEY WORDS: prevention; behavioral disorders; service utilization.
This study determined whether a short conduct-
problems screening instrument, administered in
kindergarten, could predict children’s involvement
with the mental health, special education, and juve-
nile justice systems by the time they entered middle
Department of Psychology and Human Development, Vanderbilt
University, Sewanee, Tennessee.
Center for Child and Family Policy, Duke University.
Department of Health Policy and Administration, Pennsylvania
Kenneth Dodge’s colleagues in the Conduct Problems Prevention
Research Group are, in alphabetical order, Karen L. Bierman,
PhD (Pennsylvania State University), John D. Coie, PhD (Duke
University), Mark Greenberg, PhD (Pennsylvania State Univer-
sity), John E. Lochman, PhD (University of Alabama), Robert
J. McMahon, PhD (University of Washington), and Ellen E.
Pinderhughes, PhD (Vanderbilt University).
school. If high cost children can be identiﬁed reliably,
early intervention may be cost-effective.
A small minority of children initially display con-
duct problems as early as preschool, and these prob-
lems persist well into adulthood (Mofﬁtt, 1993). This
group, called “early starters,” constitutes about 5 or
6% of the population but is responsible for 50–60%
of all known crimes (Blumstein et al., 1986). The most
reliable and robust predictor of whether a child will
display this pattern of serious and persistent con-
duct problems is extreme and stable oppositional and
aggressive behaviors early in life (Achenbach et al.,
Correspondence should be directed to Damon Jones, Department
of Psychology and Human Development, Vanderbilt University,
417 New College Drive #6, Sewanee, Tennessee 37375; e-mail:
2002 Society for Prevention Research