We are the Association for Child and Adolescent Mental Health, or ACAMH for short. And this is ACAMH Learn. Welcome to Mind the Kids podcast from the Association for Child and Adolescent Mental Health. At the heart of today's episode, we try to answer a key question. Can the cycle of violence that passes from one generation to the next actually be broken? Today I'm joined by Dr. Laura Gorla, a postdoctoral fellow at the Centre for Child and Family Policy at Duke University, whose research centres on parenting, parent-child relationship, and child and adolescent well-being. Published in the Journal of Psychiatry and Psychology, known as JCPP, Laura's paper, titled, The randomised control trial Fast Track multilevel intervention for children with early-emerging conduct problems breaks intergenerational transmission of violence across three generations, draws on one of the most ambitious longitudinal data sets in the field. Laura traces how experiences of violence ripple across three generations using data from landmark randomised controlled trial data, which follows families from high-risk communities across the United States since the 1990s. What makes this research so compelling is not just what it reveals about how intimate partner violence and parent-child violence transmits across generations, but the genuinely hopeful finding that early prevention intervention can interrupt that chain entirely. It's a fascinating piece of research, and I can't wait to hear more, so let's get started. Hi, Laura. It's lovely to be speaking to you today. Thank you for having me today. Great stuff. All right. So let's start with some introductions. So it'd be great if you could introduce yourself, maybe say a little bit about your research interests. And there's an opportunity just to name check any collaborators or contributors to the paper. Sure. So I'm Laura Gorla. I am originally Italian, but I work in the US right now. And I work at Centre for Child and Family Policy at Duke University in the United States. And I'm a postdoctoral fellow there. My research interests are parenting, parent-child relationship, child and adolescent mental health from childhood to late adolescence, and parent-child relationship in the family, child adjustment, and well-being in the family. And for this study, I have the pleasure to work with several great colleagues and researchers at the centre, such as, for instance, Dr. Rothenberg, who was in charge of running the analysis for the study that we are going to discuss today together, and Dr. Godwin, who was the one involved in data collection and organised the data set that we used for the current study, and the Conduct Problems Prevention Research Group, who are a group of great researchers where the creators of fast-track back in the '90s, so the creators of the intervention that we are discuss today. And among all the PIs of Fast Track, I work in particular with Dr. Lansford and Dr. Dodge. So these are the collaborators of mine. Great stuff, great team. So let's jump in, so be useful if we just provide some context and some kind of background. So the study's looking at early-emerging conduct problems. So why were you focusing on that? Why is that such a critical point in the developmental risk? Yeah. So I would start saying that conduct problems are among the most prevalent child maladjustment during childhood. So they are extremely important because they influence the lives of children and adolescents across their complete developmental period. So they can be defined as a consistent pattern of aggressive and disobedient behaviours. And we can think of very practical examples, such as lying to others, being aggressive, feeling and exhibit anger, stealing things, breaking stuff on purpose. And we know that some of these behaviours are normal in the first years of life of children. But the problem is when they don't go away as soon as the child like develops his brain more or as soon as the child learns that it's not possible to steal things or it's not socially accepted to be aggressive. But there are some children that still have that patterns of behaviours. And for them, we are talking about early-emerging conduct problems. And why is it important to talk about it? It's important because they are at a higher risk of developing antisocial behaviours later in life. They are at higher risk of being aggressive. They might engage in risky behaviours. They might be more risk for criminal actions later. They suffer more from mental health issues. So for all these aspects, it's kind of too important to intervene as soon as possible with these children. Yeah. OK, so really difficult to manage within the family at the time, but also here implications for mental health and life outcomes. So you focus on intergenerational transmission of violence. So could you just explain, what does that mean? It'd be really good if you could talk about the theory of that. And I love the way you gave those real-life examples in your life last answer. If you bring it to life with what that looks like on a practical terms, that'd be great. For sure. So intergenerational transmission of violence basically is a circle of violence starting in one generation and going from that generation to the others. So we can think of a chain of violence starting in the past, influencing the present, and being more likely to be transmitted in the future. So basically, we can think of people. And we have plenty of clinical evidence and research evidence of this. So people with a previous history of violence are at a higher risk to become violent with their children or become violent partners or are at higher risk to be engaged with violent partners. So in this case, violence never goes away, never fades away. It stays within a family for generations. And we need to do something about it because we don't want that. Violent actions might be transmitted across several generations, impacting future children and adolescents. And why is it important? We know that it can be a risk factor for dysregulated emotions, mental health issues later in life. They are traumatic experiences. So they are related to poor social functioning, to poor academic outcomes and academic functioning. So we want to intervene as soon as possible to break this negative circle of violence. OK. And so what was this study trying to build on, in terms of the theoretical knowledge? What were you trying to test in relation to this generational transmission of violence? Yeah. So the study had two main aims. The first one was to explore trajectories of two types of violence, which are the intimate partner violence, so the violence happening between the two romantic partners, and the parent-child violence, so the violence who has the child as the main victim. And we wanted to test the trajectories between three generations. We have a lot of studies in the literature exploring intergenerational transmission of violence with two generations. But we have data on three generations. So we have data on the grandparents that, during the '90s, were parents when we collected data. Then we have data on the current parents that, during the '90s, were children. And now we have data on the current children, who are children nowadays. So that was the first aim. The second aim was to test whether intervention can disrupt these trajectories, whether participating in a multilevel, preventive, and multicomponent intervention can basically stop this negative cycle of violence, and if yes, how and when. So these were the two main research questions that we had in this study. OK. And has there been other studies that have looked at that across three generations, or was this the first data set that's kind of enabled that? Well, I don't know all the literature, of course. For sure, I guess there will be plenty of studies with three generations. But from what I saw in the literature, we have a lot of studies using two generations and collecting data using retrospective measures or asking people to remember what happened in their childhood or during their lessons there while we really have data reported by grandparents when they were parents, parents when they were children, and the current children. So we were able to give this new perspective on intergenerational transmission of violence. Yeah. And the actual Fast Track study itself-- so my sense is that it's those kind of landmarks in developmental psychology. From a kind of a child family perspective, what did the programme actually involve? What would it have felt like to be part of that kind of intervention? Yeah. So I would start saying that Fast Track was a randomised controlled trial. So it started with selecting 55 elementary schools in different parts of the United States. And these schools were selected based on the characteristics of the neighbourhood. So there were neighbourhoods that were high in crime and poverty. And there was a screening process of several children based on reports from parents and from teachers. And then these childrens that were selected were showing early-emerging conduct problems were divided in two groups. One group was the control group, so was followed throughout the years, but did not receive any intervention. And the other group was the intervention group. So they were not only followed, but they also received intervention. And I'm making this comparison because I think that we need to understand that we can talk about intervention effects because we have the control group that didn't receive any intervention. In terms of the things that were part of the Fast Track, there were a lot of active ingredients of the intervention that started in the elementary school and continued until the last year of high school. So it was a very long intervention. And families undergoing the intervention received the activities focused on peer relationships, classroom relationship, parent-child sharing and communication skills. They were able to focus on interpersonal and intrapersonal skills. They received also academic tutoring. So there was a variety of activities for those children and those families. But overall, the main idea was that if we are able to intervene starting from early years, we can increase their mental health and help people to have a better life, also later during adulthood. So a really complex study in terms of the intervention being so complex over so long and then this follow-up over the generations. So what were some of the challenges of carrying out that research over that longitudinal period? Yeah. So, for sure, I would say that two main challenges were present. The first one was to keep contact with the families, not only during the interventions-- because during intervention was more easy because they were following school-- but also later after the intervention, especially because some families moved around the US. So it was a lot of effort from the research staff, continued to collect information about these families over the course of the years. Because like, Fast Track started in the '90s, and we are still collecting data now. So it's been a lot of time of following these families. And I would say that the key for overcoming this challenge was that the research staff was really able to build the trust and trustful relationship with families, so families seeing himself as being really seen by research staff. They consider themselves as being really part of something and really important. And then there were a couple of tips that we used. So just for give you an example, we collected information about contact of families and not only from the family itself, but we also use the friends and neighbours to be able to follow the families. The families were moving around the United States. And this was one of the first-- one challenge. The second challenge is that times change a lot from the '90s until now. So just another example-- the technology was not really a thing when we started collecting data. Now technology is one of the mega trend that is impacting families all over the world. So at the beginning, we were collecting information about the access to news through newspaper, through TV. Now we have information about social media use, new technology, access to internet of the household, stuff like that that in the '90s were not super important aspect. And another example is that at the beginning, Fast Track collected data using paper questionnaires that were shipped to families. Now we use Qualtrics, we use technology to collect data. So there has been the change. We basically needed to follow times and also follow developmental period of families, because we started collecting data from kids and then we went to adolescents, then we went to adults. So we needed to change measures to follow their life. So be really helpful if you could just give us an overview of the key findings. So as I said before, there were two types of violence, Intimate Partner Violence, which I will call IPV, and Parent-Child Violence, which I will call PCV. So the main findings for us was that IPV, in the first generation, was transmitted in the form of parent-child violence, so PCV, in the second generation. And this led to worse mental health in the third generation. So there was a chain starting from violence between the partners in the first generation, going into violence toward the child in the second generation, and now leading to worse mental health in the third generation. So this chain was very negative one but was present only in the control group. What was very interesting for us was that there was a breaking between these two types of violence, and the intervention really stopped the negative chain of violence across the three generations. So did the research suggest how the chain was broken? Yeah. So, basically, we saw that for the control group, parent-to-child violence was mediating the relationship between intimate partner violence and the negative outcomes in the third generation. But for the intervention group, that path was not significant. So we might think that the breaking happened between the first and second generation. And then it breaked the role of parent-child violence in continuing the violence against the third generation. And are these research findings in line with the wider research literature? Yeah. They are completely in line. So they are strengthening the idea that intervention might really help people and might really break negative consequences of violence. In a kind of similar way as we said before, the thing that are truly interesting about this study are two. The first one is that we had three generations data. And the second one is that we have the control group, so we were able to really see differences across between the two groups. So we were really able to test the effect of the intervention. I would say that another point that is very important to understand and to keep in mind while looking at these results, and that is that Fast Track was in a multilevel component. It had the several active ingredients. So a future direction might be to disaggregate the specific activities that family did to see which one, whether, and if yes, which one was more important to breaking the chain. So for the moment, we used the Fast Track as the global intervention. So in the future, it might be interesting to see if there were certain activities that were more important for families. Yeah, because I guess the intervention itself was incredibly expensive, operating on so many layers. So I guess there's really wanting to hone in on what the active impacts and effects were from. For sure, for sure. We know that in an ideal world, we could do preventive interventions involving both families and schools and health practitioners, having several components, providing several activities to children. But in reality, we know that these kind of interventions are very costly. They are very hard to build in the first place and then to maintain throughout the years. So knowing which aspect is more important would be also helpful for future interventions because then we can select specific parts and use them in different environments. And was there anything that particularly surprised you? Were there any bits of the research that you went, oh, I wasn't expecting that? Yeah, kind of related to the types of violence. So we were expecting to find a domain-specific transmission between the two types of violence. So we were expecting to find that IPV in the first generation was related to IPV in the second generation and PCV in the first generation was related to PCV in the second one. What we found instead was that the transmission occurred from IPV to PCV. So we found, basically, that one type of violence in the past influenced the other type of violence in the present, which was kind of surprising. And basically, we think that gives us a more idea and more proof that violence is such a complex phenomenon, where it's very hard to disaggregate the types of violence and the effects of violence. Yeah, so not a direct, linear, one type of violence leading to another, but a much more complicated construct. Yeah, yeah, for sure. Like, we always need to consider that it's also very difficult in psychology in general to focus on specific aspects without looking at the others. So it's kind of similar to, like, at the beginning, when we are talking about conduct problems, there is always a variety of aspects that play a part in mental health. So I'd like us to think a little bit about the implications of the work. And you mentioned a little bit about the future. So what does the study tell us about the nature of conduct problems and the kind of interventions that are most likely to be effective? Yeah. So as we were mentioning before, I think what intervention the study is saying to us is that we cannot target a specific aspect of child behaviours or child mental health without looking at the context and without involving the community surrounding the child. So when we think about the child, we always need to consider that the child is embedded in a wider context, of course, the family, but also the extended family, the school, the community, the infrastructures that surround the child. So if we are able to build an intervention that puts the child in the middle and create opportunities for the child to engage with other important and significant adults, this can have a real impact on the children's life. And another thing that I would add is that, basically, what the study is saying is that if we invest in the future generation, we are already working on improving the life of the future generations. So each intervention that we do now will have good outcomes now, but also in the future. So this gives us a lot of hope-- at least gives me a lot of hope. Yeah. It feels like a very hopeful study. And young people's lives are not set, that there are lots of opportunities for change and that people's outcomes are not predetermined. It feels like it's very hopeful in its heart. Yeah. So sometimes there is the idea that if you live in a certain environment, you are basically done. So, like, if you grow up in a difficult neighbourhood, in a violent family, this means that you will be violent. You will have mental health issues. You won't be able to exit the patterns that are already determined and are already stable and are already there for you. I think that what Fast Track does is that it gives hope that this is not true. So we selected people that were at higher risk for severe conduct problems later in life and that were showing early-emerging kind of problem. And then we saw that their children are not impacted by their parents' history now. So if we provide an intervention, if we follow these children, if they have the chance to be involved and to work on specific skills, they can break this deterministic idea of violence. And with that kind of strength of evidence, what does the study suggest from a policy perspective? What does the study suggest would be the optimal sort of time of those early intervention opportunities? I think it says that public infrastructure needs to be present for families and for children. It says that we need to intervene now for increasing the well-being of future generations. So, again, in an ideal world, there is a consensus among researchers and clinicians that the sooner we start an intervention, the better it is. But then most of the time, we lack the facility, we lack the support, we lack the infrastructure to do it. So what we can learn from this study is that if we are able to invest in families, invest in school, helping the families, we can really make an impact on the lives of children and adolescents, not only now, but also in the future generations. So, again, the earlier we start, the better it is in general. And then starting generations before, it's like the top that we can aim for, right? Yeah. So we're coming to the end of the podcast. I just wondered whether there is a central message from the study if you were wanting clinicians, educators, policymakers to really understand one key thing from the study. I think that the key message is that preventive intervention work. They protect the future generations. So they break the chain of violence, and they kind of act as a shield for people living in the future, not only for people living now. In terms of the questions that remain for us and for the field open, I would say that we should explore which component of the intervention were more effective so we can create and develop better future interventions that might be less expensive and equally effective as Fast Track. And this is one thing. The other one is that we always need to remember that while this intervention was very effective, it might not have been working for all children. So each intervention that we think about needs to start from assessing the needs of children. Because there are some children-- each children has its own specificity. So there are children that can benefit more from interventions than others. So the key for clinicians and practitioners and policymakers is kind of balance, a preventive intervention that we know are evidence based and they work, with the idea that each child has its own story and we need to do a good assessment of this to create the best intervention as possible for these children, which is a giant challenge. Yes. Yeah, indeed, indeed. It's been so interesting talking to you, Laura. If our listeners want to find out a little bit more about your work or the field, are there resources or websites or links that you'd suggest people look up? So, for sure, there is the Fast Track website. And there are plenty of publications about Fast Track, which has been a study started in the '90s. So you could imagine how many papers, books, chapters, books are over there on the internet. So if you type Fast Track intervention, Duke University, there is the website. You can look at all the measures that we used, all the research that were involved in the study, all the components of the Fast Track. So this is, for sure, a website that people should look at if they're interested in Fast Track. And then if they are more interested in seeing my work or the environment where I work at-- and CCFP, Centre for Child and Family Policy, has its own website, where you find events going on or you find spotlight of researcher that are conducted in the centre. And we do a lot of interesting research, not only on fast track, but we have longitudinal studies. So if somebody is interested in understanding developmental trajectories of children and adolescents and their parents, CCFP is the right place to search for this information. Brilliant. Laura, thank you so much for your time. It's been a great, really interesting conversation. Thank you for having me. That was great to be able to talk to Laura about her work. For me, the most powerful takeaway was the hopeful one. There's often talk about cycles of disadvantage and violence, as though they're kind of inevitable, that we end up predetermined. But what this study shows is, that's just not true. When families receive Fast Track intervention, a chain can be broken. The intimate partner violence that shaped one generation didn't have to go on to define the next. And that's a remarkable finding and a remarkable piece of evidence. I was also struck by Laura's point about the complexity of violence itself, but that it was intimate partner violence in the grandparent generation that predicted parent-child violence in the next, rather than a like-for-like transmission. It's a reminder that these experiences don't travel in straight lines. And we need to reflect that in how we approach interventions and responses. So once again, thanks for joining me. Do please subscribe where you get your podcasts. Sign up to the YouTube channel. Just search ACAMH, and it finds us all across, kind of like social media. So next week, we'll be speaking to Susan Swingler on a similar topic about violence exposure and adolescent conduct problems in high-adversity settings, this time in South Africa. [RELAXING MUSIC]