Cumulative Risk

The kinds of problems described above often combine to increase the total risk for the development of antisocial behavior in childhood. The figure below presents an overview of the factors that can increase risk early in a child’s life and shows how a program of home visitation by nurses may prevent such a negative developmental process from unfolding.

For example, subtle damage to the developing fetal nervous system can interfere with children’s capacity to respond effectively to their parents’ efforts to care for them. This establishes patterns of frustration and anger that interfere with the development of secure attachment (Rodning, Beckwith, and Howard, 1989; Sanson et al., 1993; Moffitt, 1993a, 1993b). To compound the problem, the parents of children with neuropsychological impairment are more likely to provide inconsistent discipline and may themselves be impatient and irritable. There are many possible causes for such dysfunctional caregiving, including genetic links, overwhelming stress, or substance abuse (Moffitt, 1993b). Poor parenting practices can lead to vicious cycles of interaction in which the child’s problems with emotional and behavioral regulation contribute to parental child abuse or neglect that further intensifies the child’s emotional and behavioral
imbalances.

Poor caregiving occurs more frequently when parents experience financial difficulties (Conger et al., 1993) and have larger families (Hirschi, 1994). In such cases, children’s risks for antisocial behavior are further increased by their exposure to environments that are often associated with poverty and that may surround them with criminal influences (Felner et al., 1995; Hirschi, 1994; Moffitt, 1993a, 1993b).

Children from low-income households that are characterized by aggression and include family members with a history of school failure are more likely to be placed in low-level reading groups. This placement tends to worsen their aggressive behavior and academic problems, because these groups are likely to be made up of other children with similar problems and include classroom disruptions that interfere with education (Eder, 1983). Vulnerable children then become even more susceptible to rejection by prosocial peers and to negative peer influences (Dishion et al., 1995; Coie et al., 1995). When parents with limited social skills are confronted by school officials about their children’s disruptive school behavior, they are more likely to harshly reject their children, which pushes the children further toward delinquency and crime (Coie, 1996).

Preventing the accumulation of risk factors from such a wide variety of sources is possible through comprehensive programs like the model of nurse home visitation described in this Bulletin. By attending to health, social, and environmental issues all at once, nurse visitors can help families get off to a strong start that enables their children to develop and mature into healthy, productive individuals. In some cases, the positive skills families develop seem to neutralize the negative influence of other risk factors that are harder to reduce or eliminate.

Moreover, for the first time there exists solid, scientifically validated evidence that prenatal and early childhood nurse home visitation services prevent crime and delinquency (Olds, Henderson et al., 1998). As described in a 15-year followup of the Elmira nurse home visitation program, the long-term effects of the program on children’s criminal and antisocial behavior are substantial and have groundbreaking implications for juvenile justice and delinquency prevention. Adolescents whose mothers received nurse home visitation services over a decade earlier were 60 percent less likely than adolescents whose mothers had not received a nurse home visitor to have run away, 55 percent less likely to have been arrested, and 80 percent less likely to have been convicted of a crime, including a violation of probation (Olds, Henderson et al., 1998). They also had smoked fewer cigarettes per day, had consumed less alcohol in the past 6 months, and had exhibited fewer behavioral problems related to alcohol and drug use.

Prenatal and Early Childhood Nurse Home Visitation	OJJDP Bulletin • November 1998