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Identifying intervention strategies for preventing the mental health consequences of childhood adversity: A modified Delphi study

Published online by Cambridge University Press:  06 May 2021

Leslie R. Rith-Najarian*
Department of Psychology, Harvard University, Cambridge, MA, USA
Noah S. Triplett
Department of Psychology, University of Washington, Seattle, WA, USA
John R. Weisz
Department of Psychology, Harvard University, Cambridge, MA, USA
Katie A. McLaughlin
Department of Psychology, Harvard University, Cambridge, MA, USA
Author for Correspondence: Leslie Rith-Najarian, Department of Psychology, Harvard University, Room 1006, William James Hall, 33 Kirkland St, Cambridge, MA 02138, USA; E-mail:


Exposure to childhood adversity is a powerful risk factor for psychopathology. Despite extensive efforts, we have not yet identified effective or scalable interventions that prevent the emergence of mental health problems in children who have experienced adversity. In this modified Delphi study, we identified intervention strategies for effectively targeting both the neurodevelopmental mechanisms linking childhood adversity and psychopathology – including heightened emotional reactivity, difficulties with emotion regulation, blunted reward processing, and social information processing biases, as well as a range of psychopathology symptoms. We iteratively synthesized information from experts in the field and relevant meta-analyses through three surveys, first with experts in intervention development, prevention, and childhood adversity (n = 32), and then within our study team (n = 8). The results produced increasing stability and good consensus on intervention strategy recommendations for specific neurodevelopmental mechanisms and symptom presentations and on strength of evidence ratings of intervention strategies targeting youth and parents. More broadly, our findings highlight how intervention decision making can be informed by meta-analyses, enhanced by aggregate group feedback, saturated before consensus, and persistently subjective or even contradictory. Ultimately, the results converged on several promising intervention strategies for prevention programming with adversity-exposed youth, which will be tested in an upcoming clinical trial.

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Copyright © The Author(s), 2021. Published by Cambridge University Press

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