From the April 2017 Desktop News | Trying to circumvent the cycle of violence that is growing within Pakistan—especially among young children—Pakistani native Asia Mushtaq recently relied on an adapted version of UA professor Dr. John Lochman’s Coping Power program to reduce aggression among 9-to 11-year-old boys in Rawalpindi, Pakistan.

“The proliferation of violence has become a serious social problem in Pakistan today,” Mushtaq wrote in her study which will be published in Prevention Science. “Environmental factors can initiate aggression and conduct problems in children and serve to escalate or stabilize it … A country like Pakistan, which has been experiencing violence for a long time, has much to [be] concern[ed] about her children’s mental health.”

Mushtaq notes that in Pakistan intervention programs for children with behavioral problems are scarce for a variety of reasons: there is a lack of public awareness, funding is limited, and there has been an absence of evidence-based research showing the legitimacy of such programs—among other things.

Wanting a cost-effective way to show that aggression can be reduced among children, Mushtaq set out to find a prevention program that she could adapt for her local community. She found Lochman’s Coping Power program during her literature review for her dissertation, and after contacting Lochman to get the details on the program, she decided to adapt it for Pakistani children.

In 2009, she received an award from a Pakistani research initiative which allowed her to travel to Alabama for six months to work at UA’s Center for the Prevention of Youth Behavior Problems.

“It wasn’t a simple thing,” Lochman said. “To come over here, she had to have permission from her father and all of the adult males in her family. They were all in support of her work.”

After living in the United States for six months and learning how the Coping Power program worked, she returned to Pakistan, translated the program into Urdu, and incorporated religious and cultural beliefs into the program to make it more accessible for her local population.

Working with 112 boys from five public schools over the course of a single academic school year, Mushtaq had positive results.

“The Coping Power Program did well in Pakistan, a culturally different country, so I believe that this program is culturally sensitive and can be used universally,” Mushtaq said. “The preliminary efficacy study of the culturally adapted version of the Coping Power program provides a base for future interventions studies in Pakistan.”

Lochman agrees.

“The boys who were screened are likely exposed to greater levels of violence in the world around them,” Lochman said of Mushtaq’s study. “For the program to still have an impact on them suggests that the mechanisms we look at—like poor perspective taking abilities, poor problem-solving skills, and hostile attributional biases—are relatively universal links to aggressive behaviors in children.”

Though perhaps the most violent country where the program has been implemented, Pakistan is not the only place where Coping Power has found a foothold.

In the last 25 years, Coping Power has been adapted for use by researchers in the Netherlands, Puerto Rico, Canada, Sweden, Ireland, Greece, Portugal, and Italy.

Lochman and his team typically works with the researchers and clinicians to help them find valuable adaptations that will work well in the local community, but he says that the basics of the program remain the same.

The original Coping Power Program, which typically targets small groups of students in fourth and fifth grade, consists of 34 child sessions and 16 parent sessions. The child sessions focus on setting goals, organizing, managing anger, working on social skills, problem solving, resisting peer pressure, and engaging with positive peer groups, while the adult sessions teach parents how to discipline appropriately, give clear instructions, communicate, manage stress, give positive attention and praise, and reinforce the skills their children learn in the program.

For some schools in some areas, 34 sessions is unsustainable, so Lochman has helped to create shortened versions that in some cases do not rely on the parent component.

“We learn a lot from the adaptations done in other countries,” Lochman said, “and we continue to do a lot of research ourselves on adaptation.”

Within the last four years, UA’s Center for the Prevention of Youth Behavior Problems has received more than $2.2 million to expand the Coping Power program—and it continues to grow internationally as well.

“We’re having an impact on many children and parents,” Lochman said. “That’s true here in Alabama but also in these international settings. It’s a great service embedded in a serious and rigorous research effort.”