Flashcards in 23 Treatment of conduct problems Deck (27):
What are the four guiding principles for effective treatment of a conduct disorder?
1. Focus on the ecology of the child
2. Take a developmental perspective
3. Be formulation driven
4. Attend to consultation process
Why are interventions that focus on the child unlikely to produce lasting change?
Because the child's behaviours are embedded in family/social relationships. Treating child individually leaves environment unchanged.
What treatments have the best outcomes for conduct disorder in a) childhood and b) adolescence?
a) early to middle childhood
Parent training: after the child has been diagnosed working exclusively with the parents
Parent training + youth-focused components (anger management, social skills)
When is the optimal time for intervention in conduct disorder?
Why is early childhood the optimal time for intervention in conduct disorder? 2 reasons
- Early in life, the parents are child's whole world. Harder to control environment later in life when peers are involved.
- Adolescents' social skills build on early development. If child doesn't have these foundations, harder and harder to establish them.
What are the key targets for child behaviour change in early-middle childhood?
Coercive cycles (reinforcement traps)
What are the key targets for child behaviour change in late childhood/adolescence?
Monitoring and supervisions – skills for regulating child activities outside home.
Why must children be included in intervention once they have reached late childhood/early adolescence? 3 reasons
1. With physical development, kids are able to resist limit-setting strategies that are effective with younger children (e.g. time out)
2. Kids' world is bigger than just parents. Need participation from whole family in order to effect change. Unique family challenges of problem-solving and communication are best targeted with parents-children jointly.
3. Emerging cognitive resources (abstract reasoning, perspective-taking, meta-cognition). Kids can engage in self-regulatory skills training not possible when younger.
What distal cause underlies disrupted parenting practices, a proximal cause of conduct problems?
Could be anything.
e.g. discipline might be inconsistent because:
in family A because mother depressed,
in family B because parents not aligned
Different scenarios can contribute to the same proximal mechanisms.
Why is doing parent training in groups less effective?
Because the causes of the disrupted parenting practices are specific to each family. Treatment needs to take into account the systemic issues which may interfere with a family's success in implementing new strategies.
What three interrelating causes of a child's behaviour are offered to parents as a springboard for discussion? (And it's a useful model)
1. Genetics and biology
- the child's temperament
- the child's health
- developmental disabilities
2. Things affecting parents
- parents' levels of stress
- marital conflict
- lack of social support
- financial stress
3. Parent-child interactions
- accidental rewards for misbehaviour
- learning through watching
- ignoring desirable behaviour
- how instructions are given
- ineffective punishment
What are three key hurdles in the therapeutic relationship with parents of kids with conduct problems?
1. Involvement of fathers (full executive subsystem)
2. Empowering parents to take positive steps (collaboration; not telling parents what to do)
3. Maximising active engagement (e.g. role plays; homework)
- biggest mistake is to assume that if a skill is explained and understood it will be implemented. Cue role play.
What are the two subsystems in Minuchin's Hierarchical Structure of a Healthy Family?
'Executive' Parental Subsystem
- mother and father
In which 2 ways might Minuchin's Hierarchical Structure of a Healthy Family violated in dysfunctional families?
1. No unity between parents – executive subsystem is dysfunctional
2. Child's behaviour influences executive decisions – parents no longer in control of how time is spent. Executive subsystem is compromised
What are the 2 core components of parent training interventions? (the so-called 'active ingredient')
1. Strategies for responding to good behaviour
- Reward goodness with attention. Parent attention becomes contingent on (i.e. positively reinforces) positive/healthy child behaviour
2. Strategies for responding to misbehaviour
Use immediate, consistent non-forceful consequences, without escalating, in order to reduce reinforcing qualities of behaviour.
Discipline should be _______, ________ and ____ __ ______
Discipline should be immediate, boring and over with quickly.
What 4 kinds of positive reinforcement should be offered?
1. Descriptive praise
2. Tangible rewards
3. Physical affection
4. Spending time with child
Why might parental coercion be reinforcing for a child?
Because it meets (partially) a child's attachment needs.
In what way are parent-child interactions in coercive cycles 'attachment-rich'?
Lots of close physical contact; emotionally charged
In what way is the attachment system involved in the generation of conduct disorders?
Kids are programmed to elicit caregiver proximity. When adaptive behaviours are ineffective, maladaptive strategies emerge.
According to attachment theory, what rewards are the most salient for kids?
Attachment-rich rewards – e.g. parents' time, physical attention.
What might be some barriers to establishing an effective reinforcement system?
- Parent depression
- Family of origin experiences (e.g. parent's parents not affectionate)
What 3 mistakes can render time out ineffective?
1. Interacting too long before administering time out – this period of interaction can be reinforcing
2. Showing emotion (e.g. lecturing child)
– this can be reinforcing
3. Threatening attachment security (i.e. expressing rejection)
– rejecting a child increases its demands for proximity?
What did Harlow's studies of monkeys show about the effects of rejection on children?
It increases demands for proximity.
Poor little monkeys it makes me so sad.
How do rewards change when dealing with adolescents?
Can be negotiated but should still be immediate.
Time out is replaced with response-costs procedures (losing privileges or points).
What are the 5 principles of adolescent family intervention?
1. Grant increasing independence gradually
- do this based on demonstrations of responsibility
2. Distinguish negotiable from non-negotiable issues
3. Involve adolescents in problem-solving for negotiable issues (but maintain healthy hierarchy)
- Adaptive independence is encouraged through increasing inclusion in family decision-making.
4. Maintain good communication
- Let adolescents talk when the time comes, rather than nag
5. Develop realistic expectations
- Can be challenged by expectation that freedom=disaster; hostile attributional biases; limited knowledge of adolescent norms