What are the guiding principles for effective treatment in ADHD?
- focus on the ECOLOGY of the child
- take a DEVELOPMENTAL perspective
- be FORMULATION- DRIVEN
- attend to consultation process
Why should treatment focus on the ecology of the child?
- Conduct problems are highly embedded in family r/s and amplified by peer relationships
- interventions that do not address these dynamics are less likely to produce lasting change
What would happen if treatment did not focus on the ecology of the child?
- send child back into those systems that maintained the problems in the first place
- will not have a lasting impact on the child
What is the best treatment for early to middle childhood conduct problems?
- parent training: working exclusively with the parents
What is the best treatment for middle childhood conduct problems?
- parent training + youth focus components (e.g. Multisystemic Therapy including cognitive therapy,
What does a developmental perspective inform about treatment?
- when is the best time for intervention
- which family environment variables should be targeted
- how to best involve the child
When is the optimal period for intervention?
- early childhood
What is the reason that
- taking more and more steps away from a healthy trajectory
What are the key parenting targets for child behaviour change in early-middle childhood?
- coercive cycles (reinforcement traps) (i.e. Coercian theory, Patterson, 1982)
What does the coercian theory suggest about contingencies and reinforcements for the child and parent?
- parent engagement with child are increasingly contingent upon misbehaviour
- parent’s only interactions with the child are aversive/punishing
- low positive reinforcement for appropriate behaviour
- high positive reinforcement for misbehaviour
What are the keys to parenting targets for child behaviour change in late childhood/adolescence?
- monitoring and supervision (skills for regulating supervision outside of the home)
Why do older children/adolescence need to be included as active participants with parents for treatment in CD?
- with physical development, child increasingly capable of resisting the limit setting strategies that are effective with younger children (time-out)
- unique developmental tasks of adolescence, unique family challenges re: problem-solving and communication, best targeted with parents- children jointly
- emerging cognitive resources (abstract reasoning etc). to engage in self-regulatory skills training not possible at younger ages.
Why does treatment need to be formulation-driven?
- to plan around systemic issues that may interfere with a family’s success in implementing new strategies, a therapist needs to have a clear formulation of how child behaviour and parent behaviour may relate to those issues
“WHAT IS THE BIG PICTURE OF THE CHILD’S ECOLOGY?”
What different areas
- genetic and biology (temperament, health, DDs)
- parent-child interactions (rewards for misbehaviours, social learning, instructions given, ineffective punishment, ignoring desirable behaviour)
- things affecting parents (parents’ levels of stress, martial conflict, lack of social support, financial stress)
What does it mean by attending to the consultation process?
- the success of therapy can first JOIN with the family to create a therapeutic team
What are some issues with attending to consultation processes?
- involvement of fathers
(dont have parents working as a team together or full ‘executive subsystem)
- the way the child behaves is dictating the family dynamics - empowering parents to take positive steps (need to feel like they’re not being told what to do)
- maximising active engagement (e.g. role plays, homework)
What are the 2 core components of parent training interventions?
- strategies for responding to good behaviour
2. strategies for responding to misbehaviour
What strategies are there for responding to good behaviour?
- parent attention becomes contingent on (ie, positively reinforces) positive/healthy child behaviour
What strategies are there for responding to misbehaviour?
- removes reinforcement of escalating coercion by setting limits on child behaviour using immediate, consistent, non-forceful consequences
- a ‘behaviour correction routine’ including time-out
How is the coercian cycle changed to a positive cycle?
PARENT: attention and emotion contingent on adaptive child behaviours
- DISCIPLINE is immediate, boring, over with quickly
CHILD: high positive reinforcement of appropriate behaviour; low reinforcement of misbehaviour
What is the best way to introduce the model to the parent?
- pre-empt reactions to ‘parent-training’ –> parents as therapists, “fine-tuning” rather than replacing existing practices
