Chapter 13: Interventions For Kids Flashcards
(22 cards)
Coercive Exchanges
parent-child interactions in which the parent unintentionally rewards the child for whining or aggression (by withdrawing a demand or providing attention) and the child rewards the parent for giving in to his or her complaints (by ceasing the aversive behavior)
Positive Reinforcement
any consequence that increases the likelihood of a behavior being repeated
Time Out
a parenting strategy in which the child does not have access to reinforce for a brief period following misbehavior
Parental Monitorig
parents’ awareness and tracking of the child’s activities
Ecological Theory
a theory that examines a young person’s functioning within the multiple contexts in which he or she lives - family, school, neighborhood, etc.
Mood Monitoring
tracking mood on a regular basis, usually using a chart
Psychoeducation
teaching psychological concepts to clients in a manner that is accessible to them
Who do therapists have to convince of their services in therapy for children?
both parent and child
the parent-therapist alliance is positively correlated with appointments being kept, and parental involvement in treatment
the youth-therapist alliance predicts the patient’s subjective reports of progress
What if the youth refuses treatment?
realistically, you can probably can’t provide direct service
different for assessments with very young children
can still provide parents with guidance concerning management strategies as context is all-important
What are issues of premature termination and drop-out?
parental psychopathology: therapy is not of their choosing, misunderstanding of the therapists role
parental isolation: not having support
family conflict: if parents are separated, one may remove child from therapy without consulting the other
What are the rates of depression in adolescents?
major depressive disorder is as common in adolescence as it is in adulthood
rates increase in adolescence, with a two fold increase from 13-14 year olds to 17-18 year olds
depression is a chronic current disorder associated with: difficulties in peer relationships, poorer school functioning, troubled family relationships, increased rate of suicide
Where is the burden of child and youth mental health disorders placed?
child, his/her friends and siblings
parents, caregivers
school, healthcare, and criminal justice
What are effectiveness of evidence-based interventions in childhood disorders?
not surprisingly, there are evidence-based interventions available to deal with a variety of childhood disorders, though fewer than with adults
a total of four well-known meta-analytic studies have reviewed this literature
problem: these meta-analyses were based on published studies, which are more likely to include reports of successful outcome
solution: review doctoral dissertations, typically stronger methodologically owing to high levels of oversight, effect sizes were predictably smaller
when comparing evidence-based treatments to normal operating procedures (treatment as usual) one typically finds that evidence-based care fairs better
growing evidence that “treatment as usual” is often ineffective
no evidence that complex cases respond less favorably
What interventions for kids work?
EBT available for a variety of disorders including autism, anxiety, depression, substance abuse, medical treatment compliance, and disruptive behavior disorders
not universally applied despite supporting research: may reflect time constraints or difficulties in clinicians accessing relevant literature
sometimes clients come in requesting specific therapies which are not well supported: parents not always in a strong position to evaluate evidence, psychologist’s role to educate
What conditions are there effective therapies for?
ADHD
bipolar spectrum disorder
obsessive-compulsive disorder
effects of trauma
self-injurious behavior
substance abuse
chronic health conditions
obesity
What are the practice guidelines for interventions in kids?
formal repositories of lit review plus expert opinion
classify and summarize research in terms of likely outcomes (e.g., probably efficacious or well-established): less available for kids than for adult Tx, guidelines may change over time as research advances
some disciplines have better developed guidelines than we do: better in the sense that they are broadly endorsed by regulators
highlights the important of multidisciplinary collaboration
What are disruptive behavior disorders?
includes CD, OCD, ADHD (maybe)
among the most frequent reasons for referrals in child and adolescent populations
children with these diagnoses are also heightened risk for developing other mental health conditions such as depression and substance abuse
also at significantly higher risk for involvement with the criminal justice system, victimization, and exploitation
diagnosed children are often resistant to treatment: often treatment refractory, best bet is often to focus on the parents
What is Parent Management Training (PMT)?
based on modifying child’s environment, mostly parents’ response to child’s behavior
highlights the centrality of coercive exchanges
parents often react poorly to difficult behavior
parents experience exchanges with their kids as unpleasant, and may “back off”, i.e., monitor inappropriately or not at all
parents learn five core disciplinary practices including; skill advancement, discipline, monitoring, prosocial problem-solving, and positive involvement
simple abilities that parents often lack
these entail coaching children on a step-by-step basis, giving reinforcement appropriately, setting limits, establishing appropriate rules, monitoring children, and providing positive reinforcement through pleasant exchange as appropriate
training is extensive, delivered in a structured format, it may easily involve 100 hours of instruction
practice and role-play are essential
What is multi-systemic therapy (MST)?
adopts an ecological model of social interaction: recognizes the confluence of several social systems including family, school, peers, community
based on principles intended to correct behavior and promote stability by working jointly with the referred individual, family, and environment
MST therapies are available 24/7, and typically work in small teams
targets many of the same risk factors that PMT does
heavy emphasis on monitoring behavior and measurement of short and long-term goals
MST therapists take responsibility for coordinating multiple systems, where possible; this can include local police, probation officers, school, etc.
therapists available to intervene in real-time as needed
turns out to be unexpectedly cost effective
What is adolescent depression?
medication contraindicated for mild cases
CBT delivery closely resembles that for adults
also considers more systemic risk factors including; health, school problems, bullying, negative peer interaction
although effectiveness has been established, literature is less developed than for adults
has been manualized into programs: promotes positive self-talk, problem-solving, assertiveness, conflict resolution, affective management, and monitoring cognitions, psychoeducational in nature, lots of role-playing and homework, less stigmatizing than traditional therapies
What is the effectiveness of interventions for kids?
recall, this is often limited by attrition and lack of parental support
on the other hand, over 75% of patients are likely to complete well-organized and well-researched programs of treatment
ADHD treatments can be effective; even with patients who are poor pharmacotherapy candidates due to: concerns over side effects, age, medication effects are temporary, about one-third of children do not respond to meds, limited improvement in concentration, appetite suppression
What are modular treatment options?
Chorpita & Daleiden (2009) reviewed 322 randomized controlled trails of treatments for children and youth:
identified clusters of treatment strategies shown to be efficacious across many trials, for various disorders
advocate using such strategies to individually tailor the treatment to client needs
Weisz et al. (2012) developed modular treatment options for depression, anxiety, and conduct problems:
modular treatment out-performed treatment as usual and specific EBTs for depression, anxiety, and conduct problems
caveat: single trial requiring replication
