Flashcards in Child: Treatment Deck (19)
What are the principles for effective treatment of conduct disorders?
1. Target the ecology of the child - the context in which they are developing (change the parents/environment)
2. Take a developmental perspective - sensitive to the age and development of the child
3. Be formulation/hypothesis-drive - if I change this, what will happen?
4. Form a strong therapeutic team - make a connection
Ecology of the child
Less likely to produce lasting chages
Problems begins very early
> core treatment early is the parent
> core treatment later is the parent and the child
> most powerful in the early childhood parenting changes
When is the most optimal period for intervention?
Early childhood interventions
Parent training interventions
> Started in the 70's and 80's
> core theory is based of coercive family process
What are the problems we need to treat
> Parents pay less and less time with the child and gives them less attention
> The time spent with the child is no longer positive involvement
> Amount of time and emotion when the child is misbehaving is going up and up
> Change the pattern of differential attention
What does parent training aim to do?
1. Increasing the TIME and ATTENTION spent with the child when they are behaving nicely
2. Developing discipline strategies to REDUCE the amount of EMOTIONAL ENGAGEMENT when the child is MISBEHAVING
Reverse the coercive cycle - positive behaviour is ignored and negative behaviour is rewarded with time and attention.
What are procedures to encourage positive behaviour?
What would you like your child to do more of?
> play nicely
> speak in a nice voice
> play independently
Parent now goes home and tries to catch the child performing these 'positive behaviours'
> reward them with your time - "Sam, I just saw you do something I asked you to do, I am now yours for 10 minutes. Let's go!"
What type of reward schedule should be used to be the most powerful?
> Intermittent, unpredictable, varying rewards - don't use behaviour charts!
> Based on love and attachment, not just descriptors and artificial rewards
What is effective discipline? How to you go about getting it?
Develop a set routine:
> Child misbehaves; get the child attention in a simple way; don't keep responding and escalate the situation.
> If the child does not comply (and tries to escalate), go into calm predictable consequence eg time out (age sweet spot 2-8) or a logical consequence
> If the child complies, go straight back into attention rich engagement
What are the main points of effective Time Out
> Make it fast, emotionless - don't escolate the coercion model
> For time out to work, time in must be FUN, LOVING and full of PRAISE etc - make a differential contrast.
Effective treatment for adolescents?
> Need to know where they are
> Have to engage the adolescent
> Need to consider hormones and individualisation - rewarding and engaging with a teenager is difficult
> Parents 'executive' parental system
> Parents no longer work together and the child
How does (Harlow's) attachment theory help develop treatment for conduct disorders?
> Attachment theory states that we are driven to form a bond with caregiver: touching, feeding, eye contact etc
> Use these attachment processes as rewards for positive behaviour instead of descriptive praise and star charts etc
What is the success rate of parent training?
What are predictors of poor outcomes with parent training?
> severe parental psychopathology (depression, anxiety etc) (very high)
> marital (low predictable)
> low SES (medium predictable)
> poor response and engagement with program
What are the different treatment outcomes with cold (high callous-unemotional traits) and hot (low callous-unemotional traits) kids?
> Both types improve
> Cold kids are less responsive to parenting interventions
Why might cold (high callous-unemotional traits) kids be less responsive to parenting interventions?
> The genetic loading is much higher and the environmental loading is much lower.
> They are much less emotionally responsive - eg time out didn't phase them as much: "Yeah, I'll do the time. I'll be back."