lecture 3- aggression interventions Flashcards
(33 cards)
1
Q
for are some frequent reasons for child mental health outpatient referrals?
A
Angry outbursts and aggression are some of the most frequent reasons
for child mental health outpatient referrals.
2
Q
what is aggression commonly associated with? and who are also at risk?
A
- Aggression commonly associated with Conduct Disorder (CD) in adolescence.
- Also at risk are children with e.g. ADHD, anxiety disorders, and mood disorders
3
Q
what is conduct disorder?
A
Repeated, persistent patterns of antisocial,
aggressive, or defiant behaviour, worse than
normal for that age.
* More extreme and problematic as child gets older & more independent.
* Serious rule (and law) violations at home, school, community.
4
Q
what are risk factors of conduct disorder?
A
-being a male
- living in an urban environment
- poverty
- a family history of conduct disorder
- a family history of mental health
- having other associated psychiatric disorders
- parents with alcohol or drug addiction
- a dysfunctional home
- history of experiencing traumatic events
- being abused or neglected
5
Q
parents and teachers, what can they do?
A
- Create non-aggressive environments to reduce chances for conflict.
- Reduce or eliminate anything that might reinforce aggression, eg don’t make the aggressive act rewarding in any way > proactive aggression in particular.
6
Q
what is the incompatible-response technique?
A
- Ignore all but the most serious
aggressive behaviours - Reinforce positive acts eg sharing
Time-out: for more serious behaviours - Avoids escalating conflict and
reinforcement - Best when combined with positive
reinforcement
7
Q
modelling and coaching
A
- Help look for nonhostile cues to reappraise the situation.
- Help the child find alternative solutions to conflict.
- Help the child be more aware of others’ feelings; promote empathy.
8
Q
parents <>child<>school effective interventions
A
9
Q
interventions that help with aggression
A
- Social-cognitive competencies
- Interpersonal problem solving
- Parenting skills
- Coping with stress
- Home / school climate
10
Q
Farrington et al (2017) review:
A
- Systematic reviews of developmental prevention programs
- 5 General (multi-factor)
- 9 family-based
- 11 individually-focused (eg child skills training)
- 25 school-based
11
Q
Farrington et al (2017) review: what worked best?
A
- General (multi-factor) programs: best effects with those that included
parenting skills training and behavioural modelling. - Family programs more successful with children under 15 years old.
- In schools, universal school-wide programs worked better than small-
group ones; multi-faceted worked better than targeted. - Anti-bullying programs worked better with younger children (age5-12
years) than older children. - Start early when children are young.
12
Q
aggression interventions- two reviews:
A
- Overt / physical aggression (Sukhodolsky et al, 2016)
- Relational aggression (Leff et al, 2010)
13
Q
Review of Overt Aggression interventions
A
Focused on
(a) Parent Management Training (PMT)
The Family environment
(b) Cognitive Behavioural Therapy (CBT)
The Child
14
Q
Parent Management Training (PMT)
A
- Operant conditioning principle
- Positive reinforcement.
- Appreciates multiple interacting risk factors and pathways to
childhood anger/irritability. - PMT aims to improve family interaction patterns that maintain and
support tantrums, aggression, and noncompliance. - Mainly with parents but sometimes children are involved.
15
Q
Parent Management Training (PMT)
A
- Identify why the child is behaving aggressively / angrily
- Give praise for positive and
appropriate behaviour - Communicate instructions and directions
effectively (verbal skills) - Ignore maladaptive attention-
seeking behaviour
Use consistent approaches to
dealing with disruptive behaviours
16
Q
positive parenting program (PPP)
A
- the triple p- positive parenting program is one of the most effective evidence-based parenting programs in the world, backed up by more than 35 years on ongoing research.
Triple P gives parents simple and practical strategies to help them build strong, healthy relationships, confidently manage their childrens behaviour and prevent problems developing.
Triple P is used in more than 30 countries and has been shown to work across cultures, socio-economic groups and in many different kinds of family structures
17
Q
what is triple P?
A
triple p is a parenting program, but i doesnt tell you how to be a parent. its more like a toolbox of ideas. you can choose the strategies you need. you choose the way you want to use them, its all about how triple P works for you.
18
Q
triple P helps you:
A
- raise happy confident kids
- manage misbehaviour so everyone in the family enjoys life more
-set rules and routines that everyone respects and follows - encourage behaviour you like
- takecare of yourself as a parent
- feel confident you are doing the right thing
19
Q
PMT cont
A
- Modifications for Autism and obsessive compulsive disorder (OCD)
- Careful consideration of angry/aggressive behaviour and how to deal
with them in the context of specific conditions
20
Q
a short note on applied behaviour analysis (ABA)
A
- Aims to reinforce desired behaviours.
- Early versions included both punishment and reward.
- Debate on what is ‘desired’ behaviour, eg fitting societal
‘norms’.
21
Q
Cognitive-Behavioural Therapy (CBT): child
A
- Emphasis on learning principles.
- Targets difficulties in emotion regulation and social problem-solving.
- Parental involvement: communication, environment, support.
- Recognise child’s efforts (positive reinforcement).
- Identify reasons for and consequences of
aggressive behaviour - Strategies to learn better recognition and regulation of anger
- Cognitive restructuring, problem solving
- Model and rehearse socially appropriate behaviours to replace anger and aggression
22
Q
anger control and management training
A
- Monitor emotional arousal.
- Cognitive reappraisal and relaxation.
- Practice socially appropriate responses.
- Can help with hostile attribution bias.
23
Q
social skills training (SST)
A
- Based on Social learning theory (Bandura, 1973).
- Enhance social behaviours that can be used instead of aggression.
- Help develop more positive friendships with non-aggressive peers.
- Targets weak verbal skills, poor conflict resolution skills.
24
Q
problem solving skills training (PSST)
A
- Modelling.
- Role-playing.
- Positive reinforcement of appropriate behaviour.
- Teaching alternative behaviours.
- Child sessions but parents can observe and learn how to support.
- Homework to do.
25
review of overt aggression interventions-Randomized control trials
* Measured effectiveness of Social Skills Training (SST) and Problem
Solving Skills Training (PPST); N=26.
* Both showed reduced aggression.
* Problem-solving training showed greater reduction of Hostile
Attribution Bias.
* Social skills training showed greater improvement in anger control
skills.
26
Review of Relational Aggression interventions
“…non-physical aggression in which one manipulates or harms another’s social standing or reputation.”
(Leff et al., 2010, pg 509)
* Direct (“I don’t want to be your friend”) or indirect (spreading rumours behind backs to influence others’ opinions)
* Associated with problematic friendships, rejection, depressive symptoms, and school avoidance.
* Only recently have interventions been considered.
27
Review of Relational Aggression interventions- difficulties
Difficulties:
* Social problem-solving.
* Emotion regulation.
* Academic.
* Predicts future psychosocial maladjustment.
Can be highly associated with
physical aggression which makes
this complex to address.
28
Similarities between overt/physical and relational aggression:
* Hostile attribution bias.
* Favourable evaluations of aggressive solutions.
* Considerable social influence within their peer group.
* Adept at social manipulation, influential, popular within certain circles – high status.
29
Early Childhood Friendship Project (Ostrov et al., 2009)
* Classroom-based, children aged 3-5 years. 6 weeks.
* Designed to reduce both relational and physical aggression and increase prosocial
behaviours.
Puppet shows:
social skills, friendships.
Weekly participatory activities to reinforce social skills. Role-playing.
Concept activities: eg small group art or picture books.
Reinforcement: Praise during free- play (from a puppet and adult).
30
early childhood friendship project cont
* 9 intervention and 9 control classrooms in urban and suburban areas.
* Researcher observations within classrooms of aggression.
* Teacher measures of prosocial behaviour.
* Large positive effects on relational aggression and moderate effects on
physical aggression.
* But requires larger samples.
31
i can problem solve (ICPS)
Not specific to relational aggression but
general problem-solving skills could be
effective.
However, it is a really long and intensive
programme, school-based.
evidence based, universal primary prevention program that helps children, as early as age four, learn:
- perspective taking- awareness and sensitivity to peoples feelings
- alternative solution thinking- ability to generate a variety of solutions to interpersonal problems
32
social aggression prevention program (SAPP)
* Designed to reduce girls’ use of social aggression and increase skills in empathy, social problem solving, and prosocial behaviours.
* Small groups, 5th grade (USA; age 10-11), randomly assigned to SAPP vs control.
* Self-report, teacher-report, and peer evaluations
* Little effect overall, but further analyses suggest it may be more effective for high-risk girls in social problem solving, prosocial behaviours, and empathy.
33
Aggression interventions, design considerations
Age-appropriate
* Verbal skills, parental / teacher involvement, report tasks, medium.
Aggression-appropriate
* Physical and relational aggression, proactive vs reactive aggression.
Community-appropriate
* Include key community individuals when designing the intervention (teachers, counsellors, education psychologists, police officers, parents).
