Chapter 13: Interventions For Kids

Question 1

Coercive Exchanges

Answer 1

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)

Question 2

Positive Reinforcement

Answer 2

any consequence that increases the likelihood of a behavior being repeated

Question 3

Time Out

Answer 3

a parenting strategy in which the child does not have access to reinforce for a brief period following misbehavior

Question 4

Parental Monitorig

Answer 4

parents’ awareness and tracking of the child’s activities

Question 5

Ecological Theory

Answer 5

a theory that examines a young person’s functioning within the multiple contexts in which he or she lives - family, school, neighborhood, etc.

Question 6

Mood Monitoring

Answer 6

tracking mood on a regular basis, usually using a chart

Question 7

Psychoeducation

Answer 7

teaching psychological concepts to clients in a manner that is accessible to them

Question 8

Who do therapists have to convince of their services in therapy for children?

Answer 8

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

Question 9

What if the youth refuses treatment?

Answer 9

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

Question 10

What are issues of premature termination and drop-out?

Answer 10

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

Question 11

What are the rates of depression in adolescents?

Answer 11

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

Question 12

Where is the burden of child and youth mental health disorders placed?

Answer 12

child, his/her friends and siblings

parents, caregivers

school, healthcare, and criminal justice

Question 13

What are effectiveness of evidence-based interventions in childhood disorders?

Answer 13

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

Question 14

What interventions for kids work?

Answer 14

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

Question 15

What conditions are there effective therapies for?

Answer 15

ADHD

bipolar spectrum disorder

obsessive-compulsive disorder

effects of trauma

self-injurious behavior

substance abuse

chronic health conditions

obesity

Question 16

What are the practice guidelines for interventions in kids?

Answer 16

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

Question 17

What are disruptive behavior disorders?

Answer 17

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

Question 18

What is Parent Management Training (PMT)?

Answer 18

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

Question 19

What is multi-systemic therapy (MST)?

Answer 19

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

Question 20

What is adolescent depression?

Answer 20

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

Question 21

What is the effectiveness of interventions for kids?

Answer 21

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

Question 22

What are modular treatment options?

Answer 22

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