Disruptive Behaviors in Children (Week 7)

Question 1

According to psychodynamic theory, what is the role of defiance in the child’s interpersonal and emotional functioning?

Answer 1

Oppositional behavior may be a form of defiance (a sort of tough guy act). Child is provoking punishments to relieve guilt

Impaired object relations: misperceived directives as taking control, would lose autonomy

Question 2

What are some things to consider when working with clients who struggle with disruptive behavior?

Answer 2

-antecedents and consequences
-is child paying attention?
-are there times when the child is compliant?
-Does the client struggle with rules only at home, only in the classroom, or both?
-Need to be able to distinguish between motivation and capability (won’t vs. can’t)
-Assess for trauma: Most behavior therapy interventions will not work (and probably make things worse) for children who have experienced abandonment, abuse, and/or have poor/no attachment with caregivers.

Question 3

What are the preferred treatments for disruptive behavior?

Answer 3

1 behavioral-systemic therapy (BST)***

#2 collaborative problem solving (CBS)***

Parent-child interaction therapy (PCIT) has similar components to BST, but also uses client-centered play therapy techniques, which are taught to parents to enrich interactions

Question 4

What is BST and when do you use it?

Answer 4

BST produces positive spillover effects, including improvement in parental feelings toward their children, improved marital and family functioning, and improved behavior in siblings who did not even participate in therapy. BST changes interactions around discipline by replacing yelling and emotion with calm implementation of procedures.

WHEN TO USE: If the child seems capable of compliance but insufficiently motivated to cooperate, BST, with its emphasis on reinforcement and incentives, would be appropriate

Question 5

What is CPS and when do you use it?

Answer 5

main alt. to BST A parent training intervention but it differs from BST by emphasizing compliance less and emphasizing remediation of emotion dysregulation more

WHEN TO USE: If the behavior is a result of emotion dysregulation, the child often seems incapable of compliance, CPS, which provides soothing and help with executive functioning, would be appropriate. Outperformed BST with the subset of noncompliant children who also have serious
depression or bipolar disorder

• In CPS, when the child’s noncompliance is
  associated with distress, parents:
  – Express empathy by reflecting the child’s feelings.
  – Soothe the child with gentle words and touch.
  – Coach the child in emotion regulation (e.g., deep
  breaths).
  – Problem-solve to find mutually acceptable
  solutions by stating nonnegotiable priorities and
  modifying negotiable aspects of the directive.

Question 6

What is social problem solving, and when do you use it?

Answer 6

This type of therapy consists of structured procedures for slowing down impulsive reactions, anticipating consequences, and planning reasonable responses

WHEN TO USE: If the child’s misbehavior seems driven primarily by impulsivity and poor judgment, social problem solving would be appropriate.

Question 7

principles of BST

Answer 7

– Reward should predominate over punishment.
– Consequences should be clear and immediate.
– Success should be attainable for the child.
– The parent should follow through on all promises and threats.
– Increasing the warmth of the parent-child relationship is a top priority.