lecture 3- aggression interventions Flashcards
for are some frequent reasons for child mental health outpatient referrals?
Angry outbursts and aggression are some of the most frequent reasons
for child mental health outpatient referrals.
what is aggression commonly associated with? and who are also at risk?
- Aggression commonly associated with Conduct Disorder (CD) in adolescence.
- Also at risk are children with e.g. ADHD, anxiety disorders, and mood disorders
what is conduct disorder?
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.
what are risk factors of conduct disorder?
-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
parents and teachers, what can they do?
- 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.
what is the incompatible-response technique?
- 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
modelling and coaching
- 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.
parents <>child<>school effective interventions
interventions that help with aggression
- Social-cognitive competencies
- Interpersonal problem solving
- Parenting skills
- Coping with stress
- Home / school climate
Farrington et al (2017) review:
- Systematic reviews of developmental prevention programs
- 5 General (multi-factor)
- 9 family-based
- 11 individually-focused (eg child skills training)
- 25 school-based
Farrington et al (2017) review: what worked best?
- 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.
aggression interventions- two reviews:
- Overt / physical aggression (Sukhodolsky et al, 2016)
- Relational aggression (Leff et al, 2010)
Review of Overt Aggression interventions
Focused on
(a) Parent Management Training (PMT)
The Family environment
(b) Cognitive Behavioural Therapy (CBT)
The Child
Parent Management Training (PMT)
- 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.
Parent Management Training (PMT)
- 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
positive parenting program (PPP)
- 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
what is triple P?
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.
triple P helps you:
- 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
PMT cont
- 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
a short note on applied behaviour analysis (ABA)
- Aims to reinforce desired behaviours.
- Early versions included both punishment and reward.
- Debate on what is ‘desired’ behaviour, eg fitting societal
‘norms’.
Cognitive-Behavioural Therapy (CBT): child
- 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
anger control and management training
- Monitor emotional arousal.
- Cognitive reappraisal and relaxation.
- Practice socially appropriate responses.
- Can help with hostile attribution bias.
social skills training (SST)
- 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.
problem solving skills training (PSST)
- 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.
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.
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.
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.
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.
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).
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.
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
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.
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).
