ODD, conduct, ADHD Flashcards
behavioural problems contextual
developmental context
diagnostic context
systemic context
functional context
developmental context
Self Regulation
Sensory Processing
Receptive (understanding) and Expressive (using) Language
Executive Functioning
Emotional Development/regulation
Social skills
Planning and sequencing
ODD
3 dimensions: angry, irritable mood; argumentative and defiant behaviour; vindictiveness
age-based criteria for clinical significance: <5 yrs daily, >6 yrs weekly
severity based on pervasiveness across settings
removal of CD exclusion criterion
defiant, argumentative vindictive symptoms in ODD
most risk for CD
angry-irritable mood symptoms in ODD
most risk for emotional disorders
CD
3 or more in past 12 months (at least 1 in past 6 months): aggression to people and animals; destruction of property; deceitfulness or theft; serious violations of rules
clinically significant impairment in social academic or occupational functioning
if over 18 years old, criteria not met for antioscial PD
onset type: childhood onset (at least one criterion < 10 years), adolescent onset (no criterion <10 years): unspecified type (crieria for CD met, but not enough information re before or after 10 years)
aetiology ODD child factors
Genetic vulnerability
Biological determinants – organic deficit, behavioural inhibition, executive functioning
Difficult infant temperament
Arousal theory – not consistently found
Information processing abnormalities
hostile attributional bias
Learning difficulties
systemic predictors of conduct disorder
Lower household income
Presence of parental mental health problem
Parental factors – antisocial, poor supervisor, low education, harsh punishment, issues more commands, unclear commands
NICE: Children aged 3-7years should be targeted for selective prevention of CD if:
They are growing up in a poor household
They are underachieving in school
There is a history of child abuse or parental conflict
One or both parents has a history of mental health problems and/or substance abuse problems
One or both parents have come into contact with the criminal justice system
Child learns behaviours from coercive interactions with parents
less positive interactions
punish children more frequently
negative reinforcement of anti-social behaviour by withdrawing consequences when child escalates
ineffective parenting practices
prosocial behaviours punished or ignored
ineffective monitoring
accidental reward of misbehaviour
ineffective use of instructions
punishment used impulsively, unpredictably, too rarely or too severe
emotional messages
sarcasm and criticism
parents beliefs and expectation
functional context: understanding the function
Topography of problem behaviour
Triggers
Consequences
Onset and course
Child, family, parent factors
Parent-child interaction factors
behavioural parent training core treatment components
modelling, skill building and home practice
BPT treatment components are focused on increasing positive attention for appropriate child behaviour, removing parental attention for inappropriate child behaviour, and implementing more effective instructions and consequences for noncompliance
incredible years
strengthening parent-child interactions
nurturing relationships
reducing harsh discipline
fostering parents’ ability to promote children’s social, emotional, and language development.
play
10mins day
Praise, no criticism
Child led
Questions are banned!
Teaching is banned!
Commentary on playing…
Gives attention to child
Provides learning opportunity without testing
praise
Specific, labeled, timely (5secs!)
Enthusiasm
Avoid ‘sting in the tail’ - e.g. ‘see what you can do when you make the effort’
rewards
using target/golden behaviours
reward system
reinforcement and schedule
refresh rewards regularly
parenting pyramid
from bottom (use liberally) to top (use selectively)
play: promote positive parent-child relationships
praise and incentives: build social competence
effective limit setting: increase cooperation
ignore, redirect, distract: decrease aggression
time out
limit setting
Specific, clear instructions
Get their attention
Give the direction
Check compliance
Praise / Add consequence
planned ignoring
Play and praise teach child how to get attention appropriately…
For undesirable behaviour – removing reinforcement
No touch, no talk, no eye contact
Positive self-talk for parents
time out
use selectively and limited
Use to help child calm – self-regulate
Key principles:
Don’t call it the naughty step!
No warning
1min per year of life
Calm and quiet before coming out
5 steps to time out
check the behaviour
tell them why
sit in time out
end time out
praise your child
goals of BPT
How to build strong relationships with children through child-directed play interactions
How to provide praise and incentives to build social and academic competency
How to set limits and establish household rules
How to handle misbehavior
BPT- key to success
Rationale based on case formulation
Skills are taught, modelled, use of role-play, home-work set up, monitored, reviewed
Expect success but address expectations
obstacles for generalisation BPT
Not preparing for generalisation IN therapy
Inadequate mastery of skills beforehand
Ineffective implementation
Parental stress and lack of support
obstacles for maintenance- BPT
Parent factors
Family factors
Social factors
Child factors
negative parental cognitions: attentional focus on negative behaviour; parents beliefs about their ability to manage behaviour; expectations of their child
Enhance BPT
video, roleplay, technology
parent self monitoring of skills and practice
use of guided self help books in addition to therapy
BPT maintenance
booster sessions: periodic retraining or relapse prevention
contingencies for a return to clinic
establish support networks
self management maintenance plans
