Treating Conduct Problems

Question 1

The presence of CU traits in a child with conduct problems alters what?

Answer 1

The presence of CU traits modifies the presentation of conduct problems and alters the treatment.

Question 2

What are the four guiding principles for the effective treatment of conduct problems?

Answer 2

1. Target the ecology of the child.
2. Take a developmental perspective.
3. Be formulation/hypothesis-driven.
4. Form a strong therapeutic team.

Question 3

What does ‘target the ecology of the child’ mean?

Answer 3

The child’s environment (parenting, routines) must be targeted in treatment. Evidence shows that counselling only the child has little effect.

Question 4

What does ‘take a developmental perspective’ mean?

Answer 4

Considering when is the optimal time for intervention, which family environment variables should be targeted and how to best involve the child.

Question 5

What does ‘be formulation/hypothesis-driven’ mean?

Answer 5

Every diagnosis is a hypothesis, which should then be tested to see its validity.

Question 6

What does ‘form a strong therapeutic team’ mean?

Answer 6

Developing a team is the only way to treat young children, need the school and parents to be involved.

Question 7

A child’s ‘ecology’ suggests that conduct problems arise from…?

Answer 7

…the ecological systems in which children develop. All environmental features can be a factor in child conduct problems.

Question 8

At what age do children form meta-cognition and what does this mean for treatment?

Answer 8

At around 8 years of age, which means they are beginning to know who they are and can potentially engage in therapy (CBT, etc.).

Question 9

What age is the sweet-spot for treating children with conduct problems?

Answer 9

2-8 years old, treatment during this time produces the best outcomes. Evidence for treatment gets weaker as people get older.

Question 10

At what stage of childhood/adolescence is key for targeting the parents role in behaviour change? Why is this?

Answer 10

Early-to-middle childhood because this is when the coercive cycles begin to form (reinforcement traps).

Question 11

When treating conduct problems, what is the best form of treatment and what are some of the types?

Answer 11

Behavioural Parent Training, some types are: positive parent program, the incredible years, parent-child interaction therapy (PCIT).

Question 12

In Behavioural Parent Training, how many sessions are needed to improve behaviour and what is the percentage of improvement?

Answer 12

About 10 sessions, and improvement occurs in 50-60% of behaviours.

Question 13

In the Coercive Family Process, what is happening pretreatment?

Answer 13

• the child’s positive behaviour is being ignored and the parents are responding to it in an attachment neutral way.
• the child’s negative behaviour is given attachment-rich attention.

Question 14

In the Coercive Family Process, what should happen after a Behavioural Family Intervention?

Answer 14

The child’s positive behaviour should increase as they are receiving more attachment-rich attention for it.

Question 15

What is the main focus in a Behavioural Family Intervention?

Answer 15

Reversing the ‘buckets’ of attention. The positive behaviour is praised with attachment-rich attention. The negative behaviour is responded to minimally, in an attachment-neutral way.

Question 16

Other than the core treatment, what are some other focuses of Behavioural Family Interventions?

Answer 16

• brief marital interventions.
• social support.
• child interventions.
• anger management.
• hi-risk settings.

Question 17

Good parenting is integral to the wellbeing of a child, thus Behavioural Family Interventions and parenting should be considered what?

Answer 17

A public health issue.

Question 18

What are some ‘positive’ behaviours that can be praised in a young child?

Answer 18

• following instructions.
• speaking in a nice voice.
• playing nicely, independently.
• accepting ‘no’ for an answer.

Question 19

What are some ways to reward positive behaviour?

Answer 19

• descriptive praise.
• physical contact.
• privileges, tangible rewards.
• Parental Time!

Question 20

According to operant theory, how should the behavioural rewards be delivered?

Answer 20

Unpredictably, sporadically with varying rewards that are different in intensity.

Question 21

What is the best way to reward a child?

Answer 21

With YOUR TIME.

Question 22

What should a punishment involve?

Answer 22

Discipline should be attachment-neutral but also attachment-secure.

Question 23

If a child misbehaves what is the first step of discipline?

Answer 23

State the inappropriate behaviour and the appropriate behaviour.

Question 24

If a misbehaving child complies with discipline, what should be done?

Answer 24

The child should be praised.

Question 25

If a misbehaving child keeps misbehaving after discipline, what should be done?

Answer 25

Once more give clear discipline - what not to do, what to do.

Question 26

After a second disciplining, if the child misbehaves again, what should be done?

Answer 26

Time out or logical consequence.

Question 27

When should a time out punishment end?

Answer 27

As soon as they are under control and complying. Praise should be contingent on their good behaviour, when it presents itself.

Question 28

What is the success of therapy reliant on?

Answer 28

The family engaging with the therapist to create change together.

Question 29

What does the Hierarchical Structure of a Healthy Family look like?

Answer 29

An effective family has an executive parental subsystem that works as a team.
The children are in a subsystem underneath the parents.

Question 30

What are the parent training success rates?

Answer 30

About 60%

Question 31

What are some predictors of poor outcomes in parent training programs?

Answer 31

• socioeconomic disadvantage.
• minority group status.
• younger maternal age.
• parental psychopathology.

Question 32

Do kids with high callous-unemotional traits improve after parent training? What doesn’t change?

Answer 32

Their behaviour does improve but callous-un-emotional traits are still high.