Treating Conduct Problems Flashcards
The presence of CU traits in a child with conduct problems alters what?
The presence of CU traits modifies the presentation of conduct problems and alters the treatment.
What are the four guiding principles for the effective treatment of conduct problems?
- Target the ecology of the child.
- Take a developmental perspective.
- Be formulation/hypothesis-driven.
- Form a strong therapeutic team.
What does ‘target the ecology of the child’ mean?
The child’s environment (parenting, routines) must be targeted in treatment. Evidence shows that counselling only the child has little effect.
What does ‘take a developmental perspective’ mean?
Considering when is the optimal time for intervention, which family environment variables should be targeted and how to best involve the child.
What does ‘be formulation/hypothesis-driven’ mean?
Every diagnosis is a hypothesis, which should then be tested to see its validity.
What does ‘form a strong therapeutic team’ mean?
Developing a team is the only way to treat young children, need the school and parents to be involved.
A child’s ‘ecology’ suggests that conduct problems arise from…?
…the ecological systems in which children develop. All environmental features can be a factor in child conduct problems.
At what age do children form meta-cognition and what does this mean for treatment?
At around 8 years of age, which means they are beginning to know who they are and can potentially engage in therapy (CBT, etc.).
What age is the sweet-spot for treating children with conduct problems?
2-8 years old, treatment during this time produces the best outcomes. Evidence for treatment gets weaker as people get older.
At what stage of childhood/adolescence is key for targeting the parents role in behaviour change? Why is this?
Early-to-middle childhood because this is when the coercive cycles begin to form (reinforcement traps).
When treating conduct problems, what is the best form of treatment and what are some of the types?
Behavioural Parent Training, some types are: positive parent program, the incredible years, parent-child interaction therapy (PCIT).
In Behavioural Parent Training, how many sessions are needed to improve behaviour and what is the percentage of improvement?
About 10 sessions, and improvement occurs in 50-60% of behaviours.
In the Coercive Family Process, what is happening pretreatment?
- 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.
In the Coercive Family Process, what should happen after a Behavioural Family Intervention?
The child’s positive behaviour should increase as they are receiving more attachment-rich attention for it.
What is the main focus in a Behavioural Family Intervention?
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.
Other than the core treatment, what are some other focuses of Behavioural Family Interventions?
- brief marital interventions.
- social support.
- child interventions.
- anger management.
- hi-risk settings.
Good parenting is integral to the wellbeing of a child, thus Behavioural Family Interventions and parenting should be considered what?
A public health issue.
What are some ‘positive’ behaviours that can be praised in a young child?
- following instructions.
- speaking in a nice voice.
- playing nicely, independently.
- accepting ‘no’ for an answer.
What are some ways to reward positive behaviour?
- descriptive praise.
- physical contact.
- privileges, tangible rewards.
- Parental Time!
According to operant theory, how should the behavioural rewards be delivered?
Unpredictably, sporadically with varying rewards that are different in intensity.
What is the best way to reward a child?
With YOUR TIME.
What should a punishment involve?
Discipline should be attachment-neutral but also attachment-secure.
If a child misbehaves what is the first step of discipline?
State the inappropriate behaviour and the appropriate behaviour.
If a misbehaving child complies with discipline, what should be done?
The child should be praised.
If a misbehaving child keeps misbehaving after discipline, what should be done?
Once more give clear discipline - what not to do, what to do.
After a second disciplining, if the child misbehaves again, what should be done?
Time out or logical consequence.
When should a time out punishment end?
As soon as they are under control and complying. Praise should be contingent on their good behaviour, when it presents itself.
What is the success of therapy reliant on?
The family engaging with the therapist to create change together.
What does the Hierarchical Structure of a Healthy Family look like?
An effective family has an executive parental subsystem that works as a team.
The children are in a subsystem underneath the parents.
What are the parent training success rates?
About 60%
What are some predictors of poor outcomes in parent training programs?
- socioeconomic disadvantage.
- minority group status.
- younger maternal age.
- parental psychopathology.
Do kids with high callous-unemotional traits improve after parent training? What doesn’t change?
Their behaviour does improve but callous-un-emotional traits are still high.
