Week 5: Treatment of DBD Flashcards
What three treatments exist for DBD
1) Parent management training (PMT)
2) Problem solving skills training (PSST)
- anger management training
- social anger prevention program
3) Multisystemic Treatments (MST)
What makes a treatment well established?
Well-established treatments:
A large series (>= 9) of single-case study designs demonstrating efficacy
OR
At least 2 between group-design experiments
Must be done by multiple research teams
Bronfenbrenner’s Ecological Model of
Human Development
What treatments target what systems?
A child exists in different systems
PSST - targets microsystem
PMT - targets mesosystem
MST - targets the meso and exosystems
Problem solving-skills training
Work with the child to reduce behavior problems
Targeting cognitive processes upstream
PSST overview
What is the underlying theory?
Underlying theory: Social-information processing Encoding Attention Interpretation Hostile attribution bias Response Search Generation Response Selection Evaluation along different dimensions
PSST (STEPS)
S ay what the situation is (encoding and interpretation)
T hink of solutions (response search)
E xamine each one
P ick one and try it out
S ee if it worked (Response decision and enactment)
E.g.
what happened, what is the evidence for this
What would you like to do, have you done something like this? How did it go have you seen other people do this, how was it?
Try many things, work with them, arrive at a solution, try it
Anger coping program (Basics)
What biases
What do they label arousal as
Treatment for aggressive behavior designed by John Lochman and
colleagues
Focuses on specific cognitive biases:
Interpretation
Hostile attribution bias
Distorted perceptions of aggressiveness
Aggressive youth underestimate their own aggressiveness and overestimate the
aggressiveness of others
Faulty emotional identification
Tend to mislabel affective arousal as anger so any emotion or feeling is labelled anger
Response search and selection
Rely heavily on direct action rather than verbal solutions
Maladaptive outcome expectancies
Aggressive youth do not think that conflict can be resolved through non-aggressive means
Anger coping program (3 steps)
Three critical steps
Children taught:
1) To inhibit early angry and aggressive reactions
2) To cognitively re-label stimuli perceived as threatening
3) To solve problems by generating alternative coping responses
and choosing adaptive, nonaggressive alternatives
Anger coping program details
Goal: To inhibit early angry and aggressive reactions
Sample Activities:
Building domino towers while being verbally distracted by peers - affords a chance to explore what an anger signal looks like and how to handle them
Learn to identify bodily cues that signal angry arousal and identify
thoughts that contribute to greater or reduced anger
“Stop! Think! What should I do?”
Anger coping program evidence
Aggressive boys randomly assigned to one of four groups: Anger Coping Goal Setting (minimal intervention) Anger Coping + Goal Setting No treatment
At one month follow up, compared to other two conditions, Anger Coping and Anger Coping + Goal Setting both led to reductions in disruptive and aggressive off-task behavior in the classroom
Note that ratings were done by observers who were blind to treatment condition
Both were better than goal setting so it is not just having access to people or empathy that worked, it was something about the program that added more.
Social Aggression Prevention
Program (SAPP) Basics
Program designed by Elise Cappella to reduce socially/relationally
aggressive behavior
Several key components
Recognition of emotions that may lead to social aggression
Social problem-solving
Social skills
Social Aggression Prevention
Program (SAPP) Evidence
Moderation?
Grade 5 girls randomly assigned to one of two conditions
SAPP
Reading group
Reading group identical to SAPP in length and number of sessions
Focus on stories with females as protagonists
Group who received SAPP had improved social problem solving
abilities at the end of the intervention
Offered more assertive/prosocial solutions to problematic social
situations
Effect of treatment was moderated by characteristics of the participants
- Among girls who were very socially aggressive prior to starting the program, those who received SAPP were rated by teachers as being slightly more empathic and slightly less likely to engage in socially aggressive behaviors than those who received the reading intervention MORE SOCIAL AGRESSION
- Among girls who were very low on prosocial behavior prior to starting the program, those who received SAPP were rated as being more prosocial by teachers after the program was over LOW PROSOCIAL BEHAVIOR
The level of social aggression moderated the relationship between SAPP and improvement
The problems with Problem-Solving Skills Training
May not be enough
Why?
In the real world, problematic behaviors may be reinforced
Children are unlikely to change such behaviors
Parents
Essentially, with kids parents are likely to give in and the kids have learned that. In other words, without changing the parents reinforcement, these behaviors will get them what they want. Consequently, they will keep doing them.
Parent Management Training (PMT) Basics
What must you warn about?
Operant conditioning
Consequences of an behavior will determine whether you get more or
less of it in the future
Education - Man y parents do not know what a reasonable expectation fo child’s behavior is
Reasonable expectations for child’s behavior
Behavior will get worse before it gets better - when you work with parents they must set new boundaries, you have to tell them to expect that the kids will push them because this has worked before and so this will get worse before better.
Communication
- “Say what you mean”, if it isnt a question, dont make it one
- Be direct
- Give directions in manageable chunks such as breaking multistep stuff down into chunks
- Tell child what to do, rather than what not to do
“Mean what you say” Let children know what will happen if they continue their behavior Pick consequences that are -Doable -Important -Immediate -Not too lengthy or extreme You must be able to follow through on what you said
It is important that the child understands what is happening. Sometimes parents are tolerant for many hours of increasing difficulty then snap at a tiny thing that was too far so the child thinks this is what they are being punished for
PMT learn to observe your child
What structure (cognitive alphabet)
Learn to observe your child’s behavior
ABC model - Antecedent-Behavior-Consequence
In which situations does this behavior occur?
What happens next?
Modify the contingencies
Monitor changes in behaviors
