News, commentary, resources, and more about Emotional and Behavioral Disorders.
The Incredible Years programs, which comprise a coordinated set of (a) parent training programs and individual family counseling, (b) teacher training and school consultation, and (c) group child training in social skills, problem-solving, and anger management, are in the news again. The IY programs are aimed at reducing conduct problems in young children. They have been researched extensively.
Continue reading ‘Incredible Years’
Sphere: Related ContentAccording to a story carried by CBS 3, a Philadelphia (PA, US) television station, authorities have charged a 12-year-old student with disabilities with disorderly conduct after she urinated in her pants at school. The CBS 3 report is based on a report published 20 December 2006 by the Danville (PA, US) Press Enterprise under the headline “Danville pupil charged with wetting her pants: Angry parents say police shouldn’t have been called” and with the lead, “A sixth-grade girl was charged by police with deliberately wetting her pants at Danville Middle School. (The Press Enterprise article requires a paid subscription, so I’m basing my coverage on an AP article carried by CBS 3. Continue reading ‘Conduct disorder?’
Sphere: Related ContentUnder the title “Troubled Children: Parenting as Therapy for Child’s Mental Disorders” in the New York Times, Benedict Carey has an extended article about parents using behavioral techniques to address the problems experienced by children with ADHD, acting out, Tourettes, and other Emotional and Behavioral Disorders. Mr. Carey focused his article on a family, the Popczynskis, who successfully learned to employ management procedures by working with William Pelham and his colleages at the the University of Buffalo.
Continue reading ‘Family therapy’
Sphere: Related ContentOver on Mentor Matters Mrs. Ris has reported on her efforts to help a child with some substantial Emotional and Behavioral Disorders. Mrs. Ris is an experienced teacher who’s seen some difficult students, but she’s decided that this particular boy needs something more than what she and her team can provide. Having had to make similar recommendations, I know how difficult it is to make such decisions. But, for some children, the plain fact is that sometimes more help is needed. Mrs. Ris explains this well.
I’m not sure if this is the same child to whom she referred when she welcomed a sixth child to her classroom, but there are two recent posts—relief and the waiting game—that tell the current story.
Sphere: Related ContentSometimes I just don’t get it.
The following abstract (from PubMed) describes research on use of medications as a treatment for preschoolers with attention deficit hyperactivity disorder, disruptive behavior disorder, and posttraumatic stress disorder. I suspect that the article reports on prior interventions that have been tried in most of the cases described in the study, but I have to wonder whether those interventions were well-conceived and -executed. Afterall, preschoolers are little kids. Most all of them are very susceptible to differential reinforcement. Did anyone test a carefully implemented time-out program with these kids (and I don’t mean one of the bogus take-time-to-get-yourself-together practices that are often labeled “time out”)?
There are surely a few preschoolers who will not respond to effective behavior management practices, and for those children and their families we must turn to additional means of therapy. But, I hope professionals concerned with Emotional and Behavioral Disorders among young children are using well-documented behavior modification procedures as a much earlier line of therapy.
Sphere: Related ContentProg Neuropsychopharmacol Biol Psychiatry. 2006 Sep 26; [Epub ahead of print] Related Articles, Links
Psychopharmacologic treatment of aggressive preschoolers: A chart review.
Staller JA.
Division of Child and Adolescent Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
Very young children with severe aggression are a growing focus of care in child psychiatry. Notwithstanding diagnostic uncertainties in this age group, medication, not usually considered a first-line intervention, is becoming a treatment option for a growing number of clinicians in spite of a dearth of research in this area. This chart review assessed the patient characteristics, diagnoses and treatment responses of aggressive preschoolers who were treated in a university child psychiatry outpatient clinic from 2001-2004. The most common diagnoses were Attention Deficit Hyperactivity Disorder (ADHD), Disruptive Behavior Disorder and Posttraumatic Stress Disorder (PTSD). Medication was prescribed for a majority of the children with prominent aggression; atypical antipsychotics were prescribed with the greatest frequency, followed by stimulants and then alpha agonists-treatment response ratings indicated moderate to marked improved in a majority of the preschoolers who received one or a combination of these medications. Findings support the need for controlled trials of medication in preschoolers with severe aggression.
Professor David Schwebel and colleagues of the Department of Psychology and the Youth Safety Lab at the University of Alabama Birmingham (AL, US) reported that mothers’ ignoring of dangerous behavior correlates with children with externalizing behavior. These results are consistent with other research showing that parental monitoring of behavior is a component in Emotional and Behavioral Disorders.
How mothers parent their children with behavior disorders: implications for unintentional injury risk.
How mothers parent their children with behavior disorders: implications for unintentional injury risk.
J Safety Res. 2006;37(2):167-73
Authors: Schwebel DC, Hodgens JB, Sterling S
INTRODUCTION: This study was designed to test the role of parental supervision in explaining why children with behavior disorders have increased risk of unintentional injury. METHOD: Children referred to a pediatric behavior disorders clinic and their mothers were unknowingly observed in a “hazard room” environment that housed several items that appeared dangerous but actually were altered to be safe. RESULTS: Mother and child behavior in the hazard room was correlated to parent-, teacher-, and observational-reports of children’s externalizing behavior patterns, children’s injury history, and mother’s parenting styles. Maternal ignoring of children’s dangerous behavior in the hazard room was the strongest correlate to children’s injury history. CONCLUSIONS: Poor parental supervision might serve as a mechanism to explain why children with behavior disorders, and those with oppositional behavior patterns in particular, have increased risk of unintentional injury.
Link to PUBMED abstract.
Sphere: Related ContentAfter a police officer killed a young man who apparently had Emotional and Behavioral Disorders, the Boise (ID, US) Community Ombudsman has recommended the officers receive additional training in handling unusual situations, according to a report by Aileen Simborio KTRV-TV. Ombudsman Pierce Murphy reviewed the incident in which officer Andrew S. Johnson shot Matthew Jones in December of 2004.
The 16-year-old was shot by Johnson on Dec. 18, 2004, after responding to the Jones family home at the request of Matthew’s father. Johnson shot Jones four times, killing him, after Johnson says he was attacked by Jones, who was carrying a World War Two Japanese rifle with a bayonet attached.
Murphy believes Johnson did not follow proper procedure when he responded. That’s why Murphy is recommending officers go through more training, specifically implementing what’s called a Crisis Intervention Team model which would help officers better respond to situations involving people suffering from mental illness or significant emotional disturbance.
Surely, responding to a situation such as this one is difficult for officers. They are accustomed to demanding (and obtaining) immediate compliance with orders, but most anyone who’s worked with kids with EBD knows that compliance is a common problem. Furthermore, confrontation rarely brings compliance; rather it often causes kids to escalate.
There are curricula available and in use for helping officers of the law to handle individuals with disabilities. Examples are here, here, and here; there are many others. Do you think your community should promote use of these curricula? Would using them reduce the chances of another child being killed? I hope so.
Link to Ms. Simborio’s story. She provided a link to Ombudsman Murphey’s full report, too.
Sphere: Related ContentA group of sociologists from the University of Montreal (Quebec, Canada) showed that “kindergarten boys who from low socioeconomic areas are hyperactive, fearless, infrequently prosocial, and raised in adverse family environments” are more likely to report affiliating with deviant peer groups as adolescents than other kindergarten boys who have only one or two of those four risk factors. I wonder whether use of Shep Kellams’ preventative intereventions (see my note on Teach Effectively! yesterday) would divert these boys from the path.
Prediction of early-onset deviant peer group affiliation: a 12-year longitudinal study.
Arch Gen Psychiatry. 2006 May;63(5):562-8
Authors: Lacourse E, Nagin DS, Vitaro F, Côté S, Arseneault L, Tremblay RE
CONTEXT: Deviant peer group involvement is strongly related to onset, aggravation, and persistence of conduct problems during adolescence. OBJECTIVE: To identify early childhood behavioral profiles that predict early-onset deviant peer group involvement. DESIGN: A 12-year longitudinal study of behavioral development. SETTING: Fifty-three inner-city elementary schools in a large Canadian city. PARTICIPANTS: A total of 1037 boys in kindergarten from low socioeconomic neighborhoods. MAIN OUTCOME MEASURES: Annual self-reported deviant peer group involvement from 11 to 17 years of age. RESULTS: Kindergarten boys were at highest risk of following an early adolescence trajectory of deviant peer group affiliation if they were hyperactive, fearless, and low on prosocial behaviors but much less at risk if they scored high on only 2 of these dimensions. Family adversity had no main effect but substantially increased the risk of following an early adolescence trajectory of deviant peer group affiliation for boys with a profile of hyperactivity, fearlessness, and low prosocial behaviors. CONCLUSIONS: Kindergarten boys from low socioeconomic areas who are hyperactive, fearless, infrequently prosocial, and raised in adverse family environments are at much heightened risk of engaging in deviant peer groups early in their development. Boys at high risk can be identified as early as kindergarten and should be targeted for preventive intervention.
PMID: 16651513 [PubMed - indexed for MEDLINE]
If you’re interested in a model for how to change children’s behavior in a home-like setting, there are several that have strong evidentiary bases. One of these is the the Teaching Family Project, affiliated with folks at the University of Kansas. Under the title “Family-Like Environment Better for Troubled Children and Teens,” the American Psychological Association has an appropriately lauditory review of it.
The Teaching-Family Model is one of the few evidence-based residential treatment programs for troubled children. In the past, many treatment programs viewed delinquency as an illness, and therefore placed children in institutions for medical treatment. The Teaching-Family Model, in contrast, views children’s behavior problems as stemming from their lack of essential interpersonal relationships and skills. Accordingly, the Teaching-Family Model provides children with these relationships and teaches them these skills, using empirically validated methods.
In 1970 Pat and I served as house parents for four children who had, until then, been residents of a state hospital for children with emotional, behavioral, and intellectual disabilities. I read about and admired the work of the Teaching Family folks and then later, while in graduate school, watched over his shoulder as Dick Jones helped conduct an external evaluation of the T-F model. Now, I’m glad to see that the model’s still going strongly.
Link to the APA article.
Sphere: Related ContentBarbara Maughan and colleagues at King’s College’s (London; UK) Institute of Psychiatry have been conducting longitudinal research on the development of behavior disorders. They have just published a report of a study (Title: Preadolescent Conduct Problems in Girls and Boys) that examines gender differences in the factors that predict disruptive behavior disorders. Here’s the abstract:
OBJECTIVE:: To examine sex differences in correlates of disruptive behavior disorders (DBDs) in preadolescent children using indicators of a wide range of well-established risk factors for DBDs and outcomes 3 years after initial assessment. METHOD:: Analyses were based on data for 5- to 10-year-olds (n = 5,913) from the British Child and Adolescent Mental Health Survey 1999, and a 3-year follow-up of selected subsamples (n = 1,440) at ages 8 through 13 years. DSM-IV diagnoses were assigned using the Developmental and Well-Being Assessment at both contacts. RESULTS:: Boys and girls were equally exposed to most social and family risks for DBDs, with little evidence of differential sensitivity to these risks. Boys were exposed more to neurodevelopmental difficulties, attention-deficit/hyperactivity disorder, and peer problems and had lower rates of prosocial behaviors; together, these factors and physical punishment could account for 54% of the observed sex differences in DBDs. At follow-up, outcomes for girls and boys with DBDs were very similar. For children with subthreshold conduct problems at initial assessment, boys were more likely to go on to exhibit DBDs than were girls (25% versus 7%). CONCLUSIONS:: Sex differences in the levels of a variety of child characteristics and interpersonal factors are likely to be important in understanding sex differences in risk for DBDs in preadolescent samples.
The study is published in a very prestigious source. Here’s the reference:
Messer J., Goodman R., Rowe R., Meltzer H., & Maughan B. (2006). Preadolescent conduct problems in girls and boys. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 184-191.
Link to the Pub Med abstract for the study. Reviewing the full study requires a subscription the AACAP journal.
Sphere: Related Content
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