Work with Children with Conduct Issues


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Teachers and social service providers are increasingly aware of the number of children who have conduct issues. This presentation provides guidelines for understanding and responding. A first step is to ask whether children have experienced trauma. A next step is to find out if the children, their peers, and their parents believe these behaviors are appropriate. Work with both children and their families is most effective. Professionals will work with children only if parents are unavailable. Parents may enjoy the socialization involved in parenting groups.

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Work with Children with Conduct Issues

  1. 1. Work with Children Who HaveConduct Issues Jane F. Gilgun, Ph.D., LICSW School of Social Work University of Minnesota, Twin Cities, USA November 1, 2008 Draws heavily from Renk, Kimberly (2008). Disorders of conduct in young children: Developmental considerations, diagnoses, and other characteristics. Developmental Review, 28(3), 316-341.
  2. 2. Oppositional Defiant Disorder  Negativistic  Hostile  Defiant behaviors for at least six months during which four or more of the following are present  Often loses temper  Often argues with adults  Often actively defies or refuses to comply with adults’ requests or rules
  3. 3. Oppositional Defiant Disorder  Often deliberately annoys people  Often blames others for his or her mistakes or behaviors  Is often touchy or easily annoyed by others  Is often angry and resentful  Is often spiteful or vindictive
  4. 4. Conduct Disorder  Repetitive, persistent behaviors  Rights of others & rules of behavior are violated  Three or more of following criteria in past 12 months
  5. 5. Conduct Disorder  Aggression to people or animals  Destruction of property  Deceitfulness or theft  Serious violations of rules
  6. 6. Case Example: Mario, 12  Two views from an early age  “bad kid” and the family scapegoat  a sweet, charming boy; excellent one-on-one  School records  “antagonistic; he likes to start things;  he gets in fights  he is very mean at times  where it seems he just wants to hurt other kids  he has a horrible temper”  “susceptible to teasing [and] reacts with both physical and verbal aggression.”
  7. 7. Mario, 12  From school records: “follower and easily swayed by his peers, needing close supervision.”  Arrested for setting a fire  Question to Ask  Is school a safe haven for Mario?  Mario has experienced complex trauma  He has difficulty with self-regulation  How do school personnel help Mario feel safe?  Do school personnel understand that Mario often feels unsafe?  How do school personnel keep other children safe when Mario dysregulates in antisocial ways?
  8. 8. Mario, 12  In a four-month period at school  nine behavior referrals  three suspensions  Typical behaviors  hitting a child in the nose  pushing a chair into a child  telling another child to “suck my dick.”
  9. 9. What’s Missing?  Context & Developmental Histories  Diagnostic Questions
  10. 10. Developmental History  Experienced complex trauma  Witnessed domestic violence  Multiple police calls; father taken out of home in handcuffs  Mother sleeps with baseball bat next to her bed  Mother has chronic health problems  Mother depressed much of the time  Father has convictions for physical assault and attempted murder  Siblings mock and tease him
  11. 11. Diagnostic Questions  Have children experienced trauma?  What are parents’ trauma histories?  If there is trauma, arrange for trauma-specific therapy  Remember to teach methods of self-regulation before trauma-specific treatment begins
  12. 12. General Plan of Action  If there is trauma, arrange for trauma-specific therapy  Remember to teach methods of self-regulation before trauma-specific treatment begins
  13. 13. Questions and Issues  Mario is suffering  Mario’s behaviors hurt others  How can social workers help parents and teachers  Help Mario work through his issues?  Help Mario to deal with his issues without hurting himself or others?
  14. 14. Plan of Action for Social Services & Teachers  Do whatever it takes to form a healthy relationship with him  Spend time with him  Do things he likes  Praise him for prosocial behaviors  Give him opportunities to develop his skills
  15. 15. Plan of Action for Social Services  Do whatever it takes to form a healthy relationship with his parents and siblings  Help with basic human needs  Listen to what parents and siblings want  Work with them to provide recreational and social opportunities that they want  Memberships in boys and girls club  Pay for sports equipment  Art/music lessons lessons  also services that they may want eventually  Examples: Parenting classes that might be a way of socializing with other parents
  16. 16. Normative Development  Physical aggression and oppositionality are normative— related to learning limits and developing “cooperative” autonomy  Peak years are ages two to four  More than half of three year-olds have difficulties with peers  25% of boys four to five years old are aggressive or highly aggressive with peers  Assess whether these behaviors disrupt development
  17. 17. Normative Development  Children must  Test their autonomy  Learn their behaviors affects others  Develop a sense of self and how they are the same/different from others  Parents and teachers  Model appropriate behaviors  Teach children appropriate behaviors  Praise appropriate behaviors  State when behaviors are inappropriate  Show children appropriate ways to respons
  18. 18. DSM Diagnoses May be Appropriate  If behaviors  Interfere with development  Occur past the time in which they are expectable  Occur repetitively in many different settings  Not self-assertive but angry, dysregulated non- compliance  There is a possibility that children believe these behaviors are appropriate  Parents believe these behaviors are appropriate
  19. 19. ODD from Diagnostic Classification: 0- 3  Disruptive Behavior Disorder  Regulation Disorder of Sensory Processing  Hypersensitive Type  Sensory stimulation aversive  Respond with  Fear and caution  Negativity and noncompliance
  20. 20. Remember  These behaviors can be responses to trauma  These behaviors can also be based on belief systems of what are appropriate behaviors in various kinds of situations  Children may believe that physical aggression is honorable  Especially if parents and others important to them believe this, too
  21. 21.  When behaviors begin in preschoolers, more than half persist.  Therefore early intervention important.  CHILDREN’S AGGRESSION AND LOW-LEVEL OF PARENTAL RESPONSIVENESS ARE ASSOCIATED WITH CONTINUED AGGRESSIVE BEHAVIORS  Authortaritarian or harsh parenting at issue, too
  22. 22. Goal: Authoritative Parenting  Love  Foster secure relationships  Limit-Setting  Clear rules  Brief recognition for following rules  Brief recognition for not following rules  Point out transgression  State what is appropriate  Have child practice appropriate behaviors  Praise child briefly for doing so
  23. 23. Interventions  Observe how parents handle these behaviors  Note: About 25% of parents of 3 year-olds are unsure of how to handle their children’s behaviors  Appropriate intervention could be with parents  Support  Psychoeducation
  24. 24.  Parents  Show good EF and SR themselves  Use attachment figures well  Expect child cooperation and independence  Set clear limits  Clear expectations  Provide clear explanations given with warmth and good timing  Briefly praise wanted behaviors as soon as they occur
  25. 25. Parent-Child Interaction Therapy  Based on attachment theory  Builds children’s expectations that parents will respond to their needs  Recognize appropriate behaviors and ignore/redirect/give short time-outs for inappropriate  Parents play with children in ways that let children take the lead  Trainers coach parents  Trainers encourage parents to practice these skills at home and recognize when they do
  26. 26. Through Videotape Modeling  Interventions  Limit setting  Handling of misbehavior  Appropriate play—don’t dominate, give plenty of room for child to develop autonomy  Group setting  Parents discuss these approaches  May practice them together  Homework—do them at home and report back
  27. 27. Teach Parents About Attachment Behaviors  Many parents don’t recognize signs of secure and insecure attachments  Many parents require guidance in how to encourage secure attachment behaviors  Group work with parents on these issues is effective  Videotaping parent-child interactions is effective
  28. 28. Social Skills Training  Direct work with children  Example: Dina Dinosaur Treatment Program  18-22 weekly two-hour sessions  Topics  Feelings  Making friends  Taking turns  Following rules
  29. 29. Social Skills Training  Modalities  Videos of role models  Live modeling  Role-playing  Homework  Outcome  Combined child and parent training more effective than parent training alone or child training alone  Great improvements in behavior that are sustained over time