The document discusses behavioral interventions for children with ADHD, ODD, ASD, and other behavior challenges, emphasizing the importance of early intervention and effective parenting strategies. It outlines the critical role of pediatric providers in addressing behavioral concerns and highlights the benefits of parent management training. Evidence-based recommendations and consultation guidelines are provided to improve treatment outcomes and parental engagement in their children's behavioral management.

1. Behavioral Intervention:
Supporting Families and Children with ADHD, ODD, ASD, and
Behavior Challenges
Meg Kincaid, Ph.D.
Licensed Clinical Psychologist

2. Objectives
Understand the benefits of behavior therapy for these
populations
Review the theoretical basis for behavioral strategies
Highlight consultation guidelines for discussing
treatment options and recommendations with parents

3. DSM V
Neurodevelopmental
Disorders
Disruptive, Impulsive, &
Conduct Disorders
Mood & Anxiety
Disorders

4. Neurodevelopmental
Disorders including
Autism Spectrum Disorder
ADHD
Communication Disorders
Intellectual Disabilities
Specific Learning Disorders

5. Disruptive, Impulse-Control,
and Conduct Disorders
ODD
Intermittent Explosive Disorder
Conduct Disorder

6. Mood and Anxiety Disorders

7. Co-occurring Disorders

8. Prevalence, Risk, & Course

9. Common Behavior
Challenges across
Disorders:
Non-compliance
Tantrums
Aggression
Difficulties in self regulation

10. Early Intervention is Critical
Children at the greatest risk of engaging in substance
abuse or delinquent behavior in adolescence exhibit
ODD and CD at a young age
Risk of later problems increased if
Child associates with deviant peers
Child’s parents engage in harsh and inconsistent discipline
Child’s parents have difficulty monitoring their child’s
activities
Child has academic failure and poor relationships at school
(Webster-Stratton, C., & Taylor,
T. , 2001)

11. Cycle Compromising Child’s
Functioning
Difficult temperament,
impulsivity
Ineffective parenting

12. Impact of Parenting Styles
Harsh
Parenting
Inconsistent
Parenting

13. Parental stress & negative
parenting
Parents of preschool children displaying ADHD and
ODD symptoms report higher levels of stress and
more frequent use of negative parenting strategies
(e.g. coercive discipline) than do other parents (Burke,
Loeber, & Birmhaher, 2002)
Negative parenting practices may contribute to co-occurring
diagnoses of ADHD and ODD. May also lead
to more severe impairment in school, social, and home
arenas in children with ADHD and play a direct role in
the development of ODD (McMenamy, Sheldrick, &
Perrin, 2011).

14. Webster-Stratton & Taylor
(2001)
“…cascading domains of risk factors make it
imperative to start prevention programs as early as
possible in order to ‘nip problems in the bud’ before
they create secondary school and peer risk factors and
in order to provide adequate fertilization for building
protective factors that guard against substance abuse
and violent behavior.”

15. Challenges and adaptation
to school
“Key developmental issues for high-risk children at school
entry are the control of aggressive behavior; the
acquisition and use of prosocial skills with peers; positive
relationships with peers, parents, and teachers; and the
development of a positive interest in school."

16. Pathways to Help
“Pediatric providers are likely to be the first health
professionals with whom parents will discuss concerns
regarding their preschool age children’s behaviors, and
they're capable of playing a key role in deciding whether
or not to take early action.”
(Glasco & Macias,2003)

17. Lavigne, et al. (1993)
Pediatricians were less likely to indicate that
preschool-age children had an emotional or behavioral
problem compared to psychologists who conducted
psychological assessments of children
Greater that 50% of preschool children who had
emotional problems based on a psychologist’s
evaluation did not receive counseling, medication, or
mental health referral from their pediatrician.

18. Preschool parent -pediatrician
consultations and predictive
referral patterns for problematic
behaviors
(Fanton, MacDonald, and Harvey, 2008)
In this longitudinal study, parents were asked whether
they consulted with their pediatric providers about
disruptive behavioral problems.

19. Transient vs Persistent
Behavior Problems
Pediatricians were able to distinguish between transient
versus persistent behavioral problems in preschoolers.
Providers did not over-refer at age 4.
Parental reports of early behavioral concerns signal
persistent behavior problems. Parents are able to
discriminate problems that were likely to persist.
No evidence for over-referral. Very few children with
transient behavior problems were referred as
preschoolers.

20. Problem of Under-referral
∙Of those diagnosed with a behavior disorder at age 6,
56% were not referred at age 4.
∙Only 22% of children whose parents consulted with their
pediatricians later outgrew their problems (vs 59% of
children whose parents did not consult later improved).

21. Reasons for Under-referral
Under-referring due to…
Stigma?
Lack of awareness of services?
Training?
Parents’ descriptions?
Inadequate screening or follow up from screening?

22. Importance of Consultation
“Children of parents who consulted with pediatricians
were much more likely to ultimately receive medication
or psychosocial treatment compared to children of
parents who did not consult with pediatricians.”

23. Parents’ Perspectives

24. Key Terms During
Consultation

25. AAP: When to involve
specialists
Child is younger than 5 years and problems don’t
respond to primary care intervention
Family is not able to maintain a safe environment
Child’s behaviors are injurious
Child is experiencing depression, anxiety, or severe
dysfunction in any domain
Problems at school are interfering with academic
functioning or with relationships

26. Efficacy Studies and
Practice Guidelines

27. AAP Guidance on Disruptive
Behavior and Aggression
Guidance from AAP-based on recommendations from
WHO
Evidence-Based and Evidence -Informed interventions
for Disruptive behavior and Aggression Psychological
interventions:
Level 1(Best Support)
Includes Parent Management Training

28. ASD
Early intensive behavioral intervention is the only well
established treatment for young children with ASD (Le
Blanc & Gillis, 2012)

29. Parent Training & ADHD
Meta-analysis (Lee, et al., 2012) examining effects of
parent training on child and parental outcomes for
children with ADHD.
Parenting competence was the only outcome that had
a large effect, which decreased to moderate effect size
at follow-up
Conclusion: Parent training in behavioral management
is an effective intervention for children with ADHD.

30. AAP Care for Children
with Disruptive Behavior
or Aggression
“All children manifesting disruptive or aggressive
behaviors require intervention…”
Engage child and family in care
“Without engagement, most families will not seek or
persist in care. Process may require multiple primary
care visits”

31. AHRQ Review
Effective parent programs help parents develop a
positive relationship with their child, teach them about
how children develop, and help them manage behavior
with positive discipline.

32. Jo Ann Loper, Director of
Parent Education @ TC
INTRODUCTION

34. AAP Plan of Care
Reinforce compliant behavior with parental attention
“Catch them being good!” Praise and rewards for
target behaviors
Ignore some inappropriate behaviors
Avoid positive reinforcement of disruptive behaviors
Give clear commands
Provide consistent consequences
Consider parenting classes

35. Components of Effective
Parenting Programs

36. Components of Parent/Child
Training @ Tuesday’s Child

37. https://drive.google.com/a/tuesdayschildchicago.org/file/d/0BzAPhqzC2P2rX3NtemVYc
3g1Wm8/edit?usp=sharing

38. Behavioral Parent Training
(Pfiffner & Kaiser, 2010)
Contingency-based intervention involve one or more of
4 key concepts
Behavior is increased either by following it with
something desirable (positive reinforcement) or by
removing something undesirable (negative
reinforcement
Behavior is decreased either by following it with
something undesirable (punishment) or by removing
something desirable (extinction)
Current behavioral treatments also incorporate social
learning theory components of modeling, imitation, and
cognitive factors

39. Behavior Management
Tools
Praise
Antecedent Planning
Differential Attention
Reinforcers
Discipline
Validation of feelings

40. Techniques, Population
Served, Peer Mentoring

41. Skills Learned
To become a good observer of behavior
To collect data on antecedents, behavior, and its
consequences
The importance of structure, routine, fair expectations,
predictable consequences
The use of visuals, schedules, social stories as aides
to support behavior plans
To learn the power of attention and to use attention as
a behavior management tool
To enhance children’s self-regulation skills by
validating feelings and encouraging good choices