COUN 6346 Child and Adolescent Counseling Week 4 – Sampl.docx

COUN 6346
Child and Adolescent Counseling
Week 4 – Sample Clients Introductions
Disruptive Behaviors
Four disruptive behavior demonstrations are shown. Critically
analyze each of them. At
the end of each clip, you will be prompted to answer several
questions based on what
you just observed.
There will be an opportunity to record your responses within the
media. It will be saved
directly to the computer you are using. It is important to view
and respond to the
questions in their entirety, as your recorded responses will only
be saved to this
computer. If you change computers, your recorded responses
will not be saved.
Press the ‘Review’ button to see your recorded responses.
[FOUR CASE FILES APPEAR WITH A PHOTO OF EACH OF
THE CHILDREN PAPERCLIPPED
ON ONE OF EACH OF THE FOUR INDIVIDUAL MANILLA
FOLDER]
Angry Adolescent

MELISSA: You are a horrible counselor. I hate being here, and
I hate talking to you. This
is worthless. And you're stupid. There is no point to this
because you don't know
anything about me. And I'll never tell you anything about me.
[FOUR QUESTIONS APPEAR ONSCREEN]
Angry Adolescent
Reflect on what you just observed. Record your responses in
the boxes provided then
press the ‘Continue’ button.
What is your initial reaction to the behavior?
How might you respond to the child with this behavior?
How would you like to respond to the child with this behavior?
How might your reaction impact the counseling process?
Withdrawn Child
GREG: I don't have any problems. I'm fine.
Withdrawn Child

Blaming Adolescent
DAVID: I already told you. It's my parents' fault. They should
be in here in counseling,
not me. And if it wasn't for one of the kids at school who told
me about taking the gym
teacher's car for a drive, I wouldn't even be here.
Blaming Adolescent

Hyperactive Child
TANYA: Ooh, I used to have one of these action figures at
home. That's cool. Have you
ever played Halo? How about Grand Theft Auto? That's another
one of my favorite
games. Do you have any other games we could play here?
Hyperactive Child
[Record your responses, and then continue to the next disruptive
behavior until you
have completed viewing all four examples.]
ASSIGNMENT
Post by Day 4, a brief description of the child or adolescent
whom you may be most

comfortable counseling, and which child or adolescent whom
you may be least
comfortable counseling, and explain why.
Then, explain one way that your reactions might positively or
negatively influence the
development of a therapeutic relationship with the children or
adolescents whom you
chose.
Finally, explain one way that you might transform a negative
reaction into an
appropriate therapeutic response and how. Be specific and use
examples.
COUN 6346
Child and Adolescent Counseling
Week 4 – Blaming Adolescent
Select one child or adolescent with a disruptive behavior. Then
critically observe the
counseling sessions for that particular child or adolescent.
You will be prompted with questions during your critical
observation.
There will be an opportunity to record your responses within the
media. It will be saved
directly to the computer that you are using. It is important to

view and respond to the
questions in their entirety, as your recorded responses will only
be saved to this
computer. If you change computers, your recorded responses
will not be saved.
Press the ‘Review’ button to see your recorded responses.
[FOUR CASE FILES APPEAR WITH A PHOTOGRAPH OF
EACH OF THE CHILDREN
PAPERCLIPPED, ONE ON EACH OF THE FOUR
INDIVIDUAL MANILLA FOLDERS]
Blaming Adolescent
COUNSELOR: So David, I know we were just in the other room
with your mom, and we
are talking about counseling and stuff. And we decided that it
would make sense for you
and l to have some time just to talk one-on-one. But before we
start, I just wanted to let
you know that what you say here is private, personal
information. I certainly won't be
sharing it with anyone unless there's a possibility that you might
be planning or doing
something dangerous to yourself or someone else. And if that's
the case, then we'll have
to get with your mom and talk about how to deal with that. But
before you say
anything, I just want to make sure that you know that. And so
now you're welcome to
start wherever you'd like.
be here in counseling, not
me. And if it wasn't one of the kids at school who told me about

taking the gym
teacher's car for a drive, I wouldn't even be here.
COUNSELOR: So you did take your gym teacher's car for a
drive? That's what you're
saying, right?
DAVID: Yeah. It was cool, but I mean, he set it up. He left his
keys in the car, so it's his
own fault.
COUNSELOR: But you're the one who got in trouble.
DAVID: But I shouldn't be in trouble. The guy left his keys in
the car. And if it wasn't for
that one jerk who told on me, I would have pulled it off.
COUNSELOR: Now, I'm not sure if you're blaming your
parents, or if you're blaming the
gym teacher for leaving his keys in his car, or if you're blaming
the other kid for narcing
on you, but one thing you're not doing, is you're not taking
personal responsibility for
the actual behaviors that have gotten you in trouble in here.
DAVID: You're just trying to make me feel bad for a joke that
went wrong. I mean, if my
dumb gym teacher hadn't left his keys in the car, it wouldn't
have happened. It's totally
lame. If you were my age, you would have done the same thing,
or something like it.
COUNSELOR: Well, I might have wanted to take the car for a

drive, but I would have
thought about the consequences, and then I would have done the
right thing because I
wouldn't have gotten in trouble, and the bottom line is, you
know, David, if you keep on
doing these kinds of things and you don't take responsibility for
it, you're just going to
get in trouble over and over and over again. And that's what we
need to work on here in
counseling, is to make it so you stop getting in trouble.
DAVID: Well, that's just totally stupid. You're pathetic.
[A SET OF QUESTIONS APPEARS ONSCREEN]
press ‘Continue’.
What approach did the counselor employ?
Was it effective? Why or why not?
What approach or techniques could the counselor have used to
create a therapeutic
relationship with this client and why would it be successful?
Press the ‘Continue’ button to view the next segment.
[INSTRUCTIONS BOX APPEARS]
You will now observe a different approach with the same client.
Look for differences in
counseling techniques compared to the earlier session.

Click the ‘Continue’ button to start the session.
COUNSELOR: So David, I know we were just in the other room
meeting with your mom,
and that we decided that it would be nice for just you and I to
speak separately. And I
just want to let you know before you say anything that what you
say here with me is
private, personal information. What you say here stays here. As
you know, I think, from
the paperwork, there are exceptions to that; kind of the standard
thing, that if you were
to be a danger to someone or yourself or some kind of risky
thing, then I would need to-
- well, we'd need to talk to your mom together about that. Not
that I suspect that's
going to be the case, but I wanted to let you know before you
said anything that was the
way things worked.
And so you're welcome to start wherever you'd like.
me. And if it wasn't for one of the kids at school who told me
about taking the gym
teacher's car for a drive, I wouldn't even be here. We wouldn't
even be here.
COUNSELOR: OK. Well, thank you for telling me that again.
And I guess I'm wondering
what would you rather talk about first? Would you want to talk
about your parents and

why they should be in counseling, or would you like to talk
about the gym teacher's car
thing?
DAVID: I thought you knew all about what happened with the
gym teacher's car thing.
COUNSELOR: Well, I know a little bit about it, and I do know
some of what other people
say, but I've never really heard your side. I'd love to hear it
straight from you, your own
perspective of what happened.
DAVID: All right. Well, my gym teacher's a jerk. But he has a
sweet car, and he left his
keys in it and I saw that, so I waited until he went inside, and I
hopped in, and I went for
a short ride. It was nothing much.
COUNSELOR: What kind of car does he have?
DAVID: A Porsche; very cool. But I never trashed it; just a
short, 10 minute ride.
COUNSELOR: So really, a very cool car; and when you think
about this, you think, “Well, I
never trashed it, so what was the harm?”
DAVID: And that's what I'm thinking. And I don't get what the
big fuss about this is for.
COUNSELOR: Yeah, I guess a lot of other people are getting
fussed up about it, but from
your perspective it's like, "Nothing bad, nothing happened,
really," right?

DAVID: Well, I guess I could have gotten in a wreck, but I'm a
good driver.
COUNSELOR: When you stopped to think about it just now,
you said, it's possible you
could have gotten in a wreck, but you're an excellent driver, so
the likelihood is no. But
there was that possibility.
DAVID: [NODDING HEAD AFFIRMATIVELY]
[INSTRUCTIONS BOX APPEARS]
You will now watch this session again. At key moments, you
will be asked to reflect on
what you observed and to answer specific questions.
It is important to view and respond to the questions in their
entirety, as your recorded
responses will only be saved to this computer. If you change
computers your recorded
responses will not be saved.
Record your responses in the boxes provided.
Click the ‘Continue’ button to start the session
[THE SESSION STARTS AGAIN]
COUNSELOR: So David, I know that we were just in the other
room meeting with your

mom, and that we decided that it would be nice for just you and
I to speak separately.
And I just want to let you know before you say anything, that
what you say here with me
is private, personal information. What you say here stays here.
As you know, I think,
from the paperwork, there are exceptions to that; it's kind of the
standard thing that if
you were to be a danger to someone or yourself or some kind of
risky thing, then I
would need to-- well, we'd need to talk to your mom together
about that. Not that I
suspect that's going to be the case, but I wanted to let you know
before you said
anything that that was the way things worked.
And so you're welcome to start wherever you'd like.
me. And if it wasn't for one of the kids at school who told me
about taking the gym
teacher's car for a drive, I wouldn't even be here. We wouldn't
even be here.
COUNSELOR: OK.

How effective was this part of the conversation? Why was it
done?
What would you recommend should have been done?
[THE SESSION RESUMES]
COUNSELOR: Well, thank you for telling me that again. And I
guess I'm wondering, what
would you rather talk about first? Would you want to talk about
your parents and why
they should be in counseling, or would you like to talk about the
gym teacher's car
thing?
DAVID: I thought you knew all about what happened with the
gym teacher's car thing.
COUNSELOR: I know a little bit about it, and I do know some
of what other people say,
but I've never really heard your side. I'd love to hear it straight
from you, your own
perspective of what happened.
[ONE QUESTION APPEARS ONSCREEN]
Reflect on what you just observed. Record your response in the
box provided then
What technique did the counselor use here and why did he use
it?

DAVID: All right. Well, my gym teacher's a jerk. But he has a
sweet car, and he left his
keys in it and saw that, so I waited until he went inside, and I
hopped in, and I went for a
short ride. It was nothing much.
COUNSELOR: What kind of car does he have?
DAVID: A Porsche; very cool. But I never trashed it; just a
short, 10 minute ride.
COUNSELOR: So really, a very cool car, and when you think
about this, you think, “Well, I
never trashed it, so what was the harm?”
DAVID: And that's what I'm thinking. And I don't get what the
big fuss about this is for.
COUNSELOR: Yeah, I guess a lot of other people are being
fussed up about it, but from
your perspective, it's like, "Nothing bad, nothing happened,
really," right?
How effective was this part of the conversation? Why was it

done?
Would you recommend different questions? What questions
would you have
asked the client?
DAVID: Well, I guess I could have gotten in a wreck, but I'm a
good driver.
COUNSELOR: When you stopped to think about it, just now,
you said, it's possible you
could have gotten in a wreck. But you're an excellent driver, so
the likelihood is no. But
there was that possibility.
DAVID: [NODDING AFFIRMATIVELY].
COUNSELOR: OK.
Describe one skill, technique, or attribute the counselor
exhibited which fostered the
therapeutic relationship with the client in the counseling
session and explain why.
Describe one skill you might teach and reinforce with the
client in the counseling
session and explain why.
Press the ‘Review’ button to review your comments.

Review
Review and edit your comments within each of the text boxes.
When ready, you can copy and paste your comments to your
computer by pressing the
‘Copy’ button, or by downloading them to your desktop as a
text file by pressing the
‘Download’ button.
Pressing the ‘Save’ button will record your comments to this
computer so that you may
return later to edit your responses.

Program Transcript
[MUSIC PLAYING]
NARRATOR: Disruptive behaviors vary from child to
adolescent. Their causes
are just as varied. Doctors John Sommers-Flanagan and Eliana
Gil discuss
disruptive behaviors and therapeutic approaches that can be
utilized.
ELIANA GIL: I think of disruptive behaviors as the child's
action language. And
I'm always happy when they can do that, because it is a way that
they're showing
the world that I need something, and I need something to
happen soon. And they
kind of escalate if they're not given the attention or the help
that they need.
The most disruptive behaviors that we get are kids who are
basically disregulated
in school. So they get up and down from their chairs. They don't

listen. They
won't follow the directions of the teachers. They go into recess,
and they're
completely aggressive with other children. They're pushing
children down.
So they are kids that become real control issues for those that
are trying to
maintain the control in the classroom; so the aggressive
behaviors, definitely, the
kicking, and punching, and biting, and those kinds of things.
And then again, the
kids who just don't pay attention, and cannot be re-directed,
those kids get a lot
of attention as well. So those are the referrals we most typically
get.
JOHN SOMMERS-FLANAGAN: So what you're saying is that
the behavior is
communicating something important. Do you have some
examples that you can
think of that might be related to a child you worked with or an
adolescent you
worked with who was behaving in a disruptive way, and that it
was
communicating something in particular?
ELIANA GIL: I think that one of the things that I find most
frequently is that the
kids need more limits, that they need more structure, and that
they aren't being
given that-- usually in their home or their family environment.
And then they go
into a school setting, where these are now people that are
unknown to them,
unfamiliar to them, who begin to try to set that structure and

that foundation. But
because it hasn't been provided earlier, then the kids really don't
know how to
follow directives, don't know how to use their internal controls.
I think for all of us as parents, when we're working with our
littlest kids-- our
children, grandchildren, whatever it may be-- we're really trying
to teach them
how to regulate themselves and their emotions. So the earliest
thing we see in
little kids is temper tantrums.
And those are really the kids' way of saying, you know, I have
feelings. And
they're big feelings. And I don't know what to do with them
anymore.
©2013 Laureate Education, Inc. 1

So I think that what they're looking for is their parents to really
coregulate them,
and to say to them, you're really tired right now. You haven't
eaten. You're going
to feel better later. You probably need to go to sleep. You need
to take a little nap
right now.
And so the parent kind of coregulates, and explains, and helps
the kids, and
holds them close to them. And eventually the kids calm down.
This foundation is really important, not only because it shows
the child that they
can trust someone, but also it teaches internal controls, so that
eventually as the
kids grow older, they know, “When I feel this big feeling, now I
understand that
sometimes I can make it smaller, that sometimes going to my
mom will make it
smaller.”
If that isn't set early on, the kids just kind of are all over the
place. And that's what
happens in the schools. They get in there, and they cannot be
contained.

There's just a disregulation that is not working for them. And
there's no way for
them to reach out to others or to go inside. And so I think what
it's communicating
is, I need someone to help me regulate myself. I need someone
to show me what
to do with these big emotions. And that's pretty classic.
We had a case recently where there's a little six-year-old child.
And the parents
are leaning towards a very permissive approach to the child,
partly because
they're new at parenting. It's an adopted child.
And the child is saying pretty clearly, I'm going to go urinate on
the floor
whenever you tell me I can't do something. And the child says
it, and says, “No I
don't want to do that. I'm going to go pee.” And the parents say
nothing. And the
child does it. And then they clean it up.
So what's going on there? It's a very disruptive behavior. But
the child is needing
something from them. And I think what he needs is more
structure, someone who
says, “No, that's not OK for you to do that,” someone who, if
the child does it,
says, “Now you need to clean that up.” So you're beginning to
teach the internal
controls.
So I think there's a disconnect there, that sometimes these
communications that
are done through action are not addressed properly. And a little

aggressive child,
sometimes they go and they bang into someone. And it may be
that they want to
be friends with them. And it may be that they want to somehow
get the attention
from them, and they don't have any ways to do it.

So I'm always thinking that these are children who need
something, and that my
job is to figure out exactly what that is, and to engage the
people who can
provide that for them. And that may be the parents.
And it might also be talking to the teachers and saying, “You
know your response
to this particular disruptive behavior actually escalates it
sometimes.” So if they
get into an altercation with the child, where the child yells and
they yell back. And
the child yells back more, and so forth and so on.
That isn't going to help. But I also understand that for teachers,
to have a child
who is present daily with these kinds of provocative behaviors
can also really
wear you down.
JOHN SOMMERS-FLANAGAN: So it really may be a call for
coregulation or
limits that the child needs, which reminds me of Diana
Baumrind's old model of
the permissive parents and the authoritarian parent on both
extremes, and your
example of the permissive parents, who maybe doesn't set those
limits, and then
maybe the authoritarian teacher, who just gets in a yelling
match, you know, it's
my way or the highway.
And I think it's so hard for parents and teachers to operate from
the middle. I've
done a fair amount of parent education. And one of the lessons
that I try to get

through is, it's OK to set a limit and show empathy at the same
time, to say, “I
know you really want that second piece of cotton candy, but you
can't.” It's hard
though. I know it's hard.
And then the child, of course, will roll around in the sawdust at
the fair grounds,
and throw a tantrum. And yet there still needs to be that firm
limit with empathy at
same time.
ELIANA GIL: Exactly. And I think that, again, systemically
what ends up
happening, is that often the parents are doing the best they can.
But they may
not have the tools. And they may have a history behind them
that hasn't really
allowed them to develop those tools. So we really can't work
with these issues in
isolation from the families and those primary caretakers who
need to do whatever
they can, I think, to assist the children.
There's a wonderful model called circle of security, which is an
attachment-based
model. And I've found that some of the basic principles that
they communicate
are very helpful to parents.
But one is, when do you step in, and when do you take control,
and when do you
follow the child's lead? And those are two different things. And
getting parents to
really begin to recognize, and also recognize what is
developmentally

appropriate in children, so they don't begin to take a disruptive
behavior as some
kind of sign that the child doesn't like them or-- Parents'
perceptions of that can

be pretty critical, in terms of what they're then able to provide
to the child.
JOHN SOMMERS-FLANAGAN: I have heard of the circle of
security model. And
I think it does provide parents with this nice practical
foundation for how to
intervene and when not to intervene. I also know, as we speak
diagnostically for
just a couple of minutes, that the disruptive behavior disorders
that we're talking
about probably include ADHD and its variants, as well as
oppositional defiant
disorder, and conduct disorder.
And one of the things that my impression about the research is,
that there's a
little bit of a developmental trajectory if a child with maybe
some challenging
temperamental qualities, parents have trouble setting limits, and
maybe there's a
little bit of a difficult family process that reinforces
misbehavior. And then you see
this evolution of behavior moving out of the attention deficit
sort of behaviors, into
oppositional behaviors, and then maybe into more serious
misconduct, where
there's a systematic violation of interpersonal rules, and legal
boundaries, and
those kinds of things.
And I’m wondering, in your practice I know you do a fair
amount of play therapy,
I'm wondering if you've seen that more extensive misbehavior
that you might
associate with conduct disorder, and how that gets manifest in

your experience?
ELIANA GIL: Yes, we definitely get a lot of kids along that
continuum that you
just described with conduct disorders, ADHD-- at least the
question of ADHD,
because I think that that sometimes gets a little bit over-
diagnosed-- impulse
control problems. And these kids are very difficult to contain in
a therapy setting.
The play therapy that we do is a combination of the non-
directive play therapies.
But I think in this particular instance, with any of the
behavioral problems, we
need to bring in more of the cognitive behavioral play therapy.
We need to bring
in much more attention, with the kids, to assessing their own
affective state.
So for example, we have a little piece of paper that we give kids
when they come
in. And we say to them, point to the feeling you feel right now.
And so we give
them choices. But they also get to draw one in.
And then once they point to it, we go to a second page that has
the smaller little
face, and then growing all the way to a big one. So it's kind of
like a Likert Scale.
But it's very visible. And then we say, “What size is that feeling
for you right
now?”
So we're really teaching kids to look at the difference, in terms
of being able to

scale how big that feeling can get, and what it feels like when
it's this big. And
how do we make it just a little less big? How do you bring it
down?

So that already begins to really work on the cognitive
behavioral piece, where
you're looking at the relationship between what they think, what
they feel, and
what they do. So we spend a little bit more time doing that and
being more
directive when kids have behavioral problems, particularly that
are getting them
identified for negative attention from others, that that's
affecting their own self
esteem, where they're beginning to say very negative things to
themselves like, “I
can't do anything right, and nobody likes me,” and those kinds
of things.
I think the integrated approach there becomes much more
beneficial. The non-
directive play therapy alone, I think has its limitations
sometimes, with these very
disregulated disruptive behaviors.
So I always use a little bit of that, just to kind of assess the
child's ability to
regulate self. But they can come in, and pretty much destroy
your office, or try to
throw things out the window, or break things just to break them.
They have to have limits. And after that, thinking a little bit
more about, “So what
was going on right before you took that and broke it,” and
having those kind of
discussions about the behavior when the kids calm down.
I mean I've gotten to the point with some disruptive behaviors
where I have to
stop the session. And the child just isn't able to really respond

to a container.
I've started trying not to use the word resistant. I'm trying to say
to myself, they're
ambivalent or they're hesitant. And somehow that makes a little
bit of a difference
to me, because there's less of an emotional charge to just saying
the child is
resistant to you.
But I notice that they're very ambivalent about being in a
contained place or
having the structure in anything that they do. And of course that
manifests itself
in the therapy situation.
With the older kids, it's interesting. Sometimes they just come
in, and they say,
“I'm not talking to you. I don't want to be here. Forget about it.”
And that's an
interesting thing for me, because as a non-directive play
therapist, or as
someone who's trained in that, I can say to them, “That's OK.
You don't have to
talk.“
And then I say something like, “But go find something”-- and I
give them a whole
bunch of miniatures—“that shows kind of what's on your mind
today. And you
don't have to talk to me about it. Just find something.”
And sometimes the kids will do that. And then I say to them,
“OK, now find
something that might be something that might help with that
right now.” And

suddenly they have a miniature and a whole bunch of other little
miniatures.
And I don't push them to say anything. And sometimes even
slightly paradoxical
interventions where, I don't really want to hear about it. It's just
what you're

getting from that. And that's what's important.
But sometimes that takes away this power and control
differential that sometimes
kids feel, especially the older kids, because I think they're
getting a lot of that
from their environments, whether it's at school or at home. And
so I try to create
a different kind of a space for them. And sometimes that can
work as well.
JOHN SOMMERS-FLANAGAN: Yeah, I'm hearing kind of a
combination of some
non-directive play therapy, maybe that's a little more
expressive, as well as some
focus in cognitive behavioral realm of skill building. How do
we really build up
these skills?
ELIANA GIL: Exactly. And the combination is, I think, what's
really the best,
because sometimes engaging kids can be best done through
some of the
expressive therapies. So I've started, for example, doing drama
therapy
techniques. Art therapy is wonderful, sometimes music therapy.
All of these are designed to kind of move something in a
different direction, take
away the expectations that kids have of therapy-- that they're
going to come in
and get a Q&A from the therapist or the counselor-- and their
hesitancy about
that.
And so inviting them to do other things, and taking away that

expectation that this
is going to be really horrible for me, that's the engagement
process. Now once
they're engaged, then we go back to, OK, let's figure out what's
going on.
How are you going to monitor that particular reaction that you
have, and how you
make it smaller, what the alternatives are to that behavior. So
what can you do
instead of that? And so then we really begin to do some of the
work.
And again systemically, I always come back to that, because the
kids are always
in an environment that's really necessary to become involved
with.
JOHN SOMMERS-FLANAGAN: Sure, and so if they're not
engaged, obviously,
you can't even do any productive work. And now you just
mentioned the systems
issue. And I want to just get to that before we stop this segment.
And that is, how
do you decide whether to intervene individually with a child or
adolescent versus
family counseling?
ELIANA GIL: To me, it's never an either or. It's always I will
do both. And I know
that from the outset. The only distinction for me is when to do
what.
JOHN SOMMERS-FLANAGAN: Which one.

ELIANA GIL: Exactly. And so it's looking at I meet with the
family at the
beginning, and I advise them of that. I usually call myself a
family play therapist,
because it's the combination of those two major theories. And I
say, “So there's
going to be times I'll invite all of you in. Sometimes I'll invite

some of you in
together, dyads together. Sometimes I'll invite you to do some
play activities or
some expressive activities. And other times we'll be doing
conversations.”
And then it's a question of what suits that child best, and also
what needs that
child has immediately from their system. It may be that this
child needs to know
directly from the parent, immediately, “I don't want you to die.
I love you. I don't
want to have you gone from my life. I need you to be safe.”
And that sounds really like an intuitive, automatic kind of thing.
But sometimes
the parents have obstacles to actually expressing that directly.
Or they'll say
things like, “Oh you know he doesn't mean that stuff,” or “He
knows we love him.”
And that's not enough.
And so getting them immediately to do that in that situation
would be, I need you
guys, the parents, in here. And I need you in here today. And
this is what I need
you to say. And make that to the extent that they can talk with
me, about making
that as genuine as they can. That's the important thing to do.
And there may be another case where I really need to build
rapport with the child.
And that might take precedence until I feel like we're OK and
we are engaged,
and then bring the family system in. So it's a little bit of an
assessment, in terms

of when you do it. And from my point of view, it depends on the
family. And I
need to take my cues from them, but not hesitate to do either.
And so I meet, over my training experiences, lots of people who
are purists, so
the play therapists who never work with the parents, and the
family therapists
who don't include children. And both of those just amaze me,
because they need
to be, obviously, combined.
And some people have very rigid-- maybe that's too strong a
word-- but very
structured approaches, where they say, “We always do this. And
then we always
follow it with this.”
And I just really like to meet the family that I'm working with,
and the person of
the child, and really think relationships are important. So my
best way sometimes
to help the whole family is to have a positive relationship with
the child, and build
on that. If I can do it with the parents and the entire family
there, that's great. But
if I can't, then I do it differently.
[MUSIC PLAYING]

Additional Content Attribution
MUSIC:
Creative Support Services
Los Angeles, CA
Dimension Sound Effects Library
Newnan, GA
Narrator Tracks Music Library
Stevens Point, WI
Signature Music, Inc
Chesterton, IN
Studio Cutz Music Library
Carrollton, TX

1
In the DSM-IV, attention deficit and disruptive behaviors were
grouped as a category within the
classifications of disorders usually first diagnosed in infancy,
childhood, and adolescence.
Though it is true that these disorders are generally first
diagnosed during these stages, the
classifications of these disorders has been reconceptualized to
reflect their similarities in
manifestation, as well as considerations for the impact on social
functioning. ADHD, for
example, is grouped in the DSM-5 with neurodevelopmental
disorders; research has supported a
strong biological basis for this disorder as well as for others
found in this classification (see
“Exceptionalities” in Week 11 of this course). However,
because the expression of ADHD often
includes behaviors that can be disruptive to the child’s social
environment, it will be included
with the topics for this week.
Other disorders addressed this week are those now included in a
new chapter of the DSM-5:
disruptive, impulse-control, and conduct disorders. This new
grouping of diagnoses reflects a
recognition of the similarities of these diagnoses—all of these
are associated with an intrusion
upon the rights, property, or physical safety of others. In
addition, individuals with these
disorders generally act against societal expectations and norms
and show a significant inability to

control behavioral or emotional impulses.
Disruptive, Impulse-Control, and Conduct Disorders
This new DSM-5 chapter includes oppositional defiant disorder,
intermittent explosive disorder,
conduct disorder, antisocial personality disorder (also listed in
the personality disorders chapter),
pyromania, kleptomania, other specified disruptive, impulse-
control, and conduct disorders, and
unspecified disruptive, impulse-control, and conduct disorders.
Two of these diagnoses are new to the DSM-5: other specified
disruptive, impulse-control, and
conduct disorders, and unspecified disruptive, impulse-control,
and conduct disorders. These
take the place of disruptive behavior disorder NOS in the DSM-
IV, which has been removed.
Both of these diagnoses represent significant clinical distress or
impairment based on criteria for
disruptive, impulse-control, and conduct disorders, but do not
meet full criteria for a specific
diagnosis in this class. Clinicians should use other specified
disruptive, impulse-control, and
conduct disorders and add the specific reason for the more
general diagnosis (e.g., falling short
of duration or frequency criteria). The latter diagnosis—
unspecified disruptive, impulse-control,
and conduct disorders—is used when clinicians cannot (or
choose not to) identify reasons for the
inability to make a more specific diagnosis, yet clearly observe
multiple criteria from the
disruptive, impulse-control, and conduct disorder classification.
The following is a summary of key changes to diagnostic

criteria for this group of disorders.
Oppositional Defiant Disorder
Criterion A has been revised in several ways. First, the
symptoms have been grouped into
categories relating to mood, behavior, and malicious intent.
Second, the duration, persistence,
and frequency requirements have been more clearly described,
with considerations made for
2
differences related to age, developmental level, gender, and
culture. Lastly, a severity rating
associated with pervasiveness has been included in the
specifiers for this disorder.
Intermittent Explosive Disorder
The criteria for this diagnosis have been considerably revised in
the DSM-5. Criterion A has
been expanded with more specific detail added, including the
inclusion of verbal aggression and
non-destructive aggressive behavior. Language has also been
added regarding intensity and
frequency of the outbursts that are key components of this
diagnosis. In addition, the minimum
age for this diagnosis is now 6 years old; this change helps to
distinguish the diagnostic criteria
from normal temper and behavioral variations in very young
children.
Conduct Disorder

The DSM-5 criteria for a conduct disorder diagnosis is similar
to that found in the DSM-IV.
However, an important addition has been made: The DSM-5
includes a specifier for observed
limitations in socially appropriate emotional response. This may
be exemplified by deficits in
empathy, remorse, or guilt. This may also be reflected in a
general lack of concern over impact
of behaviors and decreased expressive affect.
Neurodevelopmental Disorders
This group of disorders is covered more thoroughly in Week 11
of this course. However, one of
the disorders from this group frequently has a disruptive
component to it and is, therefore,
included in this week.
Attention-Deficit/Hyperactivity Disorder (ADHD)
Though the basic diagnostic criteria for ADHD is very similar
in the DSM-5, there are a number
of key differences from the DSM-IV, including stage-related
examples to aid in diagnosis in
childhood, adolescence, and adulthood. One of the key changes
has been to raise the
identification of symptomology from before age 7 to before age
12 and to use a single diagnosis
with specifiers rather than several related diagnoses in a group.
Specifiers replace prior subtypes,
identifying the predominant presenting symptomology.
Specifiers are also now used to reflect
severity of impairment of functioning.
Reference:

• American Psychiatric Association. (2013). Highlights of
changes from DSM-IV-TR to
DSM-5. Retrieved from:
http://www.dsm5.org/Documents/changes%20from%20dsm-iv-
tr%20to%20dsm-5.pdf
© 2013 Laureate Education, Inc.
· Doesn't take responsibility
· Tell me what your peers told you about the teacher's car.
· Stop blaming others for your action
· Make him shut down or get angry.
Exemplary
Proficient
Progressing
Emerging
Element (1): Responsiveness: Did the student respond to the
main question of the week?
9 points (28%)
Posts exceed requirements of the Discussion instructions (e.g.,
respond to the question being asked; go beyond what is required
[i.e., incorporates additional readings outside of the assigned
Learning Resources, and/or shares relevant professional
experiences]; are substantive, reflective, and refers to Learning
Resources demonstrating that the student has considered the
information in Learning Resources and colleague postings).

9 points
Posts are responsive to and meet the requirements of the
Discussion instructions. Posts respond to the question being
asked in a substantive, reflective way and refer to Learning
Resources demonstrating that the student has read, viewed, and
considered the Learning Resources and colleague postings.
7–8 points
Posts are somewhat responsive to the requirements of the
Discussion instructions. Posts are not substantive and rely more
on anecdotal evidence (i.e., largely comprised of student
opinion); and/or does not adequately demonstrate that the
student has read, viewed, and considered Learning Resources
and colleague postings.
4–6 points
Posts are unresponsive to the requirements of the Discussion
instructions; miss the point of the question by providing
responses that are not substantive and/or solely anecdotal (i.e.,
comprised of only student opinion); and do not demonstrate that
the student has read, viewed, and considered Learning
Resources and colleague postings.
0–3 points
Element (2): Critical Thinking, Analysis, and Synthesis: Is the
student able to make meaning of the information?
9 points (28%)
Posts demonstrate the student’s ability to apply, reflect, AND
synthesize concepts and issues presented in the weekly Learning
Objectives. Student has integrated and mastered the general
principles, ideas, and skills presented. Reflections include clear
and direct correlation to authentic examples or are drawn from
professional experience; insights demonstrate significant
changes in awareness, self-understanding, and knowledge.

9 points
Posts demonstrate the student’s ability to apply, reflect OR
Objectives. The student has integrated many of the general
principles, ideas, and skills presented. Reflections include clear
and direct correlation to authentic examples or are drawn from
professional experience, share insights that demonstrate a
change in awareness, self- understanding, and knowledge.
7–8 points
Posts demonstrate minimal ability to apply, reflect, or
Objectives. The student has not fully integrated the general
principles, ideas, and skills presented. There are little to no
salient reflections, examples, or insights/experiences provided.
4–6 points
Posts demonstrate a lack of ability to apply, reflect, or
Objectives. The student has not integrated the general
principles, ideas, and skills presented. There are no reflections,
examples, or insights/experiences provided.
0–3 points
Element (3): Professionalism of Writing: Does the student meet
graduate level writing expectations?
5 points (16%)
Posts meet graduate-level writing expectations (e.g., are clear,
concise, and use appropriate language; make few errors in
spelling, grammar, and syntax; provide information about
sources when paraphrasing or referring to it; use a
preponderance of original language and directly quote only
when necessary or appropriate). Postings are courteous and

respectful when offering suggestions, constructive feedback, or
opposing viewpoints.
5 points
Posts meet most graduate-level writing expectations (e.g., are
clear; make only a few errors in spelling, grammar, and syntax;
provide adequate information about a source when paraphrasing
or referring to it; use original language wherever possible and
directly quote only when necessary and/or appropriate).
Postings are courteous and respectful when offering
suggestions, constructive feedback, or opposing viewpoints.
4 points
Posts partially meet graduate-level writing expectation (e.g.,
use language that is unclear/inappropriate; make more than
occasional errors in spelling, grammar, and syntax; provide
inadequate information about a source when paraphrasing or
referring to it; under-use original language and over-use direct
quotes). Postings are at times less than courteous and respectful
when offering suggestions, feedback, or opposing viewpoints.
2–3 points
Posts do not meet graduate-level writing expectations (e.g., use
unclear/inappropriate language; make many errors in spelling,
grammar, and syntax; do not provide information about a source
when paraphrasing or referring to it; directly quote from
original source materials or consistently paraphrase rather than
use original language; or are discourteous and disrespectful
when offering suggestions, feedback, or opposing viewpoints).
0–1 points
Element (4):
Responses to Peers: Did the student respond to peer posts and
contribute professionally?
9 points (28%)
Responds to two or more peers in a manner that significantly
contributes to the Discussion.
9 points

Responds to one or more peers in a manner that significantly
7–8 points
Responds to one or more peers in a manner that minimally
4–6 points
Does not respond to any peer posts.
0–3 points
32 points
100%
25–28 points
78–88%
14–21 points
44–66%
0–10 points
0–31%
© 2015 Laureate Education, Inc.
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