Work with Children Who HaveConduct

IssuesJane F. Gilgun, Ph.D., LICSW

School of Social WorkUniversity of Minnesota, Twin Cities, USA

jgilgun@umn.eduNovember 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.

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

 

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

 

Conduct DisorderRepetitive, persistent behaviors

Rights of others & rules of behavior are violated

Three or more of following criteria in past 12 months

Conduct DisorderAggression to people or animals

Destruction of property

Deceitfulness or theft

Serious violations of rules

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.”

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?

Mario, 12In a four-month period at school

nine behavior referrals three suspensions Typical behaviors

hitting a child in the nosepushing a chair into a childtelling another child to “suck my dick.”

What’s Missing?Context & Developmental Histories

Diagnostic Questions

Developmental HistoryExperienced complex trauma

Witnessed domestic violenceMultiple police calls; father taken out of home in

handcuffsMother sleeps with baseball bat next to her bedMother has chronic health problemsMother depressed much of the timeFather has convictions for physical assault and

attempted murderSiblings mock and tease him

Diagnostic QuestionsHave 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

General Plan of ActionIf there is trauma, arrange for trauma-specific

therapy

Remember to teach methods of self-regulation before trauma-specific treatment begins

Questions and IssuesMario is suffering

Mario’s behaviors hurt others

How can social workers help parents and teachersHelp Mario work through his issues?Help Mario to deal with his issues without hurting

himself or others?

Plan of Action for Social Services & Teachers

Do whatever it takes to form a healthy relationship with himSpend time with himDo things he likesPraise him for prosocial behaviorsGive him opportunities to develop his skills

Plan of Action for Social Services

Do whatever it takes to form a healthy relationship with his parents and siblingsHelp with basic human needsListen to what parents and siblings wantWork with them to provide recreational and social

opportunities that they wantMemberships in boys and girls clubPay for sports equipmentArt/music lessons lessonsalso services that they may want eventually

Examples: Parenting classes that might be a way of socializing with other parents

Normative DevelopmentPhysical aggression and oppositionality are

normative—related to learning limits and developing “cooperative” autonomy Peak years are ages two to fourMore than half of three year-olds have difficulties

with peers25% of boys four to five years old are aggressive or

highly aggressive with peers

Assess whether these behaviors disrupt development

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

 

DSM Diagnoses May be Appropriate

If behaviors Interfere with developmentOccur past the time in which they are expectableOccur repetitively in many different settingsNot self-assertive but angry, dysregulated non-

compliance

There is a possibility that children believe these behaviors are appropriate

Parents believe these behaviors are appropriate

 

Possible Diagnosis other than ODD from Diagnostic Classification: 0-3

Disruptive Behavior Disorder

Regulation Disorder of Sensory ProcessingHypersensitive Type

Sensory stimulation aversive Respond with

Fear and cautionNegativity and noncompliance

RememberThese behaviors can be responses to trauma

These behaviors can also be based on belief systems of what are appropriate behaviors in various kinds of situationsChildren may believe that physical aggression is

honorableEspecially if parents and others important to them

believe this, too

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

Goal: Authoritative Parenting

LoveFoster secure relationships

Limit-SettingClear rulesBrief recognition for following rulesBrief recognition for not following rules

Point out transgressionState what is appropriateHave child practice appropriate behaviorsPraise child briefly for doing so

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 parentsSupportPsychoeducation

ParentsShow good EF and SR themselvesUse attachment figures wellExpect child cooperation and independenceSet clear limitsClear expectationsProvide clear explanations given with warmth and

good timingBriefly praise wanted behaviors as soon as they

occur

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

Parent Training Through Videotape Modeling

 

InterventionsLimit settingHandling of misbehaviorAppropriate play—don’t dominate, give plenty of

room for child to develop autonomy

 

Group settingParents discuss these approachesMay practice them togetherHomework—do them at home and report back

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

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

Social Skills Training

Modalities

Videos of role models

Live modeling

Role-playingHomework

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