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Work with Children
Who HaveConduct
Issues
Jane F. Gilgun, Ph.D., LICSW
School of Social Work
University of Minnesota, Twin Cities, USA
jgilgun@umn.edu
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.
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 Disorder
 Repetitive, persistent behaviors
 Rights of others & rules of behavior are violated
 Three or more of following criteria in past 12 months
Conduct Disorder
 Aggression 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, 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.”
What’s Missing?
 Context & Developmental Histories
 Diagnostic Questions
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
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
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
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?
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
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
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
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 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
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
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
 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
 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
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
 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
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
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
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-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

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Work with Children with Conduct Issues

  • 1. Work with Children Who HaveConduct Issues Jane F. Gilgun, Ph.D., LICSW School of Social Work University of Minnesota, Twin Cities, USA jgilgun@umn.edu 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. 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. 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. Conduct Disorder  Repetitive, persistent behaviors  Rights of others & rules of behavior are violated  Three or more of following criteria in past 12 months
  • 5. Conduct Disorder  Aggression to people or animals  Destruction of property  Deceitfulness or theft  Serious violations of rules
  • 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. 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. 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. What’s Missing?  Context & Developmental Histories  Diagnostic Questions
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.  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. 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. 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.  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. 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. 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. 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. 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. 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