Behaviour and Mental Health Problems The Centre of Knowledge on Healthy Child Development is dedicated to finding, evaluating and summarizing only the very best research on subjects pertinent to healthy child development and child and youth mental health. http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56 Sun, 23 Nov 2014 01:48:08 +0000 Joomla! 1.5 - Open Source Content Management en-gb Attention Deficit/Hyperactivity Disorder, Conduct Disorder, and Young Adult Intimate Partner Violence http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/323-attention-deficithyperactivity-disorder-conduct-disorder-and-young-adult-intimate-partner-violence http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/323-attention-deficithyperactivity-disorder-conduct-disorder-and-young-adult-intimate-partner-violence In Short…

Children and youth with AD/HD, Conduct Disorder, or both, may be at high risk of engaging in intimate partner violence as young adults.   Interventions for these conditions should address the promotion of healthy relationships.

The Issue: People who engage in violence against their partners – both men and women – often have a history of a troubled early home life.  Many have been abused as children or have witnessed violence between their parents or a parent and his/her partner.  They often have behaviour problems such as Conduct Disorder and Attention Deficit/Hyperactivity Disorder or other mental health problems that may persist into adulthood.   What is not well understood is how these conditions act, either alone or in concert, to increase the risk of intimate partner violence (IPV), and which characteristics of the adolescents are the most important to target for treatment.

The Research: This study was part of the National Longitudinal Study of Adolescent Health, the participants in which were a representative sample of 11,238 United States youth aged between 20 and 23 years. The authors sought to understand whether childhood ADHD symptoms predict IPV in young adulthood when the symptoms of conduct disorder are also considered.  The participants were asked often they had pushed, shoved or thrown something at their partner or how often they had slapped, hit or kicked their partner in the year previous to the survey.   To elicit instances of injurious IVP those who had answered yes to either of these two questions were later asked if their partner had experienced a sprain, bruise or cut because of a fight with them.  Participants were also surveyed using checklists about their recall of AD/HD symptoms between ages 5 and 12 and symptoms of conduct disorder in childhood or adolescence.

The Results: The analysis showed that early conduct disorder was consistently associated with later IPV.  Symptoms of hyperactivity/ impulsivity, but not inattention, predicted young adult IPV resulting in injury, but not IPV without injury.

This research suggests that interventions with children and youth with AD/HD and/or conduct disorder should address the potential for intimate partner violence and promote knowledge about healthy relationships.

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The preceding is a summary of: Fang X, Massetti GM, Ouyang L, Grosse SD, Mercy JA.  Attention-Deficit/Hyperactivity Disorder, Conduct Disorder and young adult intimate partner violence.  Archives of General Psychiatry. 2010; 67(11): 1179-1186.

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jonathan@mixxmedia.com (Administrator) ODD and CD Fri, 21 Jan 2011 20:54:25 +0000
Adolescents’ Conduct Problems 40 Years Later http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/315-adolescents-conduct-problems-40-years-later http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/315-adolescents-conduct-problems-40-years-later In Short…

Teenagers with conduct problems, no matter their severity, frequently go on to experience serious personal and social adversity.  Society as a whole would benefit from prevention and treatment of behaviour problems.

The Issue: Previous research has shown that children and teenagers who have behaviour problems go on to have higher rates of unemployment, divorce, legal problems, and depression and anxiety compared to those without these behaviours. The most severe form, conduct disorder, is found in about 7% of children between 9 and 15 years of age.   Most research has focused on children and youth with conduct disorder and there has been little or no research done on those with “mild” symptoms. 

The Research:  At ages 13 and 15 adolescents were assessed by their teachers for conduct problems (externalizing behaviour problems).   Surveys later carried out with these 3652 participants of the British 1946 Birth Cohort study at ages 36, 43, and 53 asked about their life experiences in adulthood. The outcomes the researchers looked at were mental health, family life, employment and educational achievement and a measure of global adversity that applied one point for each problem, such as depression, anxiety or other “nervous trouble”, substance abuse, divorce, family or relationship problems, teen parenting, early school leaving, unemployment, and financial problems.  

The Results:  Of the original group of 13 and 15 year olds, 61.7% were assessed by their teachers as having no externalizing behaviour problems, while 9.5% had severe externalizing behaviour, and 28.8% had mild externalizing behaviour, with more males than females being identified.  By age 53, compared to the group with no externalizing behaviour problems, those with either mild or severe behaviour problems were more likely to have adverse personal, family, legal, and other social problems.  Thus, as they aged, people first identified with externalizing behaviour problems at ages 13 and 15, no matter the severity, experienced more adversity, psychiatric problems, family discord and other social problems, all of which have wide personal and societal effects.

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The preceding is a summary of: Colman I, Murray J, Abbott RA, Maughan B, Kuh D, Croudace TJ, Jones PB. Outcomes of conduct problems in adolescence: 40 year follow up of national cohort. BMJ. 2009; 338:a2981.

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jonathan@mixxmedia.com (Administrator) ODD and CD Thu, 23 Dec 2010 20:38:13 +0000
A follow up study of children with mental health and behaviour problems: What predicts change over time? http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/314-a-follow-up-study-of-children-with-mental-health-and-behaviour-problems-what-predicts-change-over-time http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/314-a-follow-up-study-of-children-with-mental-health-and-behaviour-problems-what-predicts-change-over-time In Short…

Children who are exposed to multiple personal and environmental risk factors tend to have persistent  mental health and behavioural problems that put them at risk for poor outcomes as they get older.

The Issue: Research has given us solid information about what personal and environmental factors influence child mental health and behaviour problems.  Less is known about what predicts whether these conditions will either persist or change over time. 

The Research: This was a follow up to the 1999 British Child and Adolescent Mental Health survey in which over 10,000 children and their families participated. This time, a sample of 2573 parents, 1842 teachers, and 1681 children 11 years of age and over were given the Strengths and Difficulties questionnaire in order to get information about the children from multiple sources, including the children themselves. All of them were asked about conduct problems, hyperactivity, problems with classmates and neighbourhood children, caring about and feeling empathy towards others, and stressful life events.  The goal was to see what factors predicted if the behaviour and mental health of these children stayed the same, got better, or got worse at 3-year follow up.

The Results: There were multiple factors that predicted poor outcomes at the end of 3- year follow up:

  • Conduct disorder at the outset of the study
  • Young age
  • Physical health problems
  • Low reading and verbal skills scores
  • Being male
  • Having a distressed mother
  • Living in a step- or single-parent family
  • Low income
  • Exposure to stressful life events such as parental separation, family financial problems, parental mental health problems, and loss of friendship.

This study found that behavioural and mental health problems in children exposed to multiple adverse conditions tended to persist through the follow-up period. These chronic problems have serious consequences for the child, his/her family, and society as a whole. Some of the risk factors for them, like poor reading skills, could be alleviated with individual interventions provided in the schools.  Others, like low income can be helped through government policies.  Family problems can be addressed through the availability of social programs and agencies.  Whatever the level of intervention, children’s mental health and behavioural problems need to be addressed to ensure children’s healthy development.

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The preceding is a summary of: Ford T, Collishaw S, Meltzer H, Goodman R. A prospective study of childhood psychopathology: Independent predictors of change over three years.  Social Psychiatry and Psychiatry Epidemiology. 2007; 42: 953-961.

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jonathan@mixxmedia.com (Administrator) ODD and CD Thu, 23 Dec 2010 20:31:12 +0000
Delinquent Girls Grown Up: Young Adult Offending Patterns and Their Relation to Legal, Individual and Family Risk http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/313-delinquent-girls-grown-up-young-adult-offending-patterns-and-their-relation-to-legal-individual-and-family-risk http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/313-delinquent-girls-grown-up-young-adult-offending-patterns-and-their-relation-to-legal-individual-and-family-risk In Short…

Understanding the different paths that delinquent girls take as they mature could help prevent them from becoming chronic offenders. This would help reduce crime and the personal, family, and community costs that come with it.

The Issue: Teenaged girls may not commit as many crimes as boys, but the numbers who do are growing.  We need to understand what drives their behaviour if we want to reduce crime rates.  Up until recently, there were only two groups of teenaged offenders identified: those who were arrested, tried, jailed and then never appeared before the courts again (desisters), and those who committed more crimes and went through the system again (recidivists).  Such groupings do not describe the real situation very well and are not helpful in understanding, treating, and preventing adolescent criminal behaviour. 

The Research: This study tracked 499 girls from age 16 to 28, whose records formed part of a study of criminal recidivism ordered by the New York State Legislature in 1995. One of the goals of the study was to look at their criminal “careers” to see if there were separate groups with different risk factors and outcomes as they became adults. Knowing these things could help prevent crime by intervening in the situations that caused them, and help turn around the young women’s lives. The researchers wanted to determine if there were distinct paths followed by the girls that could predict who would be a desister and who would be a recidivist. Their arrest, court, jail and prison records were searched, as were state death records, the latter because girls and women involved in criminal activity are more likely than those in the general population to die young.

The Results: Of the 499 girls, 81% were recidivists, with the remaining 19% classified as desisters.  The recidivists each had an average of 6 adult arrests by age 28. The risks for adult criminal activity in this group were being Black, family criminality, and having experienced multiple forms of child maltreatment. Being Hispanic and being at an older age at first juvenile arrest reduced individual rates of recidivism.

Four pathways were found for these girls by the time they reached 28 years of age:

Rare/Non-offending: This group only rarely offended after age 16. Of the 32% making up this group, 82% were arrest free after they turned 21.

Low-chronic offenders: This was the largest group, making up over 53% of the recidivists.  They accounted for over 50% of all adult arrests experienced by this sample. They tended to commit crimes in adolescence, with their arrests peaking at age 18, by which time about 19% have been arrested. The rate then started to slowly decline to less than 10% by age 28.

Low-rising offenders: These young women made up about 9% of the sample. They tended to experience steadily increasing numbers of arrests starting with an arrest rate of about 19% at age 16, that rose to  57% by age 28. They accounted for 24% of all the arrests in the group of 499.

High-chronic offenders: They had the highest arrest rates overall, peaking at 40 to 60% of the group members being arrested from age 16 to 21, and then slowly declining by age 28.  While comprising only just over 5% of the entire sample, they accounted for 21% of all arrests.   This group was arrested at a younger age than girls in the rare/nonoffending and low chronic groups. They were most likely to have significant mental health problems identified when they entered the system and to have poor reading and math skills, and to have experienced both sexual and physical abuse, and to have been in foster care compared to the low chronic and rare/nonoffending groups.

Girls in the low-rising and high-chronic groups comprised only 14% of the 499 girls followed in this study, but they were responsible for 45% of adult arrests in this group. 

This study showed that understanding the different trajectories of delinquent adolescent girls and the risk factors associated with their criminal “careers” offers opportunities to interrupt these paths. Adverse family situations and personal experiences of abuse predicted arrests that occurred into adulthood.  Preventing these events and circumstances could reduce the personal and societal costs associated with them. 

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The preceding is a summary of: Colman RA, Kim DH, Mitchell-Herzfeld S, Shady TA. Delinquent girls grown up: Young adult offending patterns and their relation to early legal, individual, and family risk.  Journal of Youth and Adolescence.  2009; 38: 355-366.

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jonathan@mixxmedia.com (Administrator) ODD and CD Thu, 23 Dec 2010 20:19:02 +0000
Parent groups for child antisocial behavior: The SPOKES Project http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/297-parent-groups-for-child-antisocial-behavior-the-spokes-project http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/297-parent-groups-for-child-antisocial-behavior-the-spokes-project In Short…

A parenting and literacy program reduced problem behaviours, including those of ADHD, in the home and improved the reading skills of six-year-old children at risk for developing antisocial behavior, both risk factors for developing antisocial behavior in late childhood and adolescents.  Changing harsh and ineffective parenting practices and encouraging reading could lead to improved parent-child relationships and reduce the number of children who develop antisocial behavior later on.

The Issue: Behaviour problems that lead to antisocial behavior in the home, school, and community need to be addressed early on.  Treatment, even if it is evidence-based and intensive, may not resolve the risk factors for the development of antisocial behavior, especially if it is given when the child is older.  In most cases, ineffective and harsh parenting practices and other environmental risk factors are strongly related to the development of antisocial behavior and it is these that can be targeted through prevention programs.

The Research: This was a randomized controlled trial run with six-year-old children from eight schools in England.  Nine hundred and thirty-six children were initially screened for antisocial behavior and 279 scored in the problem behavior range.  Of these, 128 (40%) of the families were interested and ultimately 112 children and their parents were randomized to either the parenting groups (the Incredible Years) or to a no-treatment control group.  The parenting program, lasting 28 weeks, had components that addressed both child behavior and literacy, as many adolescents and adults with antisocial behavior are known to have problems reading.  The general characteristics of the family and measures of the mothers’ mental health were elicited,  direct observation of interactions between parent and child were made, and questionnaires about  the parents’ perceptions of their child’s antisocial behavior, their ADHD symptoms, emotional problems, and reading ability were administered.

The Results: There were follow-up data available on 109 families. Compared to the control group, children in the parenting group showed significant changes in their behavior as perceived by their parents, including symptoms of ADHD, and improved their reading skills.  Teachers saw no differences between the treatment group and the control group children, so the behaviour improvement did not extend to the classroom.

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The preceding is a summary of: Scott, S., Sylva, K., Doolan, M., Price, J., Jacobs, B., Crook, C., Landau, S. Randomised controlled trial of parent groups for child antisocial behavior targeting multiple risk factors: The SPOKES Project. Journal of Child Psychology

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jonathan@mixxmedia.com (Administrator) ODD and CD Tue, 09 Feb 2010 05:00:00 +0000
Oppositional Defiant Disorder and Conduct Disorder http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/odd-and-cd http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/odd-and-cd Nobody’s perfect and all children will have bouts of bad behavior. For example, a child may be tempted to take a dollar out of mother’s purse, but feels guilty later. He or she may become sassy and answer back. Occasional outbursts of anger and aggression do occur in otherwise healthy children and adolescents.

Usually, it is the persistence of the behaviour problems that provides a good rule of thumb about whether or not to seek help, but caution should be exercised here.  Children can start acting out when there are other stresses in their lives, so it is important to know if the behaviour problem started when mother became sick, or when grandma died, or when  the child’s parents announced their divorce. Sometimes, their behaviours may be manifestations of other disorders. For example, aggressive behaviours may occur in children who are anxious. Professional help might be in order if reassurance and extra care during stressful times don’t alleviate the child’s symptoms.  It’s time to get professional help, too, if these behaviours start to escalate, when friendships are negatively affected, or when siblings or the whole family are distressed. 

Children who are angry and aggressive may be frustrated and upset, but not have  skills necessary to understand how to get along with others or how to solve problems. They are at high risk for school failure because their behaviours interfere with their learning and because they may have underlying learning disabilities. Children with severe behaviour problems are often suspended or expelled from school, further disrupting their education. 

When children display angry outbursts or behave aggressively towards their peers or teachers they cause problems in the classroom. Not only is the education of other students jeopardized because of disrupted lessons, but the other students may experience anxiety about the on-going chaos caused by acting-out kids.

Continual anger and aggression can be symptoms of Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD).

Oppositional Defiant Disorder: If a child repeatedly steals money from his/her parents or has started to shoplift, or if there is a consistent pattern of disobedience, nastiness, or argumentativeness, these can be signals of oppositional defiant disorder.

Conduct Disorder: When serious problems emerge with a child engaging in physical or social aggression towards other children or adults, a diagnosis of conduct disorder may be warranted. Conduct disorder, or its beginnings, can be identified in preschoolers. While most children with the aggressive behaviours eventually “grow out” of them, there is a significant group who do not who then go on to develop conduct disorder.  Children and adolescents with conduct disorder are at risk for school and job failure. They have an increased likelihood of becoming involved with the criminal justice system. Their hostility and aggression cause them to be rejected by other children and it is difficult for them to make enduring friendships.3 Surveys have shown that many children in juvenile detention facilities and older teens or young adults in prisons meet the criteria for a diagnosis of conduct disorder and most adult criminals were children with conduct disorder.

Causes

Although not always the case, behaviour problems like ODD and CD tend to flourish in homes where

  • discipline is inconsistent,
  • there is little supervision,
  • parenting practices are coercive, and
  • there are parental mental health problems such as depression or a history of conduct disorder.

Both genetics and environment play a role. There is some evidence that children with CD have deficits in their ability to understand social interactions or the social use of language. The same symptoms are often seen in their parents, making it difficult to sort out whether it is genetics or the environment that is at work producing the condition. There is likely an interplay the two.

Children who are treated aggressively or punished or criticized harshly are more likely to show symptoms of conduct disorder. Parents may react to their child’s challenging behaviours by using inappropriately aggressive discipline because that is how they were treated as children, themselves. Other risk factors include rejection by mother during infancy, institutionalization, and parental mental illness such as depression, or parental drug abuse. Children who suffer neglect or who are not adequately supervised are also at risk.   Children born into poverty are more likely to develop the condition.

Treatment

In ODD, Cognitive Behavioural Therapy helps with mood and anger management. Social skills training may also be helpful to the child with ODD.  For treatment to be successful, it is very important to identify other conditions. Children who have ADHD, depression, or anxiety tend to lose their oppositional symptoms when their other disorders are successfully treated.

Family therapy that helps change how the family functions can also help. Many parents of children with ODD punish their children harshly and are very critical of them, usually because of their own life experience and their current depression. Changing these parenting practices can help the child and benefit the family as a whole. If the parents, particularly the mothers, are unable to develop new ways of parenting, their children may go on to develop the more serious condition, conduct Disorder.

Conduct disorder is harder to treat than ODD and worsens as an affected child ages, so early intervention is important.  Multisystemic Therapy, parent training programs, and family therapy have sometimes been found to be effective in treating the symptoms and causes of CD.4  Programs like “Scared Straight” that are punitive or threatening in nature have been found to be either ineffective or to cause more harm than good.5

Sources

  1. Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM IV).1994. Washington, DC: American Psychiatric Association.
  2. Waddell C, McEwan K, Shepherd C, Offord DR, Hua JM. 2005. A Public Health Strategy to Improve the Mental Health of Canadian Children. Canadian Journal of Psychiatry; 50:226-233.
  3. U.S. Department of Health and Human Services. 1999. Mental Health: A Report to the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services.
  4. Lillienfeld SO. Scientifically Unsupported and Supported Interventions for Childhood Psychopathology: A Summary. 2005. Pediatrics; 115(3): 761-764.
  5. Petrosino A, Turpin-Petrosino C, Buehler J. "Scared Straight" and other juvenile awareness programs for preventing juvenile delinquency. The Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002796. DOI: 10.1002/14651858.CD002796.

Resources

Books

[coming soon]

Websites

 

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jonathan@mixxmedia.com (Administrator) ODD and CD Thu, 05 Feb 2009 20:34:29 +0000
Family and parenting interventions in children and adolescents with conduct disorder and delinquency aged 10-17 http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/252-family-and-parenting-interventions-in-children-and-adolescents-with-conduct-disorder-and-delinquency-aged-10-17 http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/252-family-and-parenting-interventions-in-children-and-adolescents-with-conduct-disorder-and-delinquency-aged-10-17 In Short…

Family and parenting interventions can be effective in the management of conduct disorder and delinquency as measured by a reduction in the time spent in juvenile justice facilities. High quality research is necessary to determine whether or not interventions can improve overall family functioning or parenting practices in families with children between 10 and 17.

The Issue: The problem of conduct disorder and delinquency in children and teenagers –there are significant personal, family, and social consequences of these conditions and it is known that specific characteristics of home life and parenting practices contribute to the development of these conditions.

The Research: This review looked at a range of parenting and family interventions to determine their effectiveness in managing conduct disorder and delinquency. The studies reported on the effectiveness of family and parenting interventions on child and adolescent behaviour, parenting practices, parental mental health, family functioning and relationships, running away and family reunion, school performance, criminality, risk of re-arrest, length of time in institutions, risk of incarceration, self-reported delinquency, future employment, sibling delinquency, and peer relations.

The Results: The authors searched the literature relevant to parenting or family functioning interventions that used at least one objective test such as the arrest rate or family functioning to determine their effectiveness in managing conduct disorder and delinquency. The data from the 8 studies that met the inclusion/exclusion criteria for the review showed that interventions aimed at improving parenting practices and family functioning reduced the time spent in institutions and may have reduced the incidence of re-arrest. There is evidence from this review that the interventions may reduce the likelihood of siblings becoming delinquent. There was no significant evidence that parenting and family functioning interventions had a positive effect on parenting practices, parental mental health, family functioning, school performance, future employment, or peer relationships. There is insufficient evidence that these interventions improve overall family functioning or parenting practices that are associated with conduct disorder or child/adolescent delinquency.

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The preceding is a summary of: Woolfenden SR, Williams K, Peat J. Family and parenting interventions in children and adolescents with conduct disorder and delinquency aged 10-17. The Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD003015. DOI: 10.1002/14651858.CD003015

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jonathan@mixxmedia.com (Administrator) ODD and CD Wed, 12 Nov 2008 18:34:50 +0000
Preventing Disruptive Behavior in Elementary Schoolchildren: The Good Behavior Game http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/247-preventing-disruptive-behavior-in-elementary-schoolchildren-the-good-behavior-game- http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/247-preventing-disruptive-behavior-in-elementary-schoolchildren-the-good-behavior-game- In short…

A class-room based program showed that it is possible to prevent the development of behavior disorders requiring treatment in young children at risk for this condition. The Good Behavior Game taught children how to get along with others, and to adopt socially acceptable behavior in a setting that did not further stigmatize children with poor behavior because it was directed at all children in a classroom.

The Issue: Children who, as they begin school, tend to be impulsive, lack self control, and try to force people to do what they want often get worse as they get older.  They often behave this way because they don’t know how to negotiate with other people, or don’t choose to.

Some studies have shown that these children are often “marked” at the beginning of their school career by their disruptive behavior.  Teachers may single them out for negative attention, and rarely compliment them on their good behavior.  Their peers can become fearful of them and give in to their aggression, thus reinforcing their negative behaviour.  Finding themselves disliked by both teachers and the more socially well adjusted children, they seek out children with the same negative attitudes and behaviours. Making interventions with only these children can further stigmatize them and make them feel even more rejected and angry by pulling them out of the classroom. 

The Research: The Good Behavior Game is a universal, school-based intervention whose aim is to prevent the development of serious behavior problems in school.  Rather than targeting only the “problem” children, all children in the participating classes take part. Teams of children that included both those with problem behaviours and those without decided what was acceptable behavior and what wasn’t. Each of these behaviours was posted in a prominent place in the classroom. Children were encouraged to work together to reinforce each other’s good behavior and were rewarded by the teacher if they maintained a record of good behavior. Attention to negative behaviour was limited.

The Results: This was a randomized, controlled trial of The Good Behavior Game, a school-based  intervention given to all children in a class, not just the troubled children. Classrooms were randomized, not individual children. Teachers identified and rated behaviours in Grade 1 students. The children were then categorized into three groups according to their levels of disuptive behavior. The Good Behavior Game was then introduced at the beginning of Grade 2. After the intervention, those ranked as having intermediate levels of disruptive behavior at the beginning showed the most improvement in all types of disruptive behavior. The children with the highest number of  problem behaviours did not get worse as time went on.  The program demonstrated that it had a preventive effective because children with high levels of problem behavior usually get worse as they age. The children in this study either stayed at one level of problem behaviour or they got better.

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The preceding is a summary of: van Lier PAC, Muthen BO, van der Sar RM, Crijen AAM. Preventing Disruptive Behavior in Elementary Schoolchildren: Impact of a Universal Classroom-Based Intervention. Journal of Consulting and Clinical Psychology. 2004; 72(3): 467-478.

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jonathan@mixxmedia.com (Administrator) ODD and CD Wed, 12 Nov 2008 18:34:50 +0000
Treat the family, treat the child: Multisystemic therapy as a treatment for social, emotional and behavior problems http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/248-treat-the-family-treat-the-child-multisystemic-therapy-as-a-treatment-for-social-emotional-and-behavior-problems http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/248-treat-the-family-treat-the-child-multisystemic-therapy-as-a-treatment-for-social-emotional-and-behavior-problems In Short…

Children and teenagers who have behavioural, emotional, or social problems need services that can help prevent bad outcomes for them, particularly becoming involved in crime and being sent to juvenile detention centres or to jail. It has been claimed that  Multisystemic Therapy, an intensive program that treats the whole family and involves school and community, as well, produces better results than usual types of care.  This review found that there was no evidence that MST is better than usual care but that it does not cause harm. MST is, however, one of very view interventions for very high risk children and adolescents and no other therapy is better.

The Issue: Children and adolescents who act out or who habitually engaging in criminal acts often experience multiple family and social problems that contribute to their behaviour.  Many current interventions are aimed at changing the child or teen but nothing is done to alter the environment that likely promotes such negative behaviour.

The Research: This review assessed studies of Multisystemic Therapy (MST) to see if it is effective in changing the psychological and behavioural problems of children and teens aged 10 to 17, as well as family and social circumstances that may contribute to their aggressive and antisocial behaviour. The goal of MST is to keep families together and involves care by professional therapists who are on call 24 hours a day to provide standard interventions tailored to each family that address parenting and communication skills, family and peer relations, academic performance, and cognitive behavioural therapy.

The Results: This review assessed the literature on Multisystemic Therapy (MST) use with children and adolescents aged 10 to 17 who had behavioural, emotional or social problems, and their families.  A very comprehensive literature search was conducted to find studies on MST.  Of 35 studies on MST found, 8 met the authors’ inclusion criteria and were assessed for this review. All compared MST to standard care and looked at multiple outcomes, particularly those relating to reduction of criminal activity and incarceration of young clients.  Statistical analysis of the data suggested that there is no good evidence that MST is more effective than other interventions with children and adolescents. There was no evidence that MST causes harm. However, MST does have advantages in that it looks at the child in his/her environment, viewing peer and other social interactions as important to how behaviour develops. Rather than focusing strictly on the child, MST encourages change in the environment and offers crisis intervention, while most other interventions don’t. MST is one of very few interventions that address the needs of very high risk populations and there is no other intervention that is better in this situation.

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The preceding is a summary of: Littell JH, Popa M, Forsythe B. Multisystemic Therapy for social, emotional, and behavioral problems in youth aged 10-17. The Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004797.pub4. DOI: 10.1002/14651858.CD004797.pub4.

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jonathan@mixxmedia.com (Administrator) ODD and CD Wed, 12 Nov 2008 18:34:50 +0000
The Fast Track Intervention Trial to Prevent Antisocial Behavior http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/249-the-fast-track-intervention-trial-to-prevent-antisocial-behavior http://knowledge.offordcentre.com/behaviour-and-mental-health-problems/56-odd-and-cd/249-the-fast-track-intervention-trial-to-prevent-antisocial-behavior In Short…

This study demonstrated that a high-quality, multi-component intervention can reduce the likelihood that high-risk children will develop serious behavior disorders. Screening is essential to identify those at high risk since those at moderate risk did not benefit.

The Issue: The risk factors that contribute to the development of serious behavior disorders have been known for many years. For many children, treatment of oppositional defiant disorder (ODD), conduct disorder (CD), and attention deficit hyperactivity disorder (AD/HD) may, in some cases, have only limited success. Treatment is costly and resources in many areas are scarce, putting it out of reach of many families. It would be far better to attempt to prevent these problems from starting, than waiting until they are established. Prevention would reduce suffering in the children and their families and reduce the negative social consequences for communities.

The Research: The Fast Track Program is a long-term intervention with the aim of preventing antisocial behavior and psychiatric disorders in children and youth. It consists of several parts: parent training, social skills and social understanding training, reading tutoring, child and youth mentoring, home visitation, and classroom programming given to all students not just those at risk for problem behaviours. The program started with a screening of all kindergartners in schools in four American cities who were identified as being high risk institutions because of both local crime and poverty levels. Children who were considered at moderate or high risk of developing behavior problems were randomly assigned to receive either the Fast Track Program or to serve as the control group. The data from a low-risk group of children were used to determine how strong the effect of the intervention was. The study looked at diagnoses made of AD/HD, CD, ODD, or other antisocial behaviour, after grades 3, 6, and 9.

The Results: Only the high-risk children got significant benefit from the program. The effects were found by grade 3 in some children and were maintained through to grade 9.  Their risk for CD was reduced by 75%, for ADHD by 53%, and by 43% for all psychiatric disorders related to antisocial behavior.

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The preceding is a summary of: The Conduct Problems Prevention Research Group. Fast Track randomized controlled trial to prevent exernalizing psychiatric disorders: Findings from Grades 3 to 9. Journal of the American Academy of Child and Adolescent Psychiatry. 2007; 46(10): 1250-1262.

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jonathan@mixxmedia.com (Administrator) ODD and CD Wed, 12 Nov 2008 18:34:50 +0000