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Healthcare Training Institute - Quality Education since 1979CE for Psychologist, Social Worker, Counselor, & MFT!!
Section 15
Treatment for Child Conduct Problems
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Young preschool and early-school-age children with early
onset conduct problems are at high risk for school dropout, substance
abuse, violence, and delinquency in later years. Consequently,
developing treatment strategies for reducing conduct problems
when aggression is in its more malleable form prior to age 8,
and thus interrupting its progression, is of considerable benefit
to families and society. This article describes a treatment program—the
Dina Dinosaur Social, Emotional and Problem Solving Child Training
Program—that was designed specifically with developmentally
appropriate teaching methods for young children (ages 4 to 8 years)
and based on theory related to the types of social, emotional,
and cognitive deficits or excesses exhibited by children with
conduct problems. The program emphasizes training children in
skills such as emotional literacy, empathy or perspective taking,
friendship and communication skills, anger management, interpersonal
problem solving, school rules, and how to be successful at school.
Emphasis is placed on ways to promote cross-setting generalization
of the behaviors that are taught by involving parents and counselors
in the treatment.
Program Content And Goals
The Dina Dinosaur Treatment Program targets children with conduct
problems, but it is also appropriate for addressing comorbid problems
such as attention problems and peer rejection. The curriculum
consists of 18 to 22 weekly 2-hour lessons. It can be delivered
by counselors or therapists in a mental health–related field
or by early childhood specialists who have experience treating
children with conduct disorders or early-onset behavior problems.
Therapists receive extensive training in the content and methods
of the treatment program. They use comprehensive group leader
manuals that describe each session’s content, objectives,
videotapes to be shown, and small-group activities. Treatment
integrity is monitored through session-by-session protocols and
unit checklists completed by therapists as well as by supervisor
and peer videotape reviews. This program is an ideal companion
to the Incredible Years parent programs. The 22-session parent
group and the child training group can be offered concurrently.
(This arrangement also helps with parents’ childcare needs,
so the parents can attend parent sessions knowing their children
are well cared for.) In the material to follow, we provide a brief
description of and rationale for each of the treatment components
(see Note).
Detective Wally Teaches Problem-Solving
Steps (Stegosaurus Program)
Children who are hyperactive, impulsive, inattentive, and aggressive
have been shown to have cognitive deficits in key aspects of social
problem solving (Dodge & Crick, 1990). Such children perceive
social situations in hostile terms, generate fewer prosocial ways
of solving interpersonal conflict, and anticipate fewer consequences
for aggression (Dodge & Price, 1994). They act aggressively
and impulsively without stopping to think of nonaggressive solutions
or of the other person’s perspective, and they expect their
aggressive responses to yield positive results. There is evidence
(Dodge, Pettit, & Bates, 1994) that children who employ appropriate
problem-solving strategies play more constructively, are better
liked by their peers, and are more cooperative at home and school.
Consequently, in this next program of the intervention, therapists
teach children to generate more prosocial solutions to their problems
and to evaluate which solutions are likely to lead to positive
consequences. In essence, these children are provided with a thinking
strategy that corrects the flaws in their decision-making process
and reduces their risk of developing ongoing peer relationship
problems. Children learn a seven-step problem-solving process:
1. How am I feeling, and what is my problem? (define problem and
feelings) 2. What is a solution? 3. What are some more solutions?
(brainstorm solutions) 4. What are the consequences? 5. What is
the best solution? (Is the solution safe? fair? Does it lead to
good feelings?) 6. Can I use my plan? 7. How did I do? (evaluate
outcome and reinforce efforts)
A great deal of time is spent on Steps 1, 2, and 3 to help the
children increase their repertoire of possible prosocial solutions
(e.g., trade, ask, share, take turns, wait, walk away, take a
deep breath). In fact, for the 3- to 5-year-olds, these three
steps may be the entire focus of the unit. One to two new solutions
are introduced in each session, and the children are given multiple
opportunities to role play and practice these solutions with a
puppet or another child. Laminated cue cards with pictures of
more than 40 solutions are provided in Wally’s “detective
kit” and are used by the children to generate possible solutions
and evaluate whether they will work to solve particular problems.
Children role play solutions to problem scenarios introduced by
the puppets, the video vignettes, or the children themselves.
In one activity, the children draw or color their own solution
cards so that each child has his or her own detective solution
kit by the end of the unit. The children are guided to consult
their own or the group solution kit when a real-life problem occurs.
Activities for this program include writing and acting in a problem-solving
play, going “fishing” for solutions (with a magnetized
fishing rod), and working as a group to generate enough solutions
to join Wally’s Problem-Solving Detective Club.
Detective Wally Teaches Problem-Solving
Steps (T-Rex Program)
Aggression and inadequate impulse control are perhaps the most
potent obstacles children with conduct problems face with regard
to effective problem solving and forming successful friendships.
Without help, these children are more likely to experience ongoing
peer rejection and continued social problems for years afterwards
(Coie, 1990). Such children have
difficulty regulating their negative affect in order to generate
positive solutions to conflict situations. Furthermore, there
is evidence that aggressive children are more likely to misinterpret
ambiguous situations as hostile or threatening. This tendency
to perceive hostile intent in others has been seen as one source
of their aggressive behavior (Walker, Colvin, & Ramsey, 1995).
Consequently, once the basic skills for problem solving have been
acquired, the children are taught anger management strategies.
Anger management programs based on the work of Novaco (1975) have
been shown to reduce aggression in aggressive middle and high
school clients and to maintain gains in problem-solving skills
(Lochman & Dunn, 1993). Clearly children cannot solve problems
if they are too angry to think calmly. A new puppet, Tiny Turtle,
is used to teach the children a five-step anger management strategy:
1. Recognize anger. 2. Think “stop.” 3. Take a deep
breath. 4. Go into your shell and tell yourself, “I can
calm down.” 5. Try again.
Tiny’s shell is the basis for many activities: making a
large cardboard shell that children can actually hide under, making
grocery bag “shells” or vests, molding Playdough shells
for small plastic figures (the children pretend the figures are
mad and help them to calm down in the Playdough shells), and making
teasing shields. Each of these activities provides multiple opportunities
for the therapist to help the children practice the steps of anger
management. Children learn to recognize the clues in their bodies
that tell them they are getting angry, and to use self-talk, deep
breathing, and positive imagery to help themselves calm down.
Therapists also use guided imagery exercises with the children
(having them close their eyes and pretend to be in a cocoon or
turtle shell) to help them experience the feelings of being relaxed
and calm. Videotapes of children handling anger, being teased,
or being rejected are used to trigger role plays to practice these
calming strategies. In addition, the puppets talk to the children
about problems (e.g., a parent or counselor was mad at them for
a mistake they made, they were left out of a birthday party, a
parent is getting divorced or doing something that disappoints
them). The situations that the puppets bring to the group are
formulated according to experiences and issues relevant to particular
children in the group. For example, if a child in the group is
teased at school (and is reacting in an aggressive or angry way),
Wally might tell the group that someone at school called him a
name and Wally was so mad that he hit the person. Wally would
then talk about the consequences of hitting (he felt bad afterwards,
and he got in trouble). The group would then generate alternative
solutions for Wally and would help him practice them. The child
who has this same difficulty at school would often be chosen to
act out an appropriate solution with Wally.
Throughout the discussion of vignettes and role-play demonstrations,
the therapists and puppets help the children to change some of
their attributions about events. For example, Molly Manners (Wally’s
sister) explains, “Maybe he was teasing you because he really
wanted to be your friend but didn’t know how to ask you
nicely” or, “You know, all kids get turned down sometimes
when they want to play; it doesn’t mean they don’t
like you” or, “I think that it was an accident that
he bumped into you.” The Pass the Hat Detective Game is
played to help the children determine when an event might be an
“accident” versus when it might be done “on
purpose” and how each event could be handled.
Molly Manners Teaches How to Be Friendly (Allosaurus
and Brachiosaurus Programs)
Children with conduct problems have particular difficulty in forming
and maintaining friendships. Our research, and that of others,
has indicated that these children have significantly delayed play
skills, including difficulties waiting for a turn, accepting peers’
suggestions, offering an idea rather than demanding something,
or collaborating in play with peers (Webster-Stratton & Lindsay,
1999). They also have poor conversation skills, difficulty in
responding to the overtures of others, and poor group-entry skills.
Consequently, in the friendship program we focus on teaching children
a repertoire of friendly behaviors such as sharing, taking turns,
asking, making a suggestion, apologizing, agreeing with others,
and giving compliments. In addition, the children are taught specific
prosocial responses for common peer situations. An example would
be entering a group of children who are already playing: 1. Watch
from the sidelines and show interest. 2. Continue watching and
give a compliment. 3. Wait for a pause. 4. Ask politely to join
in and accept the response.
As with other new material, the children see these friendship
skills modeled by the puppets or in videotape examples and practice
using them in role plays and cooperative games.
Integration of Cognitive, Affective, and
Behavioral Components
Each unit uses this combination of cognitive, affective, and behavioral
components to enhance learning. For example, the anger thermometer
is used to teach children self-control and to monitor their emotional
state. Children decorate the thermometer with pictures of feeling
faces from “happy” and “relaxed” in the
blue (or cool) section of the thermometer all the way up to “angry”
or “stressed out” in the red (or hot) section of the
thermometer. The therapist can then ask a child to describe a
recent conflict, and together they retrace the steps that led
to the angry outburst. The therapist writes down the child’s
thoughts, feelings, and actions that indicated an escalating anger
pattern, for example, “He always takes my toys” (thought),
“That really makes me mad” (feeling). “I got
so mad that I kicked him” (action). The therapist and the
child discuss thoughts, words, and actions that the child can
use to reduce his or her anger. As the therapist retraces the
steps of the angry outburst, she or he helps the child identify
the place where the child was aware that he or she was getting
angry. This is marked as the “Danger Point” on the
thermometer. Once the child has established this danger point,
he or she chooses a name that will be the signal for reaching
that point (e.g., chill out, cool down, code red, hot engine).
This code word will be the counselor and child’s signal
that anger or stress has reached the threshold and will trigger
the use of an agreed-upon calming strategy, such as taking three
deep breaths.
Fantasy Play and Instruction
Fantasy play provides the context for this program because a high
level of sociodramatic play in early-school-age children is associated
with sustained and reciprocal verbal interactions and high levels
of affective role taking (Connolly & Doyle, 1984). Fantasy
play gives children the opportunity to develop intimacy and work
out emotional issues (Gottman, 1983). For preschool-age children,
sociodramatic play is an important context in which perspective
taking, social participation, group cooperation, and intimacy
skills develop. This important skill can easily be fostered through
the use of the child-sized human puppets.
Promoting Skills Maintenance and Generalization
Because the children are learning these skills in a setting removed
from the classroom and home environments, the therapists must
do everything they can to promote generalization of skills to
other settings. Therapists should look for opportunities to praise
and coach prosocial behavior even during less structured times,
such as in the waiting room before the group starts, snack time,
bathroom breaks, and transitions. For each main intervention component,
parents and counselors are sent letters explaining the content
of the unit (e.g., expressing feelings, sharing, problem solving)
and suggesting ways they can reinforce these behaviors at home
and at school. Several times during the program, phone calls are
made to parents and counselors to tell them about the children’s
successes, which behaviors to reinforce, and which ones to ignore.
Parents and counselors need to offer praise and reinforcement
whenever they see the children using these prosocial behaviors
in naturally occurring settings. The homework assignments, which
children complete with parents each week, also reinforce these
concepts and help parents to learn and understand the same terminology
that their children are using in Dinosaur School so that there
is cross-setting consistency in responses from therapists and
parents.
Group Management
The implementation of the Dinosaur program is dependent on the
variety of therapeutic processes and methods described in this
article. A final key element of successful group therapy with
children who have conduct problems is utilizing research-based
group-management strategies (e.g., incentives and time out; Brophy,
1996). In order to be able to teach these difficult children and
provide a safe environment for them, the therapists must manage
oppositional and aggressive behaviors extremely well. Research
has shown that when children with conduct problems are placed
in groups, they may reinforce each other’s antisocial behaviors
and actually become worse instead of better if their negative
behaviors are not managed well (Dishion, McCord, & Poulin,
1999). A well-managed group with consistent rules and limits can
provide these children with one of the first opportunities they
have ever had to be successful in a learning environment with
their peers. In fact, after an initial testing period, most children
with conduct problems who participate in these groups enjoy coming
to group, follow the rules consistently, and make some of the
first positive friendships they have ever had. Group leaders work
together, and in consultation with parents and classroom counselors,
to develop individual behavior plans for each child in the group.
Thus, although all of the children are expected to follow basic
group rules, one child may have a special program designed to
decrease rude talk, another child might be working on remembering
to think before impulsively blurting out answers, and a third
child might be working on listening carefully to adult instructions.
In this way, the particular issues of each child can be addressed
in a group context.
- Webster-Stratton, Carolyn and Jamia M. Reid, Treating Conduct
Problems and Strengthening Social and Emotional Competence in
Young Children: The Dina Dinosaur Treatment Program; Journal of
Emotional & Behavioral Disorders, Fall2003, Vol. 11 Issue
3, p130, 14p
Personal Reflection Exercise Explanation
The
Goal of this Home Study Course is to create a learning experience that enhances
your clinical skills. We encourage you to discuss the Personal Reflection
Journaling Activities, found at the end of each Section, with your colleagues.
Thus, you are provided with an opportunity for a Group Discussion experience.
Case Study examples might include: family background, socio-economic status, education,
occupation, social/emotional issues, legal/financial issues, death/dying/health,
home management, parenting, etc. as you deem appropriate. A Case Study is to be
approximately 250 words in length. However, since the content of these Personal
Reflection Journaling Exercises is intended for your future reference, they
may contain confidential information and are to be applied as a work in
progress. You will not
be required to provide us with these Journaling Activities.
Personal
Reflection Exercise #1
The preceding section contained information about the “Dina
Dinosaur” Treatment Program. Write three case study examples
regarding how you might use the content of this section in your
practice.
Peer-Reviewed Journal Article References:
Dadds, M. R., Thai, C., Mendoza Diaz, A., Broderick, J., Moul, C., Tully, L. A., Hawes, D. J., Davies, S., Burchfield, K., & Cane, L. (2019). Therapist-assisted online treatment for child conduct problems in rural and urban families: Two randomized controlled trials. Journal of Consulting and Clinical Psychology, 87(8), 706–719.
Porta, C. M., Bloomquist, M. L., Garcia-Huidobro, D., Gutiérrez, R., Vega, L., Balch, R., Yu, X., & Cooper, D. K. (2018). Bi-national cross-validation of an evidence-based conduct problem prevention model. Cultural Diversity and Ethnic Minority Psychology, 24(2), 231–241.
Salmanian, M., Ghobari-Bonab, B., Hooshyari, Z., & Mohammadi, M.-R. (2020). Effectiveness of spiritual psychotherapy on attachment to God among adolescents with conduct disorder: A randomized controlled trial. Psychology of Religion and Spirituality, 12(3), 269–275.
QUESTION
According to Webster-Stratton, what is the function of an
“anger thermometer?” To select and enter your answer go to .
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