Teachers and social service providers are increasingly aware of the number of children who have conduct issues. This presentation provides guidelines for understanding and responding. A first step is to ask whether children have experienced trauma. A next step is to find out if the children, their peers, and their parents believe these behaviors are appropriate. Work with both children and their families is most effective. Professionals will work with children only if parents are unavailable. Parents may enjoy the socialization involved in parenting groups.
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.”
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