This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders, with one of those focusing on changes made from the DSM-IV to the DSM-5.
______________________________________________
Evidence-Based Treatment of Disruptive Behavior by Hailey Hinkle
Oppositional defiant disorder (ODD), conduct disorder (CD), and intermittent explosive disorder (IED) are troubling for the individual experiencing the symptoms as well as those they interact with like peers, teachers, and caregivers. These disorders are characterized by problem behaviors, emotional outburst, and defiance to authority figures. These behaviors can cause problems at home, school, and within the community. The symptoms can negatively impact an individual’s social, academic, occupational, and emotional well being. Research has suggested that these types of disorders occur because of someone’s environment, temperament, or genetic and physiological background. Those diagnosed with disruptive, impulsive, and conduct disorders (DICD) vary across culture, gender, and race. Another area of concern with this class of disorders is that they are often co-morbid with other psychological disorders and can create problems with interpersonal relationships. ODD can create adjustments issues for adults and the individuals have a higher chance of meeting diagnostic criteria for depression, anxiety, and substance abuse later in life. ODD can also lead to a CD diagnosis. CD often occurs in individuals who fail to follow societal rules. They can have physical altercations with classmates and incidents of bullying. Intermittent explosive disorder can create emotional discomfort and aggressive outbursts. This can affect the parent and child relationship as well as isolate the individual from their peers.
The potential cost and level of impairment of DICDs are high. This means that treatment is vital so that these behavior problems do not escalate to a higher degree of impairment. If a child does not receive treatment at an early stage of life, the symptoms and behaviors can become worse and have bigger consequences later in life. It is not uncommon for these individuals to have problems with the judicial system. These types of behaviors are not socially acceptable and can become overwhelming for caregivers and teachers. Treatment of these types of behaviors can feel like an uphill battle and this is very discouraging to those seeking help. However, it is important that treatment is delivered as early as possible. Working on these problem behaviors earlier in life is the most effective because these behaviors can become more complex to treat as the individual ages.
One of the most effective therapies for these types of disorders is called parent management training and it mixes parent training with behavior modification. Parent management training is known for teaching parents how to handle their children’s disruptive behaviors. These behaviors can range depending on the individual. Some common behavior problems revolve around compliance with demands, arguing with authority figures, physical and verbal aggression, bullying, threatening, and destruction of property. One of the main benefits of parent management training is that it works directly with operant learning principles. Operant learning principles are taught using reinforcement strategies and often focus on the individual target behaviors. Some operant learning principles include verbal praise, token rewards systems, positive reinforcement, selective attention, and time out from reinforcement.
In the beginning of treatment, parents are trained on positive parent-child relationships and prosocial child behavior. It is during this time that the parents would improve their relationship with their child and begin reinforcing them for behaving in socially appropriate behaviors. Normally a therapist would start with an easier target behavior to help the parents become familiar with the process. Once parents have mastered these simple behavior modifications, the therapist can start working with the parents on more complex behaviors. It is also during this time that parents are learning how to define and identify problem behaviors within their child. This can help with data collection. Data collection can help a parent understand the frequency of their child’s behaviors and allow them to see if their selected intervention is working effectively. This is common among many behavioral therapies.
The next step takes place after the parents have regained some control over their child’s behaviors. This step would focus on skills that promote effective parental discipline. This is done to decrease more problem behaviors. The majority of problem behaviors are learned through the parent’s disciplinary style. Some parents fail to set firm limits on what is acceptable behavior and what is not, while others may punish their child too harshly. Punishing children too harshly and not setting firm limits can teach children to act aggressively, defiantly, and with disobedience. These types of behaviors are common within the DICDs. It is typical for parents to want to punish their child for acting inappropriately, however research has shown that punishment can cause resentment and anger from the individual being punished. It could even make the child’s problem behaviors worse. For example if a child is stealing from his parents and gets the item taken away, he may learn a different technique to not get caught the next time he steals something. Parent management training tries to correct these types of disciplinary styles and help the parents find an individualized and effective way of managing their child’s problem behaviors. Parent management training will teach the parents how to implement positive reinforcement, which allows them to focus on what they child is doing correctly. Instead of having the child steal an item, they may use that as a potential reinforcer for socially appropriate behaviors. This can teach the child acting appropriately can get them the same result with fewer negative consequences. Parent management training can help parents define the function of the behavior so that they can teach more socially appropriate skills that are individualized for their child. This technique can help shape the problem behavior into something more manageable and reinforcing for both the parents and the child.
Another benefit of parent management training and other behavior therapy strategies is that they have been effective over a variety of ages and problem behaviors. As mentioned earlier, it is important to get treatment as soon as possible, but parent management training has worked with a variety of ages. It is easier for the parent to implement these behavior changes earlier but it is not impossible to see results in older children and adolescences. Other treatment styles that have been effective with DICDs population includes parent child interaction therapy, multi-systematic therapies, and applied behavior analysis. It is important to remember that not every problem behavior is the same, but the treatment should focus on implementing socially appropriate responses.
