Psychosocial Treatment of Oppositional Defiant Disorder

Abstract

Objective:To review and describe empirical outcome studies on the psychosocial treatment of children and adolescents meeting the criteria for Oppositional Defiant Disorder (ODD).Method:To locate these treatment outcome studies, an extensive review of the literature using the PsycINFO database was conducted. Results:Psychosocial treatments designed solely for youth meeting the criteria for ODD are rare. Rather, it seems that most of the intervention studies have involved youth with Conduct Disorder as well as ODD, even though these two disorders have distinct differences. Selected psychosocial interventions, including anger control and stress inoculation training, assertiveness training, multisystemic therapy, and rational emotive therapy, have produced favorable outcomes in the studies conducted and published to date. Conclusions:Social workers serving ODD youth should seek training in these provisionally supported evidence-based practices. Given the scarcity of treatments designed solely for ODD with adolescents, there is a need for more outcome studies on this specific population, and for more studies of social work practice involving such youth.     

Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy

Children with histories of maltreatment are at significant risk of developing severe psychiatric problems. Treatment of such children is difficult and there are no empirical studies evaluating the effectiveness of outpatient treatment for children with trauma-attachment disorders. The present study examines the effectiveness of Dyadic Developmental Therapy, a treatment based on attachment theory, provided by one therapist in an outpatient setting. The 64 subjects all had trauma-attachment disorders, met the DSM-IV criteria for Reactive Attachment Disorder, and had histories of serious maltreatment. The 34 children in the treatment group were treated in weekly outpatient therapy at The Center For Family Development with Dyadic Developmental Psychotherapy. The 30 children in the control group were evaluated but did not received Dyadic Developmental Psychotherapy and received treatment from other providers at other clinics. Eligible subjects were children between the ages of five and seventeen years whose case had been closed in 2000 or 2001. All children had significant past histories of abuse, neglect, or orphanage care. Findings for children in the treatment group, as measured by the Achenback and Randolph Attachment Disorder Questionnaire, were significant decreases (p<.01) in symptoms of attachment disorder, withdrawn behaviors, anxiety and depression, social problems, thought problems, attention problems, rule-breaking behaviors, and aggressive behaviors. The findings for children in the control group showed no changes in the variables measured. Dyadic Developmental Psychotherapy appears to be an effective treatment for children with trauma-attachment disorders.The author would like to gratefully acknowledge Ms. Geraldine Gallucci, a master’s level social work intern, who was placed with The Center For Family Development. Ms. Gallucci ensured that the follow-up questionnaires were mailed to the families and returned to the agency.Arthur Becker-Weidmann is affiliated with Center for Family Development, Williamsville, USA.     

Commentary

Abstract

The diagnosis of Gender Identity Disorder (GID) in the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000) continues to be controversial. Three papers by Hill et al. (2005), Lev (2005), and Winters (2005) each offer a critique of this diagnosis. Drawing from our clinical experience and research with transgender youth and adults as well as the scientific literature on gender dysphoria, we will comment on the main issues raised by these authors: the criteria reflect bias, who needs this diagnosis, and how can we lessen the associated stigma. Our discussion will clarify the rationale behind GID, and illustrate the dilemmas inherent in reform or removal of the diagnosis from the DSM.     

Safe Havens to Abandon Babies,Part I

Abstract

The occurrence of symptoms of Attention Deficit, Hyperactivity Disorder (ADHD) in eighty children adopted from Romania was studied. Their average age on arrival was 2.10 and at the start of this study 8 years. The 72 parent-couples (response 83%) were extensively interviewed and filled out the Dutch ADHD-questionnaire and the Child Behavior Checklist (CBCL). Twelve of the 80 participant children (15%, eleven boys and one girl) clearly showed symptoms of ADHD. In addition they exhibited more Externalizing Behavior (CBCL) than the remaining 68 children (75% vs. 25%). These 12 children more often attended special education than the others (67% vs. 25%). The ADHD children also showed less recovery over time. Ten of the twelve ADHD children also showed comorbidity, i.e., symptoms of posttraumatic stress reaction, post institutionalized autism and other behavioral disorders. The ADHD children needed more professional care than the remaining 68 children. Their parents, however, judged the received care more negatively than the Other parents.     

An analysis of the relationship between parenting self-efficacy,the quality of parenting,and parental and child emotional health

ABSTRACT

The relationship between parenting self-efficacy, the quality of parenting, and parental and child emotional health has been conducted with Caucasian families and young children. The purpose of this study was to examine these relationships in ethnically diverse and impoverished families with children who have behavior problems. We examined the relationships between parenting self-efficacy, parenting practices, child externalizing problems, and caregiver depression. Participants included 213 caregivers of children with Oppositional Defiant Disorder (ODD), who rated their parenting self-efficacy and completed questionnaires on parenting practices (APQ and FAD); child externalizing behaviors (Iowa Connors Inattention and ODD subscales); and caregiver depression (CESD). Data were examined using Chi-Square tests, a Linear Regression, and a One-Way ANOVA. Results demonstrate parenting self-efficacy was positively associated with positive parenting and inversely associated with inconsistent discipline. Among parents who perceived themselves as being a “better than average parent,” there was a greater percentage of youth who met cutoff for inattention problems as compared to youth who did not meet this cutoff. Lastly, depression scores were lowest for caregivers identifying as below average parents. This study underscores the need for involving parents and enhancing parenting self-efficacy in interventions targeting Disruptive Behavior Disorders.     

Assessing behavior in children aged 12–24 months using the Strengths and Difficulties Questionnaire

Behavioral and emotional problems in infants and toddlers are common, often persist and put children at risk of later mental health problems. Reliable, efficient, and sensitive tools are needed to identify young children who may benefit from further assessment and support. The Strengths and Difficulties Questionnaire (SDQ), offers a brief, convenient means of screening for early problems, however, it lacks psychometric validation in infants. The aim of this study was to assess the validity and reliability of the SDQ in children aged 12–24 months. Ninety-three participants, with children aged 12–24 months, completed the SDQ and Child Behavior Checklist (CBCL) online. Concurrent validity of the SDQ was assessed through comparison with the CBCL. The results demonstrated that key subscales of the SDQ and CBCL were significantly correlated (r range= −.19 to –.57). Key SDQ subscales showed moderate reliability (Cronbach's alpha range = .38–.79, mean inter-item correlation range = .06–.43). The SDQ shows promising reliability and validity as a measure for rating the behavior of 12–24-months-old children, particularly for externalizing symptoms. Further research is needed to assess its predictive utility.     

Social Work Assessment of Adaptive Functioning Using the Vineland Adaptive Behavior Scales

Abstract

The assessment of client adaptive functioning is often an important component of a comprehensive social work evaluation. The Vineland Adaptive Behavior Scales (VABS) are the most commonly used quantitative measures of adaptive functioning for clients meeting the criteria for a wide range of disorders. We review the development of the VABS and current knowledge pertaining to the instrument's reliability and validity. We conclude that the ability to administer and interpret the VABS is an important skill for clinical social workers to acquire.     

The Association of Sexual Behavior with Externalizing Behaviors in a Community Sample of Prepubertal Children

Abstract

On the basis of the problem-behavior theory for adolescence, we hypothesized that already during childhood sexual behavior is associated with (non-sexual) externalizing behaviors and tested the hypothesis in a community sample. In the context of a postal questionnaire survey of 6-10 year old children, the parents of 349 girls and 326 boys completed the Child Behavior Checklist (CBCL). The CBCL Sex Problems scale did not differ between genders, ethnic groups, or age groups. For both girls and boys, the scores on the Sex Problems scale correlated significantly but modestly (maximum r = 0.35) with all other CBCL scales; only in boys did the correlations with externalizing behaviors exceed those with other scales. We conclude that children from a community sample who show sexual behavior as defined by the CBCL tend to be the ones with increased behavioral/emotional problems in general, with only modest specificity in symptomatology.     

Mental health services for children and caregivers remaining at home after suspected maltreatment

ObjectiveBehavioral problems are common among children remaining at home after suspected maltreatment, but the effectiveness of current mental health services to improve these behavioral problems is unknown. The objective was to determine whether receipt of child and caregiver mental health services was associated with improvements in behavioral problems in maltreated children remaining at home.MethodsWe retrospectively analyzed Second National Survey of Child and Adolescent Well-being data. We included 1117 children ages 2–17 remaining at home after a maltreatment investigation, excluding children with missing outcome, covariate, or survey weight data. We compared mean Child Behavioral Checklist (CBCL) change scores from baseline to 18 months between children who did and did not receive mental health services, before and after adjusting for child, caregiver, and child welfare agency factors using survey-weighted linear regression.ResultsNearly one-quarter (22.6%) of children and 16.0% of caregivers received mental health services. Children receiving services had worse unadjusted baseline and 18-month CBCL scores than children not receiving services (all P < 0.001). Adjusted CBCL change scores revealed behavioral worsening among children receiving services but improvement among children not receiving services (all P < 0.001). However, children had improved behavior, regardless of their own service receipt, if their caregivers received services and reported an absence of depression at 18 months.ConclusionsChildren receiving mental health services had worse behavioral changes than children not receiving services. Caregiver receipt of services was associated with improved child behavior, suggesting that a family-centered approach may be most influential in improving behavioral outcomes among this population.     

Complex Child Custody Evaluations: Evaluating the Alleged Incestuous Parent

SUMMARY

Professionals involved in child custody evaluations are sometimes confronted by the complex issue of one parent accusing the other parent of having sexually assaulted one of the children. There is scant research and theoretical literature to guide the professional in the evaluation of the alleged incestuous parent, or the attorney or judge reviewing such an evaluation. This paper describes the guiding principles of such an evaluation, how to structure the evaluation, methods used for data collection, interpretation of data, and the reasoning processes that lead to an ultimate opinion regarding the allegation. Hypothesis formation and testing is described. The form a recommendation should take given positive assessment findings and negative assessment findings is presented.     

The Convergent Validity of the Trauma Symptom Checklist for Young Children for a Sample of Sexually Abused Outpatients

ABSTRACT

The convergent validity of the Trauma Symptom Checklist for Young Children (TSCYC) was examined with a sample of 172 sexually abused outpatient treatment-seeking children and their caregivers. The TSCYC evidenced good convergent validity with other parent ratings (e.g., the Child Behavior Checklist, Child Sexual Behavior Inventory, and the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index [UCLA PTSD Index]). The convergent validity of the TSCYC and the Trauma Symptom Checklist for Children was weak, perhaps illustrating the lack of agreement often found between children and caregivers and illustrating the need for a multi-informant approach to screening and assessment of sexually abused children. The TSCYC seems to hold promise based on the emerging evidence for its convergent validity.     

Children of Substance Abusing Women on Federal Welfare

SUMMARY

The present study sought to characterize well-being indicators for a sample of children of substance dependent TANF women. Participants were 372 mothers meeting DSM-IV criteria for substance dependence and 156 non-substance abusing women from two urban counties in New Jersey. Children of substance dependent TANF mothers experienced significant vulnerabilities, as demonstrated by higher levels of contextual risk factors and negative behavioral and emotional and school outcomes. Overall, these rates were about double those found in children of non-substance abusing mothers. Results highlight the need for multi-systemic services to address the problems experienced by substance abusing TANF women and their children.     

Do Family Meetings Improve Measurable Outcomes for Patients,Carers, or Health Systems? A Systematic Review

Abstract

Family meetings are a common intervention in acute and subacute inpatient care settings. The aim of this systematic review was to investigate the quantitative research exploring the impact of inpatient family meetings on patient, carer, or service outcomes. A search of electronic databases (Medline, Cinahl, Embase, PubMed, and Psychinfo) was conducted from the earliest available time until July 2012. Inclusion and exclusion criteria were applied, and quality assessment of included articles was conducted. Eight studies were included in the final selection. Results indicate that there is some low-to-moderate quality evidence that inpatient family meetings reduce psychological distress of family carers and assist in meeting their information and support needs. There is weak evidence that inpatient family meetings may help to reduce readmission rates and facilitate entry to continuing care programs.     

Financial Abuse of Older People by Family Members: Views and Experiences of Older Australians and their Family Members

Abstract

Risk assessment in child protection services has been promoted as the most reliable way to ensure that maltreatment to children is prevented and has become central to practice with children and families. However, recent research in Australia has suggested that children are being left in unsafe situations, leading to further maltreatment, by the very agencies responsible for their protection. The present article explores the reasons why child protection has become central to child protection practice and presents a wide ranging critical appraisal of risk assessment and its application. It is argued that risk assessment is a flawed process and, as a central tenet of practice, is implicated in any problems that children's protective services face. Consequently, any future reconfiguration of services for children in need of protection needs to include a re-evaluation of the efficacy of risk assessment.     

Parental Imprisonment and Child Protection: A Study of Children Presented to the Melbourne Children's Court

Abstract

This paper reports on a study funded by the Criminology Research Council, Australia, which set out to investigate the intersection between the child protection and criminal justice systems and the extent to which children before the Melbourne Children's Court on child protection matters had a parent currently in prison, awaiting sentencing, or previously in prison. Magistrates identified 156 children as meeting these criteria during the study period June to December, 2006. Analysis of court records gathered quantitative and qualitative data about parents' offending, why the children had been brought to the attention of the court, and the health, welfare, and behavioural concerns the child protection service expressed about the children. There was no coordinated response by the child protection and justice systems to managing these children's situations. Early intervention and the development of child protection service protocols with the corrections system for children whose parents enter prison is essential, to better address the instability and disruption in care these children experience.     

Internet Use,Abuse, and Dependence Among Students at a Southeastern Regional University

Objective: To assess Internet use, abuse, and dependence. Participants: 411 undergraduate students. Results: Ninety percent of participants reported daily Internet use. Approximately half of the sample met criteria for Internet abuse, and one-quarter met criteria for Internet dependence. Men and women did not differ on the mean amount of time accessing the Internet each day; however, the reasons for accessing the Internet differed between the 2 groups. Depression was correlated with more frequent use of the Internet to meet people, socially experiment, and participate in chat rooms, and with less frequent face-to-face socialization. In addition, individuals meeting criteria for Internet abuse and dependence endorsed more depressive symptoms, more time online, and less face-to-face socialization than did those not meeting the criteria. Conclusions: Mental health and student affairs professionals should be alert to the problems associated with Internet overuse, especially as computers become an integral part of college life.     

Suicide ideation,anxiety, and depression: Are children a protective factor for male Veterans?

ABSTRACT

Numerous mental health disorders plague our veterans when they return from deployment including anxiety and depressive disorders, which have been linked to elevated suicide risk when left untreated. Family factors, such as parenthood status, may serve as a protective factor against these mental health issues. This study examined the role of parenthood status of male veterans (N = 234) based on age of the child in order to determine whether a child’s age (minor children v. adult children) affects the likelihood of meeting diagnosis criteria for anxiety, depression, and suicide ideation after controlling for marital status. Three hierarchical binary logistic regression models were constructed to assess the predictive influence of children 18 years old and younger, children older than 18, and no children with the results indicating that parenthood status did meaningfully enhance the prediction of suicide ideation. Complete findings, clinical implications, and future considerations are discussed.     

Current Empirical Assessment Methods for Adolescents and Children Who Sexually Abuse Others

Abstract

The assessment of adolescents and children who commit sexually abusive behavior is a complex and challenging task. Incorporating empirically based assessment methods into psychosexual evaluations promises appropriate coverage of relevant domains, sound interpretation of the meaning of data, reduced clinician biases and error, and greater certainty in decision-making. In this paper we review empirically-based assessment methods currently available for use in psychosexual assessment of adolescents and children who sexually abuse others. Our review describes the robustness of these measures and provides guidance for their appropriate use in assessment. The review highlighted that several empirically-based measures are suitable for clinical use with adolescents, but very little is available to guide assessment of children's abusive behavior per se.     

A Checklist for Supervised Access and Quality Care Possession Determinations

ABSTRACT

Clinicians have historically made recommendations about the need for supervised visitation, when allegations short of actual physical violence have been raised that implicate the safety of the children, on the basis of previous critical incidents and patterns of problematic behavior by the one or both of the children's parents. These recommendations, as a result, may not have always been tailored to the best interests of the children. What is needed is a procedure that considers and documents all the factors–the child's status and special needs, the parent's physical and mental status, the parent-child relationship, the suitability of the environment, and the availability of resources to support visitation–that have an important role in deciding on the need for supervised visitation. The “Supervision Checklist,” which is based research and the experience of the author, proposed in this paper is a first step toward accomplishing this kind of differentiated perspective on supervised visitation. The Checklist is based on the five criteria mentioned above, with a large number of specifiers for each of the criteria. The clinician is asked to assign a score to most of the specifiers, with a score of zero indicating that that specifier is within normal limits, up to a score of two indicating that there is a clear need to consider some kind of intervention. Guidelines for assigning these scores are discussed in the paper. Even in the absence of comprehensive data for assigning scores, the documentation of the factors affecting the specifiers has the advantage that many of the issues and mitigating circumstances in the specific areas of concern have to be addressed.