Addressing problematic behaviour - a systemic approach Dr Rosario Power Principal Clinical Psychologist, Linn Dara CAMHS

Problematic Behaviour If a child engages in behaviour that interferes with his/her ability -to feel ok about him/herself, -relate ok with others, or - deal with the demands of life, that’s problematic behaviour.

Bronfenbrenner(1986)

Risk factors to Developing psychological difficulties: Difficulties with quality of parent-child attachment, (Carr 1999) Experience of being physically punished (Olweus 1993) Parents experiencing significant personal adjustment problems, (Goodyer 1990, Kazdin 1995, Harrington 1993) Social disadvantage and poverty in early life (Garmezy and Masten 1994) Being brought up in an institution

Maintaining Factors -Inadvertent reinforcement -Insecure attachment -Coercive interaction -Over involvement -Disengagement -Inconsistent discipline -Confused communication patterns -Triangulation

Maintaining Factors (cont’d) -father absence and poor identification with father (for boys) -lack of social support high family stress -unsuitable educational placement -deviant peer group membership -community problems

Protective Factors Aspects of the family system, Individual characteristics of the child’s parents or primary care givers and Features of the wider social network including the child’s school Features of the treatment system, (Carr 1995)

Prevalence Rates Prevalence of psychological problems in international studies varies from 4% to 23% and rates are higher in western, urban centres. Vary with gender-more prevalent among boys than girls. Conduct problems are more prevalent than emotional problems. Conduct problems arise more frequently among boys than girls. Emotional problems are more prevalent among girls.

are the single most costly disorder of childhood and adolescence Conduct Disorders are the single most costly disorder of childhood and adolescence (Carr 1999)

Outcomes Domain Outcome Criminality More criminal behaviour Mental health Higher rates of psychiatric hospitalisation, Higher rates of all psychological symptoms Physical health Higher rates of hospitalisation and mortality

Outcomes Educational attainment Higher rates of school drop out and lower attainment levels Occupational adjustment Higher unemployment. Lower occupational status if employed and more frequent job changes Marital Adjustment Higher rates of separation, divorce and remarriage Social Adjustment Less contact with relatives, friends, neighbours and church Intergenerational transmission More children with conduct problems

Responding to difficulties Clinical Services do not have the resources to respond directly to all children who present with problematic behaviour. Less than half the children with emotional and behavioural problems in the US receive a service. (kazdin and Kendall 1998) < 1/5 of children with conduct disorders in London were seen by specialist services.

We’ve got a problem We know that there are children who present with behaviours that make life more difficult for them and for others, We know that they can’t all access clinical services We know that these problems respond best to interventions when they are younger (<8) We know that the presence of behaviour problems in childhood is indicative of difficulties in the future in terms of the child him/her self, but also how others relate to that child

Think of solutions! Effective psychological intervention for ADHD has three principal elements -parent management training -school-based behavioural management -child focused skills training (Hinshaw et al., 2007) The importance of intervening at the level of the young person, the parents and the wider school and relevant agencies has also been identified in responding to adolescents with more severe conduct disorder.. For pre-adolescent behaviour problems, behavioural parent training is the most strongly supported evidence-based intervention. (Carr 2009)

Ask the following questions Is the solution -FAIR -SAFE -DOES IT LEAD TO GOOD FEELINGS