Evidence-Based Psychosocial Treatment of Disruptive Behavior Disorder - Overview Developed by the Center for School Mental Health with support provided in part from grant 1R01MH A1 from the National Institute of Mental Health and Project # U45 MC00174 from the Office of Adolescent Health, Maternal, and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services

Defining Disruptive Behaviors Two main types of Disruptive Behavior Disorders (DBD): Two main types of Disruptive Behavior Disorders (DBD): Oppositional Defiant Disorder (ODD) – loses temper, argues with adults, easily annoyed, actively defies or refuses to comply with adults. Oppositional Defiant Disorder (ODD) – loses temper, argues with adults, easily annoyed, actively defies or refuses to comply with adults. Conduct Disorder (CD) – aggression toward peers, destruction of property, deceitfulness or theft, and serious violation of rules. Conduct Disorder (CD) – aggression toward peers, destruction of property, deceitfulness or theft, and serious violation of rules.

Oppositional Defiant Disorder A pattern of negativistic, hostile and defiant behavior lasting greater than 6 months of which you have 4 or more of the following:  Loses temper  Argues with adults  Actively defies or refuses to comply with rules  Often deliberately annoys people  Blames others for his/her mistakes  Often touchy or easily annoyed with others  Often angry and resentful  Often spiteful or vindictive

Oppositional Defiant Disorder (ODD)  Prevalence-3-10%  Male to female -2-3:1  Outcome-in one study, 44% of 7-12 year old boys with ODD developed into CD  Evaluation-Look for comorbid ADHD, depression, anxiety &LD/MR

Conduct Disorder (CD)  Aggression toward people or animals  Deceitfulness or Theft  Destruction of property  Serious violation of rules

Conduct Disorder (CD)  Prevalence %  Boys greatly outnumber girls (3-5:1)  Co-morbid ADHD in 50%, common to have LD  Course-remits by adulthood in 2/3. Others become Antisocial Personality Disorder

Conduct Disorder “You left your D_MN car in the driveway again!”

Disruptive Behavior Disorder NOS Disorders characterized by conduct or oppositional defiant behaviors that do not meet criteria for ODD or CD Disorders characterized by conduct or oppositional defiant behaviors that do not meet criteria for ODD or CD Still must have impairment in functioning Still must have impairment in functioning

MH interventions shown to be EFFECTIVE for Disruptive behavior and Willful misconduct problems “Parent Training in behavior management has the clearest support for its efficacy, having been evaluated in 24 controlled tests…” “Parent Training in behavior management has the clearest support for its efficacy, having been evaluated in 24 controlled tests…”

What is Parent Training? Why children misbehave – correcting misperceptions Why children misbehave – correcting misperceptions Identifying and removing barriers to effective child management Identifying and removing barriers to effective child management Paying attention to and reinforcing child’s good behavior (improving emotional relationship) Paying attention to and reinforcing child’s good behavior (improving emotional relationship) Issuing effective commands (compliance training) Issuing effective commands (compliance training) Use of time-out Use of time-out Reinforcement and response cost system (tokens or points) for appropriate/inappropriate behaviors Reinforcement and response cost system (tokens or points) for appropriate/inappropriate behaviors Extension to school and public settings - behavior report card Extension to school and public settings - behavior report card

ODD/CD: Practice Components

What works for DBD? Most of the evidence-based practice elements used for Disruptive Behavior Disorders have their basis in Clinical Behavior Therapy. Most of the evidence-based practice elements used for Disruptive Behavior Disorders have their basis in Clinical Behavior Therapy. We covered the basic premises behind behavior therapy in the first unit. We covered the basic premises behind behavior therapy in the first unit. We will cover the specifics of effective interventions for DBD in this unit. We will cover the specifics of effective interventions for DBD in this unit. Problem-solving is also effective for treating students with Disruptive Behavior Disorders. Problem-solving is also effective for treating students with Disruptive Behavior Disorders.

What doesn’t work for DBD? Treatments with little or no evidence of effectiveness include Treatments with little or no evidence of effectiveness include Special elimination diets Special elimination diets Vitamins or other health food remedies Vitamins or other health food remedies Psychotherapy or psychoanalysis Psychotherapy or psychoanalysis Biofeedback Biofeedback Play therapy Play therapy Chiropractic treatment Chiropractic treatment Sensory integration training Sensory integration training Social skills training Social skills training Self-control training Self-control training

Clinical Behavior Therapy: Theory Proposed Mechanism: Individuals with ODD/CD have difficulty understanding the consequences of their actions. Approach: Application of the principles of social learning theory to modify children’s behavior by training parents and teachers to manipulate environmental antecedents, consequences and contingencies.

The ABC Model Contingencies

An example: The ABC Model

The ABC Model Contingencies Teacher makes eye contact with student, says, “Take out your math books.”

Specific interventions to help the ODD/CD student Parent praise Parent praise Commands/limit setting Commands/limit setting Tangible rewards Tangible rewards Response cost Response cost Parent monitoring Parent monitoring Time out Time out Psycho-education with parent Psycho-education with parent Problem solving Problem solving

Resources Several empirically-supported protocols exist: Several empirically-supported protocols exist: Defiant Children/Defiant Teens (Russell Barkley) Defiant Children/Defiant Teens (Russell Barkley) Helping the Noncompliant Child (Rex Forehand) Helping the Noncompliant Child (Rex Forehand) Videotape Parent Modeling (Carolyn Webster-Stratton) Videotape Parent Modeling (Carolyn Webster-Stratton)

Resources Parent/Teacher DBD Rating Scale Parent/Teacher DBD Rating Scale Vanderbilt Assessment Scales Vanderbilt Assessment Scales

Resources The University of Buffalo Center for Children and Families The University of Buffalo Center for Children and Families Free resources on disruptive behavior disorders: Free resources on disruptive behavior disorders: Parent handouts Parent handouts Teacher handouts Teacher handouts Assessment tools Assessment tools