Guideline 1: Interventions Need to Address the
Biological Characteristics of the Child
Interventions focused primarily on the environment of the family
and child have been criticized because they have not addressed
the underlying biological characteristics of the child. Clarke
and Clarke (1988) pointed  out that a prevailing popular belief
is that "there are no problem children, only problem parents"
(p. 16). This assumption leads the school social worker away from
assessing problems of a biological nature in the child. Recent
research addressing this issue of biology versus environment has
focused on determining who is causing the dysfunctional relationship--that
is, who owns the problem, the child or the parent (Lytton, 1987,
1990).
This issue is of particular significance to the school social
worker, because historically, the social work profession has been
criticized for a "blame the parent, remove the child"
philosophy that characterized the child-saving movement of the
early 1900s (Costin, 1985). The ideology of the era declared that
children needed to be saved from their "bad" environments,
with parents considered to be the source of their children's problems
(Petr & Spano, 1990). In addition, the unique social work
focus on person-in-environment has led to an overemphasis on the
person with the neglect of the environment or vice versa, with
the pendulum swinging according to the latest theories.
Researchers in the field of child development emphasize that underlying
biological factors contribute to the development of conduct disorders
in children far more than the environment alone (Lewis, 1990;
McCord & Tremblay, 1992). These underlying characteristics
are defined as biopsychosocial vulnerabilities (Lewis). Unfortunately,
the underlying pathology in the child is often overlooked because
the child's behavior is so upsetting to parents, counselors, and
professionals (Lewis; Lytton, 1990).
Aggression is an example of a temperamental factor
that is integral to the conduct disorder diagnosis. Olweus (1979)
found that aggressiveness in children is a highly stable personality
trait across settings and comparable to intelligence quotient
in terms of stability. Other researchers support this finding
(Kazdin, 1987; Loeber, 1982; Quay, Routh, & Shapiro, 1987).
In addition, Margalit and Shulman (1986) found a developmental
delay in boys diagnosed with conduct disorder in regard to behavioral
control and inhibition of aggression. Their study suggested that
aggressiveness is caused by slow maturation. A gap existed between
expected behavior and the boys' ability to control their behavior.
This gap created frustration that led to "acting out"
behavior.
These findings support the idea that the biological
characteristics of the child drive the relationship. The child's
aggressive temperament, as well as his or her unresponsiveness
to parenting strategies, may exhaust the parents so that they
become more permissive of the child's behavior, serving to increase
the child's aggressiveness. It may appear that it is the parenting
style causing the problem, but the parent is merely responding
functionally to the child's aggressive temperament expressed through
aggressive behavior. Patterson (1974) referred to this as the
"coercive spiral."
In addition to temperament, neurological difficulties such as
hyperactivity have been the focus of numerous studies of conduct
disorder. A 60 percent overlap was found in the diagnoses of attention
deficit hyperactivity disorder (ADHD) and the conduct disorder
diagnosis, with the overlapping characteristics being inattentiveness,
impulsivity, and overactivity (Farrington, Loeber, & Van Kammen,
1990). Studies that follow children from the early years to late
adolescence indicate not only that the prenatal, postnatal, and
perinatal environment is an indicator of future conduct disorder,
but also that children identified as hyperactive in childhood
are more likely to be diagnosed with adolescent conduct disorder
(Lambert, 1987; Lewis, 1990).
Studies of the psychiatric functioning of children
and adolescents diagnosed with conduct disorder indicate that
clinical depression, psychosis, and anxiety disorder are prevalent
in this population (Lewis, Pincus, & Lovely, 1987; Robins,
1966). Research has indicated an exceptionally high correlation
(.73) between conduct disorder and depression (Cole & Carpentieri,
1990; Marriage, Fine, Moretti, & Haley, 1986). Identification
of both disorders is also important because of the possibility
of the use of a pharmacological intervention to treat the disorder.
Research has shown that when medication was used to treat depression,
conduct problems remitted, only to reoccur when medication was
withdrawn (Marriage et al.). DuPaul and Barkley (1992) also investigated
the efficacy of medication with children identified with ADHD
and diagnosed conduct disorder. They found that counselors and
parents responded more positively when the child was on medication.
Guideline 2: Interventions Need to be Multimodal
There has been extensive research in the field of child development
that focuses on environmental interventions with children who
have conduct disorders. As noted in guideline 1, the development
of a conduct disorder is an interactive process between the biological
makeup of the child and his or her environment. As children grow
up, they increasingly interact with more systems that influence
their development outside of the family, such as peers, the school
system, and community facilities. Kazdin (1997a) noted that interactions
are dynamic rather than static, thereby contributing to the complexity
of treating the disorder as the child grows older.
Traditionally, parent interventions and school interventions
have taken place separately. Ramsey, Patterson, and Walker (1990)
studied the generalization of child behavior from the home setting
to the school. They found that aggressive behavior in children
was consistent in both the home and school settings. They concluded
that treatments need to be delivered in more than one setting
for effective change to occur. Ramsey et al. recommended that
intervention be focused in three primary areas: "teaching
family management techniques to parents, decreasing academic deficits,
and remediating the peer-related and adult-related interactional
social problems of the child" (p. 221). Because of the importance
of addressing both the home and school settings, parental involvement
is viewed as critical to the success of these interventions. Parents
or primary guardians are an integral part of the treatment process
and should be involved in all phases, from assessment to intervention
and follow-up.
Guideline 3: Interventions Need to be Multisystemic
The following studies point to the importance of multisystemic
intervention. A multisystemic intervention is one that takes place
in more than one large (macro) system--that is, the school, social
services agencies, or corrections and community agencies such
as the YMCA. The influence of the schools as a systems variable
can be demonstrated in a study conducted by Garmezy (1991). Particular
school factors were identified as contributing to better outcomes
in the children attending those schools. Schools with equal resources
in poverty areas were compared, with findings indicating that
there were high-achieving schools and low-achieving schools among
this group.
The high-achieving schools demonstrated high expectations
for clients, class-based participatory instructional methods,
positive management, and disciplinary control. School variables
were identified as being an important part of an intervention
process that can redirect a child who has antisocial tendencies
to a more competent path.
Beyond determining the effects of schools, other systemic factors
in the child's life need to be addressed, such as poverty, history
of child abuse or neglect within the family, and lack of social
support (insularity). Whittaker, Schinke, and Gilchrist (1986)
advocated the ecological paradigm and stated that effective programs
are those that address skills training and social supports for
families.
A treatment program entitled multisystemic treatment
(MST) was developed, based on the ecological model, using family
systems theory to work with the family and other systems to reduce
the delinquent behavior of their child (Henggeler & Borduin,
1990). Others, primarily researchers, in the field identified
MST as one of the most promising intervention programs for children
with conduct disorders (Kazdin, 1997b; Tolan & Gorman-Smith,
1997).
Aftercare and community resources also are essential in maintaining
effective interventions. Many researchers indicate that support
systems after treatment have been neglected, although these systems
are crucial to maintaining gains (Lewis, 1990; Maluccio &
Marlow, 1973; Whittaker et al., 1986). Lewis stated that "it
makes no sense to provide a troubled adolescent with sophisticated
medical, psychological, and educational assistance while in residence,
only to deprive him of these supports following discharge to the
community" (p. 208). Maluccio and Marlow reviewed the literature
on residential treatment for emotionally disturbed children and
found that often the programs lacked a way to involve families
in the treatment plan. These programs commonly neglected to provide
an aftercare plan and failed to coordinate between various agencies
once the child was discharged.
Guideline 4: Interventions Need to Focus
on Prosocial Skills with Prosocial Peers
Peer networks are a crucial link in a child's resistance to behavior
change. Failing to address the social networks of conduct-disordered
youths has been linked to treatment failure for these youths.
The research that follows suggests that interventions are successful
only if they target peer networks by including prosocial peers
in the intervention process.
O'Donnell (1992) studied intervention programs that were not successful
to understand why the results were not more positive. He found
that what the unsuccessful programs had in common was that they
brought delinquent youths together so that they were able to form
social networks with other delinquent youths. Friendships formed
in the programs were likely to continue when the program ended
and contributed to an increase in future antisocial acts rather
than a decrease after the intervention. As an example, the Group
Guidance Project was targeted toward members of four gangs. Its
first attempt at intervention involved dances and group activities
at a community center. When negative gang activity increased,
the researchers changed the intervention to involve individual
treatment, such as helping gang members get jobs or employment
training. This approach decreased their gang activity and delinquent
behavior. Another example is the work of Chamberlain and Friman
(1997) who analyzed a randomized field study that focused on boys
in residential care. They found that the more time boys spent
associating and being influenced by antisocial peers during treatment
predicted the number of serious crimes committed after discharge.
Guideline 5: Interventions Need to Include
Cognitive Processing
In addition to the inclusion of prosocial peers, child development
research suggests the need to address more than just behavior.
Interventions also must focus on the beliefs and the decision-making
process of the child. The importance of addressing cognitive processing
has been studied extensively by Dodge, although his studies were
specific to boys (Dodge, 1986; Dodge & Frame, 1982). His research
focused on how the aggressive child interprets environmental stimuli
and then acts on them. Dodge (1986) found that the behavior of
the aggressive child was related more to an interpretation of
the situational stimulus than to the stimulus itself. An example
of this is when an aggressive child is bumped by another child
by accident. The aggressive child will interpret being bumped
as a purposeful act by the other child and respond aggressively.
Another example is when a peer is looking at the aggressive child
with a neutral facial expression; the aggressive child will interpret
that expression as being hostile.
Most often school social workers in elementary schools
observe these interactions during recess. During this time children
are physically active and less actively supervised; therefore,
accidental bumping or balls hitting children are likely to occur,
as well as children ganging up to pick on or bully other children.
For more detail, Dodge and Schwartz (1997) provided an explanation
of the social information-processing model.
Schonfeld, Shaffer, O'Connor, and Portnoy (1988) suggested that
the origins of cognitive deficits reside in the learning environment
of youths with conduct disorder, not in inherited cognitive abilities.
Although this perspective contradicts other research findings
cited earlier, it suggests that the child's deficits in cognitive
functioning can be improved through environmental intervention.
School interventions can address inherent cognitive deficits and
deficits that might be attributed to the environment. For example,
Arllen and Gable (1992) recommended several school interventions
that have been based on the research of Dodge and others that
pointed to skill deficits in the child. These interventions share
several common elements: teaching anger control, problem solving,
and social skill training. In addition, group management systems
are taught to the counselors to change inappropriate classroom
behaviors. Furthermore, Kazdin (1997b) emphasized that problem-solving
skills training programs conducted in schools have documented
success, indicated by replicated field studies. Finally, Pepler
and Rubin (1991) reported the success of cognitive skills training
in inpatient and outpatient settings.
Closely related to a cognitive focus on skills is
moral motivation training, advocated by two researchers who attributed
the failure of most programs to a lack of attention to the belief
systems of youths. These authors based their work on Kohlberg's
levels of moral development. Arbothnot (1992) stressed that a
cognitive process precedes every antisocial act. If the child
is operating from a preconventional level of moral development,
he or she may not take into account the victim's perspective and
may only view the situation from an egocentric perspective. The
results of this research intervention, which focused on moral
decision making, demonstrated a significant drop in antisocial
behavior in the participants, with these changes maintained at
a one-year follow-up. Arbothnot stressed that the reason these
programs, which only addressed behavior, failed is that they do
not address the adolescent's worldview. Changing the youth's belief
system, however, addresses the cognitive processes that permit
the immoral and illegal behavior (Arbothnot, 1992). Schulman (1990)
also advocated interventions that emphasized teaching adolescents
how to behave morally and scrutinize their belief systems.
- Mpofu, Elias and Ralph Crystal, Conduct disorder in children:
challenges, and prospective cognitive behavioral treatments, Counselling
Psychology Quarterly, Mar2001, Vol. 14 Issue 1, p21-32, 12p
The article above contains foundational information. Articles below contain optional updates.
Personal
Reflection Exercise #4
The preceding section contained information about five
guidelines for interventions with conduct-disordered youth. Write
three case study examples regarding how you might use the content
of this section in your practice.
Online Continuing Education QUESTION
18
According to Mpofu, what is the “coercive spiral”?
Record the letter of the correct answer the .
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