**Tutorial 8 - Child Externalising Disorders

Question 1

1. Parent training interventions are highly effective for many families, however a minority fail to benefit, and the reasons for this are unclear. Research aiming to predict treatment success/failure has focused on family/environmental factors (e.g., socioeconomic disadvantage, parental depression, parental substance abuse, marital discord), but has often ignored child factors (e.g., temperament/traits) until recently. What are the theoretical assumptions that have guided this focus on the environment, and what theoretical shifts have occurred in recent years?

Answer 1

The main theoretical assumption is that kids were a ‘blank slate’, you could shape them into whatever you wanted them to be under the right environment. However, advances in genetic research shows that isn’t necessarily the case and that a lot of who kids are are made up of inherited traits.

Question 2

2. The most significant change to the externalising disorders in DSM-5 is the introduction of a specifier for children who meet criteria for conduct disorder while also displaying ‘limited prosocial emotions’ (as operationalised by CU - callous and unemotional - traits, also known as ‘psychopathic traits’). This means that clinicians will now be focusing more on whether a child shows such traits. What are some of the pros and cons of this?

Answer 2

Allow identification of more treatment-resistant patients. Likely need different treatments.

Stigma? & assumption that trait indicates lack of response to treatment (ie. going to be a psychopath (sorry mum))

Question 3

3. What approach to assessing/measuring CU traits is discussed in the set reading, and why is this thought to be important. (Who did the researchers collect information about the child’s CU traits from?)

Answer 3

“Importantly, our demonstration of this effect using a multi-informant measurement strategy indicates that associations between CU traits and treatment outcomes are unlikely to be accounted for simply by other family risk factors that may covary with CU traits reporting error (e.g. negative maternal attributions about the child).”

Question 4

4. What are some of the key strengths and limitations of this study?

Answer 4

No control group

Controlled for lots of extraneous variables. Good sample size.

Question 5

Kids on Speed

1. Parent training (or “parent assisted therapy”) is based primarily on social learning (operant) theory, as formulated in Patterson’s coercion theory. What parent-child interactions appearing onscreen illustrate this theory?

Answer 5

· Reacting to negative child behaviour, while leaving positive child behaviour alone
· Responding to negative child behaviour with nagging/threats that little follow-through in terms of consequences
· Escalation in the level of aversive reactions (i.e., the longer the confrontation continues, the more aggressive it becomes).

Question 6

Kids on Speed

2. What effect does the children’s behaviour have on the parents in the show, and why is this important from a clinical perspective?

Answer 6

The parent reactions listed above (re: question 1) are believed to be elicited largely by child behaviour.

Question 7

Kids on Speed
3. The therapeutic relationship is a major factor in successful parent training. What are some of the specific (sometimes subtle) things done by Prof. Dadds to promote this?

Answer 7

· Using plain language (avoiding psychobabble)
· Valuing the perspective of parents as the ‘experts’ on their own children.
· Avoiding blame
· Encouraging parents to be open about the impact of child behaviour problems on their own lives, and validating parents’ experience of those problems.
· Encouraging optimising in parents by sharing information about evidence-based treatments

Question 8

Kids on Speed

4. The formulation of diagnoses can often be a complex process. What were some of the issues that made it difficult to diagnose the children on the show, and what kinds of information were particularly helpful in this process?

Answer 8

There is often overlap between the symptoms of ODD/ADHD, as well as high functioning autism. Reliable diagnosis requires information collected across a range of settings and informants – such information can be challenging to collect and integrate (e.g., observations in school settings, reliable reporting from parents whose perceptions/recall may be biased by their stressors/psychopathology).

Question 9

Kids on Speed

5. A big emphasis is placed on involving both parents in treatment. Why might this be?

Answer 9

Family environment is a hierarchical system. Any treatment that aims to impact on that system is most likely to do so when the ‘executive subsystem’ of the family participates in therapy as a united as a team (i.e., parents have shared goals and plans, are able to support each other). It is common for parents of children with behaviour problems to lack such a team (in part as a consequence of the child’s behaviour), but by including both parents in treatment, a therapist has the opportunity to promote this cooperation and shared perception of the child issues. This is key to maximising consistency in parents’ implementation of treatment strategies in the home, and the likelihood that parents will persist using strategies that may at first be very challenging.