3 Conduct Disorder: What is it? A repetitive and persistent pattern in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:Aggression to people and animalsOften bullies, threatens, or intimidates othersOften initiates physical fightsHas used a weapon that can cause serious harm to othersHas been physically cruel to peopleHas been physically cruel to animalsHas stolen while confronting a victimHas forced someone into sexual activity
4 Conduct Disorder: What is it?(Continued) Destruction of propertyHas deliberately engaged in fire setting with the intention of causing serious damageHas deliberately destroyed other’s property (other than by fire setting)Deceitfulness or theftHas broken into someone else’s house, building or car.Often lies to obtain goods or favors or to avoid obligationsHas stolen items of nontrivial value without confronting a victimSerious violations of rulesOften stays out at night despite parental prohibitions, beginning before age 13 years.Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy time).Is often truant from school, beginning before age 13 years.
5 Diagnostic MistakesSymptoms cause harm to others, so clinicians don’t ask about symptomsDon’t get outside sources of dataDiagnosing someone with Conduct Disorder labels them as “bad” and “untreatable”They have experienced trauma, so it’s just PTSDThey have an “underlying” depression, so it’s not Conduct Disorder
6 Conduct Disorder: A Serious Problem Cost to the Individual:Difficulties in relationshipsDifficulties at school and workMost common treatment referral (1/3)Boys:Girls (5:1)1 to 4% of 9-17 year oldsCosts to SocietyViolenceProperty LossCost of IncarcerationAs adults:High risk for becoming career criminals-35 to 40%Substance abuseVocational Difficulties/Financial difficultiesInability to sustain relationshipsChild abuse and neglect
10 Negative Emotionality They experience negative emotions frequently, intensely, and with little provocationAggressionLow frustration toleranceCan’t delay gratificationFrequent temper tantrumsOverwhelmed by normal demands of lifeCan’t handle disappointmentsPoor coping skillsDSM-V may call this Temper Dysregulation Syndrome with Dysphoria
11 Daring Sensation-seeking behaviors Low harm avoidance Autonomic nervous system doesn’t respond to punishmentLack of anxietyHead injuriesImpulsivity
12 Lack Of Prosociality Less sympathy and concern for others Don’t share Don’t helpUnkind behaviorsLack of guilt or remorse
13 Environmental Factors Parents poor behavior as youthsBorn to teenage parentPhysical abuse and neglectAbsence of same sex role modelWitnessed violenceAccess to other antisocial kidsLack of monitoringAntisocial or alcoholic parentsLower SESFamily hostility
14 Genetic-Environment Correlations Passive-the same genes that give the kid a bad temperament account for the bad parentingEvocative-genes that create the temperament lead to behavior that evokes bad parenting, which then increases the likelihood of conduct disorderActive-genes lead kid to seek out antisocial social environment
15 The Path to Conduct Disorder Aggressive kids gets lots of negative feedbackSchool failurePhysical abusePeer rejectionSometimes aggressive behaviors get reinforcedParents give in to intense kidAllowed to bully other kids in places where there is poor monitoring
16 The Path To Conduct Disorder Constant negative feedback from parents, teachers, and peers intensifies the kids angerAt puberty, he finds other antisocial kidsSuddenly, he’s popularBehavior problems worsen
17 Life Course-Persistent Versus Adolescent-Limited Conduct Disorder Adolescent-Limited-well-behaved child becomes rebellious teen with unconventional values and connects with antisocial peers.Life Course-Persistent-chronically aggressive child becomes antisocial teen
18 Longitudinal Studies of Conduct Disordered kids Life-Course Persistent Conduct DisorderWeak bonds with familyCallous-unemotionalImpulsiveNegative emotionalityAggressiveAdolescent-Limited Conduct DisorderUnconventional valuesWere well-behaved as children
19 Features of Life-Course Persistent Conduct Disorder (Moffitt, et. al Individual Risk factorsUnder controlled temperament at age 3Neurological abnormalities and delayed motor development at age 3Low intellectual abilitiesReading difficultiesPoor memoryHyperactivitySlow heart rateParenting Risk FactorsTeenage single parentMothers with poor mental healthHarsh or neglectful mothersFamily conflictChanges in caretakerLow SESRejection by peersChildhood onset antisocial behavior nearly always predicts poor adult adjustment
20 Are Two Groups Enough? Possible Third Groups Substance abuse driven conduct disorderAntisocial behaviors are non-aggressive and revolve around substance useLow level chronic offendersSocially isolated-less contact with antisocialsAnxiousUnmarried, unemployed, mental health needs
21 Gray’s Biobehavioral Theory of Brain Function Behavioral Activating SystemActivates when there are signals for rewardsEscape from punishmentInstrumental aggressionHope and reliefBehavioral Inhibiting SystemInhibits behavior when signals of punishment, frustration, or noveltyAnxiety and apprehensionConduct Disordered kids have overactive BAS and underactive BIS
22 Support for Gray’s Theory Daugherty and Quay, 1991Computerized card gameSubjects get money for correct responses, but lose money for incorrect.As the game goes on, the probability of correct responses decreases.Most subjects stop playing. Conduct Disordered kids keep playing.Conduct Disordered kids are reward dominant
23 Support for Gray’s Theory Walker, et. Al., 1991Conduct Disordered youth with co-occurring anxiety disorder-less deviant and less aggressiveKerr, Tremblay, Pagani, and Vitaro, 1997Followed kids in high crime urban area.Kids who showed anxiety in new situations were protected against the later development of antisocial behaviors
24 Support for Gray’s Theory Raine, Venables, and Williams, 199514 year longitudinal study of CD kidsMeasured electrodermal activity (measure of ANS arousal)Kids with higher ANS arousal ceased their antisocial behaviorsSequin, Pihl, Boulerice, Tremblay, and Harden, 1996Measured sensitivity to pain at age five and followed kidsPersistently aggressive teens had least sensitivity to pain at age five
25 Other Problems Associated with CD ADHDLearning DisabilitiesSubstance AbuseTrauma and Abuse IssuesUnstable self-esteemAnger Management
26 Deficits related to Conduct Disorder Low IQ (especially Verbal)-language processing and communicationExecutive functionsSocial skillsEmotion regulationCognitive flexibility
27 Low IQMoffitt (1993)-reviewed 47 studies. CD kids score 8 points lower, even after you control for other risk factors. Persistently aggressive kids score 17 points lower.Kids can’t express feelingsLanguage development helps us regulate emotionsKids have difficulty listening to and comprehending instructionsKids can’t express their point of view in a conflict situationLanguage development may play a role in the development of empathySets them up for social interactions full of tension
28 Executive Functions Self-regulation Maintaining a problem-solving mental set in pursuit of a goalInhibitionPlanningInterference controlAllocation of attentionLack of persistenceInitiationAbstractionCognitive flexibility
29 Emotion Regulation Grouchy, irritable Difficulty being calm enough to think clearly when frustratedGet upset and stay upset-minor things can ruin their dayOver-react, making their coping efforts ineffective
30 Social Skills and Conduct Disorder Difficulty collaboratingRefusal to ask for helpUnable to be in a non-dominant roleDifficulty accepting limitsUnaware of others/ surprised by their responseInaccurate self-perceptionDifficulty taking the others point of viewAfraid they will be perceived as “soft”EgocentricExamplesYouth who doesn’t want to sit near another kid in classYouth on an outing from a facility expects to be able to walk around without escort
31 Cognitive Inflexibility All-or-none thinkingProblems with ambiguity, uncertaintyInsistence on sticking with the original planCan’t take another’s perspectiveProblems with transitions
33 Families of Conduct Disordered Kids Lack of monitoringLack of family ritualsLack of affectionDon’t comfort distress-lock kids outLack of mirroringViolenceCoercive family environment (Patterson)
34 Coercive Family Environment Parents don’t reinforce prosocial behaviors, they use negative reactions to exert influence on kidsParents are inconsistent in addressing antisocial behaviorsChildren use aversive behaviors to terminate intrusions by family membersIrritable fathers have explosive reactionsMothers chronic nagging
35 Families of Conduct Disordered Kids Absent father-insecure motherCreate closed systemHide the dysfunctionTeens need to go through phase of devaluing parents, who don’t respond by rejectingUs against the world“I won’t hold you accountable for your behavior, if you don’t hold me accountable for mine.”Moms don’t cooperate with authorities-threatened by kids acting upCD Kids-”mom’s always been there for me.”CD Moms-”He’s always been good for me.”
36 CD Families Sexual and physical abuse Neglect Abandonment Parents are burdened by kids needsTeach kids feelings are unimportantSecrets-hide our dysfunction, defensivenessDifficult to address family’s faults-a task of adolescenceOut of touch with feelingsCD kids-skewed notion of what parenting is-leads to unwanted children
37 The Psychology of CDAntisocial behaviors help person avoid helplessness.Invulnerability.Omnipotence.Protect self-esteem.Little tolerance for bad feelings.Externalize blame.Introspection is painful.Impulsivity/immediacy.Thrill-seeking-turn the volume up.Hate boredom.
38 The Psychology of CD Externalizing disorder Moral judgment is impaired Empathy feels like pityCompetitivenessSelf-esteem is bolstered by destroying othersSeems self-serving, but is self-destructiveDifficulty cooperatingDifficulty tolerating delaysExperience limits as excessive
40 Social Cognition Human beings are social beings We attend to important social stimuli.We interpret those stimuli in meaningful waysWe use memory to associate these interpretations with possible behavioral responsesWe evaluate those responsesWe decide which response is best
41 Social CognitionWe selectively attend to certain aspects of the stimulus field.We differ as to:what we attend tothe attributions we make to other’s behaviorthe goals we havethe responses we generatethe evaluations we make of our response.Example-some people are hypervigilant to threat cues, whereas others interpret events in a way that maintains harmony.
42 Social Cognition Examples Teacher yells at kids to “quiet down.”One kid gets mildly irritated and sits quietly, thinking “Boy, she’s having a bad day.”Another kid feels disrespected, and yells back at her, “You can’t talk to me that way.”Another kid feels sorry for the teacher, and feels annoyed with the kids in the class who she sees as rude.
43 Social Cognition and Aggression Aggressive kids have been found to:Make hostile attributions regarding others intentAttribute anger to teachersGenerate fewer potential responses in situationsTend to evaluate aggressive responses favorably whatever the outcome (especially callous-unemotional kids)Boys tend to make more hostile attributions and evaluate aggression favorably
44 What Causes Biased Social Information Processing? Dodge (2001)-found kids exposed to early maltreatment had biased social information processing styles in kindergarten, and continued to have the same response pattern in grades 8 and 11.Peer rejection may result from and lead to biased social information processing style.Hostile attributional bias explains reactive aggression. It does not account for the aggression of the callous-unemotional.
45 Is This An Avenue For Intervention? Several studies targeting hostile attributional bias have found that reducing it leads to less aggressive behavior.Clinically, it’s important to understand the way your patient interprets situations.We can offer non-hostile attributions (i.e., perhaps the teacher wasn’t trying to humiliate you, perhaps she told you to quiet down because she was frustrated with the class)
46 Is This An Avenue For Intervention? We can get kids to reevaluate their goals in social situations (i.e., “does everyone have to respect you”, “some kids have no respect”)We can help kids more critically evaluate their aggressive responses.
48 The Biology of Aggression Testosterone levels are correlated with aggression.Low cortisol levels are indicative of low autonomic nervous system arousal, and are correlated with increased aggression.Aggressive kids have lower heart rates.SSRI’s decrease cortisol levels.
49 The Development of Aggression At 17 months (Tremblay, et. Al., 1999)50% of children push others25% kick others15% have bitten othersAggression increases to age three or four and then declinesAggression is a natural behavior that children learn to inhibitLanguage helps kids problem solve non-aggressivelyMiddle class kids have thousands more words in their vocabulary than poor kids at age five.Low Verbal IQ is associated with poor outcome among Conduct Disordered boys
50 Conduct Disorder and Aggression The aggressive symptoms of the disorder concern us the mostDo the most harmCreate the most countertransferenceMost useful predictor of outcome in boysLeast popular third grade boy is the most likely to be an adult offenderAggression is fairly stable for boys from third grade on.
52 Boys, Girls, and Antisocial Tendencies For life-course persistent Conduct Disorder, boys outnumber girls 10:1.For adolescent limited Conduct Disorder, boys outnumber girls 1.5:1.Among adults, male criminals far outnumber females.Adolescence is a brief period in which girls engage in antisocial behaviors.Severe CD is girls predicts teen pregnancyAntisocial girls are a key link in the intergenerational transmission of male criminality. They are romantically involved with antisocial boys, become teenage mothers, and are unable to function as parents. Their offspring are at increased risk for behavior problems.
53 Conduct Disordered Girls Girls represent 28% of juvenile arrests, up from 23% a decade ago.Study in Maryland found much of this increase resulted from domestic disputesTypically girls show a non-aggressive pattern-lying, running away, truancy, substance abuse, and non-confrontational stealing.Aggressive girls are a small percentage of all conduct disordered girls.Highly dependent on their choice of mates.Aggressive acts, if present, are perpetrated on people they know.Most likely victim of a teenage girls assault-motherMost likely victim of a teenage girls murder-her newborn
54 Gender Differences in Aggression Peaks at age three, with boys and girls both exhibiting aggressive behaviors.By age four, aggression is uncommon among girls. It takes longer for boys to reduce aggression.Aggression in kindergarten can be used to predict adolescent behavior problems.Aggression in young boys is a highly effective red flag-it predicts later conduct problems. It underidentifies later conduct disorder in girls.To predict antisocial behavior in teenage girls, you need to add oppositional and inattentive behaviors to the predictive model.
55 Aggression and Adult Criminality In males, adult criminality can be predicted from aggression in kindergartenIn females, aggression at age 13 predicts adult criminality.Physical aggression is uncommon among elementary school girls.
56 Socialization and Gender Boys are under-socialized and girls are over-socialized.Mothers disapprove of girls displays of anger. They encourage girls to resolve anger.Mothers are more lax with boys misbehavior. This is correlated with behavior problems.Parental depression is related to conduct problems is boys and care-giving in girls.
57 Gender Differences in Play Boys are more likely to engage in collaborative play (several boys engaging in a coordinated group activity).However, boys are more likely to fight because they don’t appreciate the other’s point of view and misattribute hostile intent to others.Boys fights are more likely to become physical, but boys make up quicker after a fight.Girls are better able to take each others point of view, reducing the risk of fights.However, girls interpersonal sensitivity reduces their amount of collaborative play.Girls friendships are more exclusive.When girls are aggressive, their victims is likely someone they know. This is not necessarily true for boys.
58 Parenting and Antisocial Behavior Harsh parenting and lack of affection were related to boys antisocial behavior, but not girls in early childhood.Parenting was more important for girls than boys in adolescence.Family dinners, checking homework, and family support are more strongly correlated with outcomes in girls than boys.DJS girls have more dysfunctional families than DJS boys.It appears girls are more sensitive to family factors.
59 Socialization and Antisocial Behaviors Choice of a mate is important in predicting later behavior problems for girls, but not boys.Greater negative environmental factors are necessary to elicit antisocial behavior in girls.
60 Sexual Abuse and Antisocial Behaviors Sexually abused girls are at risk for a variety of psychiatric problemsSexually abused girls exhibit more antisocial behaviors than a matched control group following the revelations of abuse.More severe abuse is correlated with worse outcomes.The differences in antisocial behaviors disappear after 7-8 years, except for girls abused by their biological fathers, who remain at increased risk for antisocial behaviors.
61 Relational Aggression Threatening to end a relationship unless the friend complies with a request.Using social exclusion to punish others.The silent treatment.Spreading nasty rumors.
62 Girls Who Bully More alienated from peers. More conflict with friends Less trust in romantic relationshipsLess committed in their friendshipsAmong girls, bullying increases during the transition between grades eight and nine.
63 Risk Factors For Conduct Disorder That Are Unique To Girls Lack of family ritualsChoice of a mateEarly onset pubertyGirls begin dating earlierMore likely to date older boys, who involve them in antisocial activitiesSexual abuseLack of school attachmentHigh crime neighborhood
64 Conduct Disorder and Social Class More prevalent in poor communitiesCan manifest differently depending on peer groupKids moved from housing project to middle class communitiesThe presence of a particular behavior may mean something different in two different communities
66 Risk AssessmentMust distinguish between risk for violence and risk for delinquencyMany factors lead to delinquencyDelinquency is complex, varies in severityChronic violence and aggression appears to have a strong heritable component
67 Biological Risk Factors Neurochemical- serotonin facilitates inhibitionHormonal-testosterone linked to aggressionPsychophysiological-lower heart rate, less galvanic skin responseNeuropsychological-executive function deficits
68 Actuarial Instruments Youth Level of Service/Case Management Inventory (YLS/CMI)-risk for general delinquencyAssessment of risks and needsPredicts re-offendingWashington State Juvenile Court AssessmentLooks at risk and protective factorsScores are used to guide case managementEmphasis is on increasing protective factors and reducing risk factors
69 The SAVRY SAVRY (Borum)-risk for violence 24 risk factors, each rated as low, moderate, or high6 protective factorsStructured professional judgmentEach risk factor is empirically associated with violence
70 Historical Risk Factors (SAVRY) History of violenceHistory of non-violent offendingEarly initiation of violencePast supervision/intervention failuresHistory of self-harm or suicide attemptsExposure to violence in the homeChildhood history of maltreatmentParental/caregiver criminalityEarly caregiver disruptionPoor school achievement
71 Social Risk Factors (SAVRY) Peer delinquencyPeer rejection-not loner, they are actively dislikedStress and poor copingPoor parental managementLack of social supportCommunity disorganization
72 Individual Risk Factors (SAVRY) Negative attitudes-criminal attitudes, hostile attributional styleRisk taking/impulsivitySubstance abuseAnger management problemsLow empathy/remorseADHDPoor complianceLow commitment to school
73 Protective Factors (SAVRY) Prosocial involvementStrong social supportStrong attachments and bondsPositive attitude toward intervention and bondsStrong commitment to schoolResilient personality traits
74 Risk Assessment in Practice Ask about violence and antisocial behaviorsInjuryWeapon useContextPrecipitantsMental stateSubstance useVictimsPurposePatterns
75 Data Gathering Can’t rely on self-report alone Assess established risk factorsAssess protective factors-small body of researchIdentify things that might mitigate riskADHD medicationFamily therapy
77 Psychopathy Not in DSM, but has lots of construct validity (it exists) Likely to be in DSM-VWe can measure the trait in youthScores not quite as stable among adolescentsIt predicts violencePeople don’t develop the capacity for empathy and then lose it
78 Psychopathy as a Predictive Construct Wooten, Frick, Shelton, and Silverhorn, 1997Looked at CD kids with and without psychopathic personality traits.Ineffective parenting was only correlated with antisocial behavior in those without psychopathy
79 Psychopathy as a Predictive Construct Applegate and McBurnett, 1993Aggressive kids with psychopathic traits had less ANS arousal than aggressive kids without psychopathic traitsFisher and Blair, 1998CD kids with psychopathic traits showed a reward dominant response style and were unable to alter behavior in response to punishment
80 The Role of the Department of Juvenile Services Conduct DisorderThe Role of the Department of Juvenile Services
81 Politics and DJS The Left The Right Rehabilitation Sees kids as victimsAnti-punishmentCrime results from povertyKids need TLCAll kids are good insidePass judgment on the more powerful-”The system failed him”The RightPublic safetySees kids as perpetratorsLock them upCriminals are bornKids need consequencesCriminals are beyond helpPass judgment on the less powerful-”He’s just a bad kid”
82 PoliticsPolitical views are deeply held beliefs about how the world worksWe cling to them to simplify the worldThey provide comfortWe seek data to confirm our theoryDon’t have a theory in search of data. Have data in search of a theory.
83 How Politics Mislead Us: The Left Studies show that incarcerated kids have the highest recidivism rates, so we should not incarcerate kids.Measures used to combat aggression (i.e., seclusion, restraint) will only re-traumatize the children and are unnecessary.If you treat them for their trauma experience, the behavior problems will go away.
84 How Politics Mislead Us: The Right Criminals are born. You can’t help these kids.We need zero tolerance and harsh punishments or we will encourage crime.Things like trauma and ADHD are an excuse. They don’t really matter.
85 DJS Facilities: A History DJS facilities were prisons without any treatment.They were run by correctional personnel with little training whose primary concern was security (don’t let anyone run away).Then, we brought in professionals to provide treatment.But, the treatment personnel just ran a clinic, providing therapy. They didn’t impact how the facility was run.Today, states differ in the degree to which trained professionals are involved in the running of facilities.No accreditation body whose approval is attached to federal dollars.Some federal oversight through the Civil Rights of Institutionalized Persons Act (CRIPA)
86 DJS Disposition: A History Judges have typically relied on probation officers to make disposition.Probation officers tend not to have the training needed to determine a youth’s level of risk.Probation officers personal feelings guide them.Psychological evaluations have helped.Actuarial instruments have also helped.
87 Conduct Disorder and DJS DJS must recognize the heterogeneity of their populationDisposition should be based on the science of risk assessment and what we know about diagnostic distinctions within the group of kids meeting criteria for Conduct DisorderDetention should be brief, used until placement can be made in a treatment-oriented facilityNothing good happens in detentionMost kids will need community-based treatmentKids who present a danger to the community should be housed in secure residential facilities that provide treatment.Must have placements and community-based treatment for those with low IQWe should avoid the use of treatments administered in groups. They bring deviant kids together.
88 Deviant Peer Influences in Programs Dodge et. al. (2006) have summarized research showing that placing youth who engage in deviant behavior together in programs has harmful effects.Proximity to criminal models is a known risk factor for criminal activity.This influence is most powerful on marginally deviant youth and younger teens.Highly deviant youth are beyond the influence of others.Well-adjusted kids are immune to the influence of deviance.This body of research suggests that we avoid placing younger, marginally deviant kids in programs where services are provided in a group format.
89 Aggression and Delinquency Delinquency-more strongly influenced by the environmentAggression-a stable, heritable traitIt is critical that we distinguish between aggression and delinquency.Kids with a long history of aggression should be treated separately from other kids.
90 A Continuum of Care for Life-Course Persistent Conduct Disorder The data suggests these will be hard kids to change, but we are not paid to give up.Longer term (12 to 18 months), locked residential programStrong behavioral componentInterpersonal skills trainingAnger management trainingConfrontation of aggression, bullying, and other antisocial behaviorsHigh number of direct care staffHighly structured athletic programsSocial information processing trainingSeclusionHigh recidivism should be expectedGradual step down into the communityKids may need to return to residential care for more treatment-preferably the same facilityHighly aggressive youngsters may spend major portions of their adolescence in residential care
91 A residential program for highly impulsive, ADHD Good psychiatric careFamily and youth education regarding ADHDSmall classroom, frequent breaks, rewards for on-task behaviorsHighly structured athletic programInterpersonal skills trainingVocational emphasis with a real vocational program.Lots of space, privacy
92 A program for substance abuse driven criminal involvement Continuum of careSolid month-long inpatient programLonger term residential programIntensive outpatient program
93 Community-Based, Evidence-Based Treatments for Conduct Disorder Multisystemic TherapyFunctional Family therapyMultidimensional Treatment Foster Care
94 Multisystemic Therapy Systems-based, strength-based treatmentIn-home services, daily contactTherapists have small caseload (3-6 cases) and are available 24/7Time-limited-3-5 monthsTherapist work in teams of three or four with supervision from MST experts to promote adherence to the model
95 Functional Family Therapy Average of 12 sessions over a three to four month periodSessions can be conducted in home, clinic, school, probation officeStrength-basedFocuses on risk and protective factorsEngagement, motivation, relational assessment, behavior change, generalization
96 Multi-Dimensional Treatment Foster Care Based on social learning theory (Patterson)Mechanism of change is through relationships with othersClear expectations and consequences delivered in a neutral, teaching mannerPoint and level systemWeekly individual therapyWeekly skill buildingClose monitoringDaily mentoring by MTFC parentsWeekly contact with parents and frequent home visitsProgram supervisor on-callWeekly family counseling-teach families behavior management
97 Individual Therapy No evidence-based individual therapies Weaknesses in evidence-based requirementConduct Disorder is more than one disorderEvidence-based-often means that the recidivism rate was lower than ‘treatment as usual.” It doesn’t mean it was zero.Many therapeutic surprisesThese kids need to build skillsSocial skillsAnger managementHostile attributional biasThey need to process traumas
98 Individual Therapy-Anger Management You must sell them on anger managementLook at thoughts-feelings-actionsTeach about the hostile attributional biasExplore the intent of other’s behaviorRe-evaluate the aggressive response-is it serving you? Do what works!Don’t expect empathy. Show them why non-aggression is in their best interest.Look at the source of underlying anger-abuse, deprivation, neglect
99 Individual Therapy-Anger Management “Real power comes from self-control”“The least powerful citizens in our society are in prison”“Your fists may help you on a street corner, but they won’t put food on your table when you are an adult”“If you go into social interactions expecting problems, you will get them”“You don’t have to be loud to stand up for yourself”“If I say ‘Good Morning’ to someone I don’t like, it doesn’t make me weak or phony; it makes me polite”Give them the words to express the angerThey will experience your words as “soft”
100 Individual Therapy-Anger Management Encourage them to try new behaviorsThey have trouble taking advice from others-stirs up feelings of envy, you have things that they don’t. Can’t be in a one-down position. So, be amazed by them sometimes.Yet, you must convince them of your expertise (inject more of yourself than with other patients) “You’re either the Wizard of Oz, or they have no use for you”“I have keys to this facility. I want you to have keys too.”“Do you think people walk all over me?”Show them how much more relaxed your approach is-they like to think they are relaxed
101 Individual Therapy-Moral Development Ok to express moral discomfort-”So, you take other people’s stuff?”“Why are you surprised that people are treating you so badly?”“If you help nine old ladies across the street, but you take the tenth old lady’s purse, you are a thief.”Pro-social behaviors are in their best interest80% of people get their job through a social connectionWhen I treat people with respect, even disrespectful people; other people notice this and respect meBy focusing on the harm others can do to you, you are missing out on the ways they can help you
102 Individual Therapy-Abuse Issues Tough to work on abuse issuesThey deny abuseDon’t want to appear weakFeel they deserved the beatingsBoys fear sexual abuse makes them gayHard for them to be vulnerableExperience empathy as pity“Do you know any children the same age you were when you were abused?”Denial of affect can be a defense or a sign of the callous-unemotional quality found in psychopathy
103 Conduct Disorder and Suicide Relationship between depression and suicide attempts is not as strong in adolescents70% of adolescent completers-Conduct Disorder15-33%-Substance Abuse40-50% are clinically depressedAttributional style- see negative events as their fault and pervasive in their life, positive events are happenstancePoor problem-solversImpulsivityPoor relationship with parentsPrecipitating Life EventsLoss of relationshipSexual concernsAchievement pressureFamily suicide
104 Problems in the Conduct Disorder Literature Is it really a single disorder or are we doing studies on kids with several different disorders?Aggression can result from non-anxious psychopathic process (low ANS arousal) or from highly traumatized, defensive, hostile attributional bias (high ANS arousal).What works for who?
105 TzkseminarsKeith Hannan, Ph.D., consultant to juvenile facilities on “Conduct Disorder.” Dr. Hannan also does a Friday afternoon webinar series on juvenile delinquencyDavid Shapiro, Ph.D., the father of clinical forensic psychology on the “Fundamentals of Forensic Assessment.” Learn forensic assessment from the best.David McDuff, M.D., consultant to the Baltimore Orioles and Ravens on “Sports Psychiatry.” This webinar is appropriate for all mental health clinicians interested in working with athletes. He also does “The Treatment of Complex Alcohol, Tobacco, and Drug Dependence.”Heather Hartman-Hall, Ph.D., internship training director and talented clinician on “Making Sense of the Complexities of Trauma.”Scott Hannan, Ph.D., seen on the show “Hoarders,” on “Cognitive Behavioral Therapy for School Refusal” and “The Treatment of Hoarding.”Monnica Williams, Ph. D., Co-Director of the Center for mental Health Disparities, on “Psychotherapy With African Americans.”New speakers coming soon!!!
106 To Get Your CEU Certificate Go to our website: tzkseminars.comLog in using your address and passwordComplete the webinar evaluationDownload your certificate