Download - Introduction to Behavioral Pediatrics
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Introduction to Behavioral PediatricsJodi Polaha, Ph.D.Assistant Professor, PediatricsMunroe-Meyer InstituteUniversity of Nebraska Medical Center
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Overview
Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)BackgroundAssessmentTreatment
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ODD
Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures.
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ODD
Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures.
Does not involve major antisocial violations.
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ODD
Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures.
Does not involve major antisocial violations.
Frequently confused with ADHD.
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ODD
DSM-IV Criteria Loses temper Argues with adults Actively defiant or refuses to comply Deliberately annoys people Blames others for own mistakes Touchy or easily annoyed Angry or resentful Spiteful or vindictive
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ODD
Enduring pattern. Early behavioral intervention
very successful. No medication treatment.
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ODD
Coercive Family Processes (Patterson)
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ODD
Coercive Family Processes (Patterson)
Child escalatesgets his way
Parent gives inGets peace and quiet
Pattern of two-way negative reinforcement
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ODD
AssessmentOf 10 commands…?
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ODD
AssessmentOf 10 commands…?Routines: eating, sleeping, public.
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ODD
AssessmentOf 10 commands…?Routines: eating, sleeping, public.Eyberg Child Behavior Inventory
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ODD
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ODD
AssessmentOf 10 commands…?Routines: eating, sleeping, public.Eyberg Child Behavior InventoryIn-clinic observation
• Formal• Informal
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ODD
What behavioral skills?
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ODD
What behavioral skills?Self-quietingAnger managementFollowing instructions, rulesIndependent playSocial skills
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ODD
What behavioral skills?Self-quietingAnger managementFollowing instructions, rulesIndependent playSocial skills
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ODD
Thinking time question #1:How to improve skill of self-
quieting?
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ODD
Self-quietingPredictablilityRepetition/PracticeHigh contrast or “big difference”
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ODD
Parent-Child Interaction TherapySheila Eyberg (1990s)Forehand & McMahon (1980s)Hanf (1960s)
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ODD
Part 1.Child’s Game“CDI”
Part 2.Parent’s Game“PDI”
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ODD
Part 1.Child’s Game“CDI”
To establish the parent’s positive attention as a reinforcer.
Part 2.Parent’s Game“PDI”
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ODD
CDI
Do: Don’t:Describe CommandPraise ReprimandTouch Question
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ODD
CDI
5-10 min. per day. Bug in the ear. Work to criteria. Feedback in subsequent
sessions.
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ODD
Part 1.Child’s Game“CDI”
GOALTo establish the
parent’s positive attention as a reinforcer.
Part 2.Parent’s Game“PDI”
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ODD
Part 1.Child’s Game“CDI”
GOALTo establish the
parent’s positive attention as a reinforcer.
Part 2.Parent’s Game“PDI”
GOALTo establish
“instructional control”
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ODD
PDI
Do: Don’t:Good commands Nag, etc.Consistent response Vascillate
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ODD
PDI
Compliance trainingTime-Out
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ODD
Time-Out (my version)
Misconceptions: Must be quiet/still Must be sorry Must understand why Length
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ODD
Time-Out (my version)
Definition:
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ODD
Time-Out (my version)
Definition: no access to attention or anything fun
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ODD
Time-Out (my version)
1-3 min in chair Noncompliance and aggression Daily reward
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ODD
Time-Out (my version)
IMPORTANT TOPICS: Extinction burst/training time-out
chair Pick your battles
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ODD
Job Card Grounding
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ODD
Job Card Grounding Rules Odd Jobs (Job Cards) Incentives
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ODD
Three types of consequences:
Natural
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ODD
Three types of consequences:
Natural Related
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ODD
Three types of consequences:
Natural Related Unrelated
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ODD
Thinking time question #2:
How to get child to stay in car seat?
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ODD
Thinking time question #3:
How to decrease disruptive behavior in church?
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ODD
Thinking time question #4:
How to get family to keep their “things” out of main areas of house?
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CD
Persistent pattern of behavior that is not socially acceptable
May violate rights of others.
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CD
DSM IVAggression to people and animals
• Often bullies threatens or intimidates• Often initiates physical fights• Has used a weapon/can cause harm• Has been physically cruel• Has stolen with confrontation• Has forced someone into sexual
activity
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CD
DSM IVAggression to people and animalsDestruction of property
• Has deliberately engaged in fire-setting to cause damage
• Has deliberately destroyed others’ property
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CD
DSM IVAggression to people and animalsDestruction of propertyDeceitfulness or theft
• Has broken into someone else’s house, building or car
• Often lies to obtain goods/avoid obligation
• Has stolen items of nontrivial value w/o confrontation
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CD
DSM IV Aggression to people and animals Destruction of property Deceitfulness or theft Serious violation of the rules
• Often stays out at night despite parental prohibitions before age 13
• Has run away from home overnight at least twice.
• Often truant from school before age 13.
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CD
Treatment OptionsJob Card GroundingProblem-Solving/NegotiatingResidential Treatment