BREAKING DOWN THE BREAKING DOWN THE WALLS:WALLS:

REACHING THE DEFIANT REACHING THE DEFIANT CHILDCHILD

Without love or caring in a child’s life, a disconnected hollow shell is likely to evolve- a living cavity without conscience, values, or character. The lost heart begins to construct a wall one brick at a time. While waiting for someone to care, someone to reach out, someone to make a difference, the wall gets bigger and bigger. The lost heart begins to use the wall to shield it from the pain of rejection and failure. It becomes easier to attack and alienate, to blame and defend, than to risk the pain of not feeling as though you have something special, something others would value, something others would care about. And if we miss the window of opportunity to nourish this hungry heart before the wall is completed, we only have to look to the streets or to our prisons, collection grounds for empty hearts who were never fully nourished, to see what the absence of this emotion can do to a child. So, before we talk about kids needing to be intrinsically motivated or “just do the right thing for the sake of doing the right thing,” we need to recognize that we might be mistaken when we assume we can walk in a child’s shoes or view the world through his eyes. Every child needs to feel that he has value, that he is cared for, that he is loved. Today we hope we will start you on your journey to “breaking down the walls.”

Breaking Down the WallsBreaking Down the Walls

From “In Search of a Heart”

ATTACHMENT DISORDERATTACHMENT DISORDER

OPPOSITIONAL DEFIANCE DISORDEROPPOSITIONAL DEFIANCE DISORDER

CONDUCT DISORDERCONDUCT DISORDER

ATTENTION DEFICIT HYPERACTIVITY ATTENTION DEFICIT HYPERACTIVITY DISORDERDISORDER

EMOTIONAL IMPAIRMENTEMOTIONAL IMPAIRMENT

ANXIETY DISORDERSANXIETY DISORDERS

FETAL ALCOHOL SYNDROMEFETAL ALCOHOL SYNDROME

ASPERGERS SYNDROMEASPERGERS SYNDROME

THE NATURE OF THE NATURE OF ATTACHMENTATTACHMENT

Presented by Steven VittoPresented by Steven Vitto

The National Adoption Center reports that 52% of adoptable children have attachment related atypical behavioral symptoms

Eighty percent of maltreated infants also have attachment related behavioral symptoms

Sixty to eighty percent of children who have spent time in foster care show marked symptoms

It is estimated that over half of all incarcerated adults suffer from of psychopathology caused by breaks in childhood attachment

“AN ATTACHMENT FORMS BETWEEN INFANT AND PRIMARY CAREGIVER SOMETIME DURING THE INFANT’S FIRST TWO YEARS OF LIFE.”

Attachment is the “lasting psychological connectedness between human beings.”

““The quality of our attachment acts as a The quality of our attachment acts as a

foundation for our future.”foundation for our future.”

The Basic Function of The Basic Function of Secure AttachmentSecure Attachment

Learn basic trust and reciprocity. Explore the environment with feelings of safety and security which

leads to healthy cognitive and social development. Develop the ability to self-regulate, which results in effective

management of impulses and emotions. Create a foundation for the formation of identity. Establish a prosocial moral framework, which involves empathy. Generate the core belief system. Provides a defense against stress and trauma.

““AN ATTACHMENT DISORDER OCCURS AN ATTACHMENT DISORDER OCCURS WHEN THE ATTACHMENT PERIOD IS WHEN THE ATTACHMENT PERIOD IS

DISRUPTED OR INADEQUATE, LEAVING DISRUPTED OR INADEQUATE, LEAVING THE CHILD WITH THE INABILITY TO FORM THE CHILD WITH THE INABILITY TO FORM A NORMAL RELATIONSHIP WITH OTHERS A NORMAL RELATIONSHIP WITH OTHERS

AND CAUSING AN IMPAIRMENT IN AND CAUSING AN IMPAIRMENT IN DEVELOPMENT.”DEVELOPMENT.”

Risk Factors for Developing Risk Factors for Developing Attachment Disorders. Attachment Disorders.

Maternal ambivalence towards pregnancy.Maternal ambivalence towards pregnancy. Sudden separation from the primary caregiver Sudden separation from the primary caregiver

(death of mother, hospitalization).(death of mother, hospitalization). Abuse (physical emotional sexual).Abuse (physical emotional sexual). Frequent moves and placements (foster care, Frequent moves and placements (foster care,

failed adoptions).failed adoptions).

Risk Factors Risk Factors (Continued…)(Continued…)

Traumatic prenatal experience (in-utero exposure to alcohol/drugs).

neglect or parental ambivalence. Genetic predisposition. Birth trauma. Undiagnosed and/or painful illness or injury. Inconsistent or inadequate day care. Unprepared mothers with poor parenting skills.

DSM-IV RAD DEFINITIONDSM-IV RAD DEFINITION

A markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age five, as evidenced by either:

Inhibited TypeInhibited Type

(failure to initiate or respond in a developmental appropriate fashion-excessively ambivalent, hyper vigilant, excessively inhibited, resistant to comforting, avoidance)

Disinhibited TypeDisinhibited Type

(diffuse attachment manifested by indiscriminate sociability (e.g. excessive familiarity with relative strangers or lack of selectability with attachment figure

Characteristics or Symptoms of Characteristics or Symptoms of Attachment Disorder:Attachment Disorder:

Superficially charming: uses cuteness to get her or his way.Superficially charming: uses cuteness to get her or his way. Cruel to animals or people.Cruel to animals or people. Fascinated by fire/death/blood/gore.Fascinated by fire/death/blood/gore. Severe need for control over adults even over minute situations. Severe need for control over adults even over minute situations. Manipulative-plays adults against each other.Manipulative-plays adults against each other. Difficulty in making eye-contact.Difficulty in making eye-contact. Lack of affection on parental terms yet overly affectionate to strangers.Lack of affection on parental terms yet overly affectionate to strangers. Bossy.Bossy. Shows no remorse---seems to have no conscience.Shows no remorse---seems to have no conscience. Lies and steals.Lies and steals. Low impulse control.Low impulse control. Lack of cause/effect thinking.Lack of cause/effect thinking. Destructiveness to self, others and material things.Destructiveness to self, others and material things.

Has difficulty making and keeping friends.Has difficulty making and keeping friends.

Speech and language problems.Speech and language problems.

Overall developmental delay.Overall developmental delay.

Demanding/clingy.Demanding/clingy.

Incessant chattering/ Non-stop question asking.Incessant chattering/ Non-stop question asking.

Hoards/Sneaks/ Stuffs food.Hoards/Sneaks/ Stuffs food.

Emotions don’t match the situation and Emotions don’t match the situation and

are unpredictable.are unpredictable.

Overly sensitive to sights/sounds/touch/smells.Overly sensitive to sights/sounds/touch/smells.

Exhibits hyperactivity.Exhibits hyperactivity.

Exhibits impulsivity.Exhibits impulsivity.

Disregulated eating/sleeping/toileting patterns.Disregulated eating/sleeping/toileting patterns.

ATTACHMENT DISORDER ATTACHMENT DISORDER CHARACTERISTICS (CONTINUED)CHARACTERISTICS (CONTINUED)

DiagnosingDiagnosing

AttachmentAttachment

Disorder Disorder

Attachment ChecklistsAttachment ChecklistsThree types of Adult/child self-report

– Parents record child’s behavior.– Refers to adult functioning.– Checklists and observational inventories used

by assessing professionals.

– Early history is key component in determining an attachment problem.

Compromised Brain Compromised Brain DevelopmentDevelopment

Ross Green (The Explosive Child) suggests that there is compelling evidence to suggest that irregularities in the prefrontal and frontal regions may contribute to the impairments of “excutive thinking skills.”

“The child’s explosive behavior may be unplanned and unintentional and reflect a physiologically based developmental delay in the skills of flexibility and frustration tolerance.”

Schore believes that early life stressful experiences may permanently damage the orbital frontal cortex. The frontal cortex is clearly involved in socialized behavior.

Part of the problems with impulse control and noncompliance may be due to damage in the orbital frontal cortex.

DIAGNOSIS???DIAGNOSIS???

It is important to remember that a diagnosis is not a scientific fact. It is a important to remember that a diagnosis is not a scientific fact. It is a considered opinion based upon the behavior of the child over time, what considered opinion based upon the behavior of the child over time, what

is known of the child's family history, the child's response to is known of the child's family history, the child's response to medications, his or her developmental stage, the current state of medications, his or her developmental stage, the current state of

scientific knowledge and the training and experience of the doctor scientific knowledge and the training and experience of the doctor making the diagnosis.making the diagnosis.

Prognosis:Prognosis:

Eighty percent of children with Oppositional Defiance Disorder showed insecure attachment.

Insecurely attached children often grow up to become insecurely attached parents, and the cycle continues

What the research says about What the research says about overcoming the effects of insecure or overcoming the effects of insecure or

interrupted attachment.interrupted attachment. Prognosis is TenuousPrognosis is Tenuous High Risk for Interpersonal ProblemsHigh Risk for Interpersonal Problems High Risk for Not Responding to Traditional High Risk for Not Responding to Traditional

Behavioral Treatment ApproachesBehavioral Treatment Approaches High Risk for Oppositional DefianceHigh Risk for Oppositional Defiance DisorderDisorder High Risk for Conduct DisorderHigh Risk for Conduct Disorder Age of Intervention is a significant variableAge of Intervention is a significant variable Most Frequently Identified Protective Factors include: Most Frequently Identified Protective Factors include:

Intelligence, Proximity, and ConstancyIntelligence, Proximity, and Constancy

OPPOSITIONAL DEFIANCE OPPOSITIONAL DEFIANCE DISORDERDISORDER

All children are oppositional from time to time, particularly when tired, All children are oppositional from time to time, particularly when tired, hungry, stressed or upset. They may argue, talk back, disobey, and hungry, stressed or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is defy parents, teachers, and other adults. Oppositional behavior is

often a normal part of development for two to three year olds and early often a normal part of development for two to three year olds and early adolescents. However, openly uncooperative and hostile behavior adolescents. However, openly uncooperative and hostile behavior

becomes a serious concern when it is so frequent and consistent that becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and it stands out when compared with other children of the same age and developmental level and when it affects the child’s social, family, and developmental level and when it affects the child’s social, family, and

academic life.academic life.

What is Oppositional What is Oppositional Defiance Disorder?Defiance Disorder?

ODD is a persistent pattern (lasting for at ODD is a persistent pattern (lasting for at least six months) of negativistic, hostile, least six months) of negativistic, hostile,

disobedient, and defiant behavior in a child disobedient, and defiant behavior in a child or teen without serious violation of the basic or teen without serious violation of the basic

rights of others.rights of others.

ODD DEFINEDODD DEFINED

The key distinction from other types

of conduct disorder is the absence

of behavior that violates the law

and the basic rights of others, such

as theft, cruelty, bullying, assault,

and destructiveness

Oppositional Defiance Oppositional Defiance DisorderDisorder

ODD is a nondelinquent conduct disorder ODD occurs in about 6% of children ODD is more common to boys prior to

puberty ODD is equal in both sexes after puberty

What are the Symptoms of What are the Symptoms of Oppositional Defiance Oppositional Defiance

Disorder?Disorder?

Frequent loss of temper; Frequent loss of temper; Arguing with adultsArguing with adultsDefying adults Defying adults Refusing adult requests or rulesRefusing adult requests or rulesDeliberately annoying othersDeliberately annoying othersBlaming others for mistakes and misbehaviorBlaming others for mistakes and misbehavior

Oppositional Defiance Oppositional Defiance DisorderDisorder

Being touchy or easily annoyedBeing angry and resentfulBeing spiteful or vindictiveSwearing or using obscene languageHave a low opinion of themselvesMoody and easily frustrated

It is important to distinguish It is important to distinguish between a won’t problem and between a won’t problem and

a can’t problema can’t problem Can be difficult to assessCan be difficult to assess Treating a can’t problem with punishment can Treating a can’t problem with punishment can

cause distrust and alienationcause distrust and alienation Treating a won’t problem with punishment and Treating a won’t problem with punishment and

reward programs can result in deceit and reward programs can result in deceit and manipulationmanipulation

Contra-Indicated Behavioral Contra-Indicated Behavioral Strategies for the ODD ChildStrategies for the ODD Child

Ultimatums Strict Boundaries: Drawing the Line in the Sand Counts, Warnings, Threats Prolonged Eye-Contact Infringing on Personal Space Social Disapproval Judgmental Responses Response Cost and Punishment Strict Boundaries or Contracts Suspension and Detention, Progressive Discipline

What Causes Oppositional What Causes Oppositional Defiance Disorder?Defiance Disorder?

The cause of Oppositional Defiant Disorder is unknown at this time. The following are some of the theories being investigated: It may be related to the child's temperament and the

family's response to that temperament. A predisposition to ODD is inherited in some families. There may be problems in the brain that cause ODD. It may be caused by a chemical imbalance in the brain. Children with ODD have often experienced a break in Children with ODD have often experienced a break in attachment or bonding during the first 2 years of lifeattachment or bonding during the first 2 years of life

Contributing FactorsContributing Factors Parents and teachers who impose inconsistent ---harsh

punishment mixed with lax, inconsistent rules, neglect, and irrational authority will exacerbate temperamental difficulties with the child.

Temperamental difficulties of the child may include intense affect, withdrawal from novelty, poor self-control, slow adaptation to change, irregular sleep and wake cycles, easily distractibility, etc.

Russell Barkley’s 4-Factor Russell Barkley’s 4-Factor Method: Etiology of ODDMethod: Etiology of ODD

Factor 1: Factor 1:

The child’s or teen’s characteristics Factor 2:Factor 2:

The parent’s characteristics Factor 3:Factor 3:

The family environment and stress Factor 4:Factor 4:

Parenting Style

Factor #1: The child or teen’s Factor #1: The child or teen’s characteristics-Temperamentcharacteristics-Temperament

Temperament is behavioral styleTemperament is behavioral style; it is the ; it is the characteristic way an individual child exper-iences characteristic way an individual child exper-iences and responds to internal and external stimuli.and responds to internal and external stimuli.

The concept of temperament leads to a view of The concept of temperament leads to a view of children as unique individuals, each with his or children as unique individuals, each with his or her own particular vulnerabilities, strengths, and her own particular vulnerabilities, strengths, and coping mechanisms.coping mechanisms.

Responding to Responding to TemperamentTemperament

Expert parenting or teaching not seen as acting according to a set of general rules.

Expert teaching and/or parenting is considered to be founded on a loving, yet objective, understanding of a particular child.

Guidelines for education, scheduling, communication, discipline, and other management strategies vary according to the temperament of the child.

TemperamentTemperament Largely determined by genetic factors.Largely determined by genetic factors. Shows considerable stability over time.Shows considerable stability over time. Can be modified by–but not transformed—by Can be modified by–but not transformed—by

environmental influencesenvironmental influences.. Early 1960’s, Thomas and Chess (New York City) Early 1960’s, Thomas and Chess (New York City)

started to publish articles about temperament; started to publish articles about temperament; described nine traits that contribute to described nine traits that contribute to temperament---temperament---

Nine traits that Contribute to Nine traits that Contribute to Temperament Temperament

1. ACTIVITY: the amount of physical motion during 1. ACTIVITY: the amount of physical motion during sleep, eating, play, dressing, bathing, and so forth.sleep, eating, play, dressing, bathing, and so forth.

2. RHYTHMICITY: the regularity of physio-logic 2. RHYTHMICITY: the regularity of physio-logic functions such as hunger, sleep, and elimination.functions such as hunger, sleep, and elimination.

3. APPROACH/WITHDRAWAL: the nature of initial 3. APPROACH/WITHDRAWAL: the nature of initial responses to new stimuli--people, situations, places, responses to new stimuli--people, situations, places, foods, toys, procedures.foods, toys, procedures.

Temperamental Traits Temperamental Traits

4. ADAPTABILITY: the ease or difficulty with which 4. ADAPTABILITY: the ease or difficulty with which reactions to stimuli can be mod-ified in a desired way.reactions to stimuli can be mod-ified in a desired way.

5. INTENSITY: the energy level of responses regardless 5. INTENSITY: the energy level of responses regardless of quality or direction.of quality or direction.

6. MOOD: the amount of pleasant and friendly, or 6. MOOD: the amount of pleasant and friendly, or unpleasant and unfriendly, behavior in various unpleasant and unfriendly, behavior in various situations.situations.

Temperamental TraitsTemperamental Traits 7. PERSISTENCE AND ATTENTION SPAN: the length 7. PERSISTENCE AND ATTENTION SPAN: the length

of time particular activities are pursued by the child, of time particular activities are pursued by the child, with or without obstacles.with or without obstacles.

8. DISTRACTIBILITY: the effectiveness of extraneous 8. DISTRACTIBILITY: the effectiveness of extraneous environmental stimuli in inter-fering with ongoing environmental stimuli in inter-fering with ongoing behaviors.behaviors.

9. SENSORY THRESHOLD: the amount of stimulation, 9. SENSORY THRESHOLD: the amount of stimulation, such as sounds or light, necessary to evoke such as sounds or light, necessary to evoke discernible responses in the child.discernible responses in the child.

Child Unhappy at Her Own Child Unhappy at Her Own Birthday PartyBirthday Party

Why was this little girl’s party a Why was this little girl’s party a failure? Overlooking Temperament failure? Overlooking Temperament

High intensity (expresses emotions in a strong way, including her present unhap-piness).

Low sensory threshold (uncomfortable in her starched dress, very aware of its scratchiness).

Initial withdrawal (her usual first impulse is to withdraw from new things, and this was a surprise party).

Temperamental Traits of This Temperamental Traits of This Particular Child Particular Child

Poor adaptability (has trouble with transition and change of routine).

Negative mood (doesn’t show pleasure openly, not a “sunny” disposition).

Parents are very disappointed the child did not enjoy her birthday party, and don’t understand why it was not fun for her; they ask her pediatrician’s advice regarding plans for next year’s party.

Factor 2Factor 2The Parent’s CharacteristicsThe Parent’s Characteristics

Physical and temperamental characteristicsPsychiatric disordersMarital problemsPredispositionInadvertent Contributions to ODD

Factor 3Factor 3The Family’s Environment and The Family’s Environment and

Family StressFamily Stress

Economic StatusHousingJobsMarital StatusStressful Environmental Conditions

Factor 4Factor 4Parenting/Teaching StyleParenting/Teaching Style

Inconsistent consequences Lack of positive attention or reinforcement to

prosocial or appropriate child and teen behaviors Poor monitoring of child or teen Punishment of prosocial or appropriate behaviors Extreme attitudes and beliefs Basic Coercive Interchange

Our Need for Power and Our Need for Power and ControlControl

Underlying Systems of Underlying Systems of ControlControl

in Schoolin School The use of reinforcementThe use of reinforcement Response Cost-loss of privileges, loss of points, loss of access to Response Cost-loss of privileges, loss of points, loss of access to

reinforcing events, etc.reinforcing events, etc. Restrictive classroom rules and boundaries-e.g., “ No going in my Restrictive classroom rules and boundaries-e.g., “ No going in my

desk.”desk.” “ “ No going into this area.”No going into this area.” “ “ No talking while in line.”No talking while in line.” “ “ Sitting with both both feet on the floor.”Sitting with both both feet on the floor.” “ “ Raising your hand before talking.”Raising your hand before talking.” Expecting immediate complianceExpecting immediate compliance Suspension, Detention, and other forms of punishmentSuspension, Detention, and other forms of punishment

How should ODD be How should ODD be evaluated?evaluated?

A child presenting with ODD symptoms should have a comprehensive evaluation.

It is important to look for other disorders which may be present; such as, attention-deficit hyperactive disorder (ADHD), learning disabilities, emotional disturbances-I.e.,mood disorders (depression, bipolar disorder) and anxiety disorders.

It may be difficult to improve the symptoms of ODD without treating the coexisting disorder.

Some children with ODD may go on to develop called conduct disorder.

What Is Bullying?Bullying in its truest form is comprised of a series of repeated intentionally cruel incidents, involving the same children, in the same bully and victim roles.

““The scars of The scars of being bullied being bullied

last a life time” last a life time”

Kinds of BulliesKinds of Bullies

Physical BulliesPhysical BulliesVerbal BulliesVerbal BulliesRelational BulliesRelational BulliesReactive BulliesReactive Bullies

By age 24, up to sixty percent of people who are identified as childhood bullies have at least one criminal conviction. A study spanning 35 years by psychologist E. Eron at the University of Michigan found that children who were named by their school mates, at age eight, as the bullies of the school were often bullies throughout their lives

•bullying occurs once every seven minutes

•on average, bullying episodes are brief, approximately 37 seconds long

•the emotional scars from bullying can last a lifetime

•the majority of bullying occurs in or close to school buildings

•most victims are unlikely to report bullying

•only 25% of students report that teachers intervene in bullying situations, while 71% of teachers believe they always intervene

•situations, therefore bullying is often overlooked

RESEARCH ON BULLYINGRESEARCH ON BULLYING

Most Children with ODD Most Children with ODD havehave

an ADHD componentan ADHD component

ADHDADHD

“That energy which makes the child hard to manage, is the energy, which makes him a manager of life.”

“Just when I thought about not doing something, I already did it.”

Logo seen on T-shirt for ADHD adult “They say I have ADHD, did you see that chicken go by?”

Characteristics of ADHDCharacteristics of ADHD

Inattentive TypeInattentive Type spacey, mild anxiety, socially withdrawn, day dreamers, difficulty sustaining attention, difficulty listening, often leaves school work

unfinished,difficulty with organization, problems with sustained mental effort, forgetful,distractible

Hyperactive Impulsive TypeHyperactive Impulsive Type fidgets,squirms,impulse control difficulties, excessive talking or blurting out, out of seat, difficulty

playing quietly, always moving, difficulty waiting turn

CONDUCT DISORDER AND CONDUCT DISORDER AND EMOTIONAL IMPAIRMENTEMOTIONAL IMPAIRMENT

WHAT IS EI? What is Social WHAT IS EI? What is Social Maladjustment or Behavioral Maladjustment or Behavioral

Disturbance?..and where does Conduct Disturbance?..and where does Conduct Disorder fit in? Disorder fit in?

Emotional Impairment is terminology used in the Emotional Impairment is terminology used in the educational setting in conjunction with Behavioral educational setting in conjunction with Behavioral Disturbance which is language used in IDEA.Disturbance which is language used in IDEA.

Social maladjustment is conceptualized as a Social maladjustment is conceptualized as a conduct problem.conduct problem.

Social maladjustment tends to be an educational Social maladjustment tends to be an educational term which is frequently interchanged with the term which is frequently interchanged with the term Conduct Disorder in DSM IV.term Conduct Disorder in DSM IV.

Social Social Maladjustment; Maladjustment;

Conduct DisorderConduct Disorder

Social Maladjustment and Social Maladjustment and Emotional Impairment are two Emotional Impairment are two distinct behavioral disorders. distinct behavioral disorders.

According to educational guidelines, According to educational guidelines, students with social maladjustment students with social maladjustment

are not truly disabled. (This however, are not truly disabled. (This however, does not mean that they do not have does not mean that they do not have

needs!)needs!)

Students with conduct disorder engage in Students with conduct disorder engage in deliberate acts of self-interest to gain attention or to deliberate acts of self-interest to gain attention or to

intimidate others. intimidate others.

They experience no distress or self-devaluation or They experience no distress or self-devaluation or internalized distress.internalized distress.

Conduct Disorder is best understood as a Conduct Disorder is best understood as a distinctive pattern of antisocial behavior that distinctive pattern of antisocial behavior that violates the rights of others. Individuals with violates the rights of others. Individuals with conduct disorder break rules/violate norms conduct disorder break rules/violate norms across settings. across settings.

Conduct DisorderConduct Disorder

Maladjusted/Conduct Disorder students:Maladjusted/Conduct Disorder students: perceive themselves as normal are capable of behaving appropriately choose to break rules and violate norms. view rule breaking as normal and acceptable. are motivated by self-gain and strong survival skills lack age appropriate concern for their behavior displayed behavior which may be highly valued in a

small subgroup display socialized or unsocialized forms of

aggression due not display anxiety unless they fear being caught intensity and duration of behavior differs markedly

from peer group

DSM-IV Criteria for Conduct DSM-IV Criteria for Conduct Disorder:Disorder:

•Aggression-bullies, threatens others, fights, uses a weapon, cruel to people/animals, forced sexual activity •Destruction of property-fire setting, destroyed others' property •Deceitfulness or theft-broken into houses/cars/buildings, often lies or cons others, has stolen without victim present •Serious rule violations-often stays out at night without permission, has run away, is often truant.

(DSM -IV, 1994)

Social Maladjustment/Conduct Disorder;Social Maladjustment/Conduct Disorder;In Search of a HeartIn Search of a Heart

Lack of a conscienceLack of empathyFailure to take responsibility for behaviorIntentional in rule violation and norms

Co-Morbidity and C.D.Co-Morbidity and C.D. A proportion of individuals with ODD later develop A proportion of individuals with ODD later develop

CD, and a proportion of those with CD will later CD, and a proportion of those with CD will later develop ASPD (Loeber, Burke, Lahey, & Zera, 2000).develop ASPD (Loeber, Burke, Lahey, & Zera, 2000).

  Studies researching the co-morbid associations with Studies researching the co-morbid associations with CD have found significant co-morbid relationships CD have found significant co-morbid relationships between CD and learning disorders, anxiety disorders, between CD and learning disorders, anxiety disorders, mood disorders, and substance related disorders. mood disorders, and substance related disorders.

The comorbidity rate for CD and ADHD in The comorbidity rate for CD and ADHD in the community population is 23 %. The the community population is 23 %. The

comorbidity rate for CD and major comorbidity rate for CD and major depression in the community population is depression in the community population is

17 %. The comorbidity rate for CD and 17 %. The comorbidity rate for CD and anxiety disorders in the community anxiety disorders in the community

population is 15 % (Carr, 2000).population is 15 % (Carr, 2000).

Students with Emotional Students with Emotional Impairment engage in Impairment engage in involuntaryinvoluntary patterns of patterns of

behavior and experience behavior and experience internalized distressinternalized distress about about

their behaviors. their behaviors.

SOMETIMES THEY JUST SOMETIMES THEY JUST REALLYREALLY CAN NOT HELP IT! CAN NOT HELP IT!

It is hard to pick a direction….It is hard to pick a direction….

What is Michigan’s Criteria for What is Michigan’s Criteria for an Emotional Impairment?an Emotional Impairment?

Emotional Impairment shall be determined through manifestation of behavioral problems primarily in the affective domain, over an extended period of time, which adversely affect the student’s education to the extent that the student can not profit from learning experiences without special education support.

Emotional Impairment MET Emotional Impairment MET Form ContinuedForm Continued

The problem result in behaviors manifested by 1 or more

of the following: (A) An inability to build or maintain satisfactory

interpersonal relationships with peers and teachers. (B) Inappropriate types of behavior or feelings under

normal circumstances. (C) A general pervasive mood of unhappiness or

depression. (D) A tendency to develop physical symptoms or fears

associated with personal or school problems.

Emotional Impairment also includes Emotional Impairment also includes students who, in addition to the students who, in addition to the characteristics specified above, exhibit characteristics specified above, exhibit maladaptive behaviors related to maladaptive behaviors related to schizophrenia or similar disorders.schizophrenia or similar disorders.

The term “Emotional Impairment” does not include persons who are socially

maladjusted, unless it is determined that the persons have an Emotional Impairment.

It is possible for a student to It is possible for a student to exhibit behaviors characteristic of exhibit behaviors characteristic of both disorders and then certified both disorders and then certified

appropriately as Emotionally appropriately as Emotionally Impaired. A thorough, objective Impaired. A thorough, objective

evaluation is the key to an evaluation is the key to an appropriate outcome. appropriate outcome.

Educational options for Emotionally Impaired Educational options for Emotionally Impaired and Socially Maladjusted students often and Socially Maladjusted students often

parallel.parallel.

Small class size, individualized programming, modified Small class size, individualized programming, modified curriculum.curriculum.

Work study, adjusted school hours, vocational Work study, adjusted school hours, vocational programming, shorten academic periods and programming, shorten academic periods and alternative placement.alternative placement.

For the child with an Emotional For the child with an Emotional Impairment, diffusing a crisis will Impairment, diffusing a crisis will often involve reducing anxiety. often involve reducing anxiety.

For the child with Conduct For the child with Conduct Disorder and effective response Disorder and effective response

should increase anxietyshould increase anxiety

Emotional Impairment does not include students whose behaviors are primarily the result of intellectual, sensory, or health factors.

Internal vs. External Internal vs. External Behaviors Behaviors

Disorders viewed as internalizing: Affective disorders, Elective Mutism, Separation Anxiety Disorder may qualify as Emotional Impairment

Disorders viewed as externalizing: Conduct Disorder, Oppositional Defiant Disorder or Anti-Social Personality Disorder, may indicated Social Maladjustment

Differential Diagnosis is important to determine if the external behavior may look the same, but the underlying reasons, etiology and intent, may be different.

IT IS NOT UNCOMMON THAT A MENTAL HEALTH IT IS NOT UNCOMMON THAT A MENTAL HEALTH DISORDER GETS MISSEDDISORDER GETS MISSED

Major Depression: Major Depression: ¼ to ½ of children with CD have either anxiety disorder or depression

Bipolar Disorder: Bipolar Disorder:

Anxiety Disorder:Anxiety Disorder:

Reactive Attachment DisorderReactive Attachment Disorder

Tourette’s SyndromeTourette’s Syndrome

Personality DisorderPersonality Disorder

Eating Disorders:Eating Disorders:

Attention Deficit Hyperactivity Disorder:Attention Deficit Hyperactivity Disorder:

Substance Abuse:Substance Abuse:

Things that you already know Things that you already know that will help with EI and CD that will help with EI and CD

students:students:Daily ScheduleTransition TimeConsistent Assignment FormatPositive Behavior SupportTeacher/Student ContactFunctional Behavioral AssessmentBehavior Intervention Plan

The ODD and CD ChildThe ODD and CD Child

We take them home with us every day. Our family knows them without ever having met them. We dream about them. They learn how to push our buttons. They can take us down a road we don’t want to travel. They make us think that maybe we should have gone

into marketing or real estate. They are extremely difficult to like at times…

Our most challenging Our most challenging childrenchildren

May not respond to traditional consequences Will require more support and change on our part Will need a significant positive relationship at

school Will need another way to find acceptance in the

school environment May be resistant to strategies to develop self

control

To Reach the 1-7% To Reach the 1-7% Abandon ineffective practices. Resist inclination to exclude. Separate what the child deserves and what he needs. Realize that he/she needs our support and forgiveness the

most. Reframe who they are. Think “outside the box.” Abandon expectation of a quick fix Need a 7:1 reinforcement ratio, with meaningful incentives Need peer support. Need to undermine harmful mentors

Problems with PunishmentProblems with Punishment Punishment focuses on external controlPunishment focuses on external control but does little to teach internal control.but does little to teach internal control. Punishment does not teach the child how to meet needs previously being Punishment does not teach the child how to meet needs previously being

served by the target behavior.served by the target behavior. Punishment backfires with students who are oppositional and defiant.Punishment backfires with students who are oppositional and defiant. Punishment often triggers an escalation of behavior and may elicit tantrums Punishment often triggers an escalation of behavior and may elicit tantrums

and aggression.and aggression. Punishment models a type of authority that resolves conflict by power and Punishment models a type of authority that resolves conflict by power and

inflicting discomfort or pain.inflicting discomfort or pain. Punishment is a quick term-fix that takes much less time than to teach the Punishment is a quick term-fix that takes much less time than to teach the

child betters ways of behaving.child betters ways of behaving. Research has shown that punishment strategies have poor transferability.Research has shown that punishment strategies have poor transferability. Punishment is inconsistent with the concept of mutual respect.Punishment is inconsistent with the concept of mutual respect. Punishment often excludes and isolates a child when teaching and support is Punishment often excludes and isolates a child when teaching and support is

needed most.needed most.

Best Practice InterventionsBest Practice Interventions To be covered this afternoon To be covered this afternoon

General Treatment of ODDGeneral Treatment of ODD Ross Green’s 3 Basket ModelRoss Green’s 3 Basket Model RAD-Protective Factors and RelationshipRAD-Protective Factors and Relationship Life Space Crisis InterventionLife Space Crisis Intervention Positive Behavioral Supports & Functional Positive Behavioral Supports & Functional

AssessmentAssessment Balanced and Restorative JusticeBalanced and Restorative Justice Howard Glasser’s Nurtured Heart ApproachHoward Glasser’s Nurtured Heart Approach

Finding the Heart:Finding the Heart:Breaking Down the WallsBreaking Down the Walls

Can we teach the CD, RAD child to care?Building a conscience one step at a timePenetrating the wallCaring for othersFinding their heartRandom acts of kindnessRight for the Sake of Right

Supportive Interventions for Supportive Interventions for the child with RADthe child with RAD

Proximity is essential Consistency and Stability Holding therapy Applied Behavioral Analysis (Barkley) Building Relationships (Bendtro) Cognitive Behavioral Therapy Life Space Crisis Intervention Positive Behavioral Supports BARJ

General Approach Strategies for General Approach Strategies for the RAD,ODD,CD Childthe RAD,ODD,CD Child

Avoid UltimatumsAvoid Ultimatums Avoid drawing the line in the sandAvoid drawing the line in the sand Avoid social disapproval and negative reprimandsAvoid social disapproval and negative reprimands Avoid Warning and Counting PromptsAvoid Warning and Counting Prompts Avoid rules that challenge (“ Don’t spit on the side walk”)Avoid rules that challenge (“ Don’t spit on the side walk”) Avoid reverse psychologyAvoid reverse psychology Avoid punishment and exclusionAvoid punishment and exclusion Avoid emotional reactionsAvoid emotional reactions Avoid bullying or external control strategiesAvoid bullying or external control strategies Avoid arbitrary or inconsistent consequences between Avoid arbitrary or inconsistent consequences between

staffstaff

Recommended General Recommended General Strategies for the RAD,ODD, Strategies for the RAD,ODD,

CD childCD child Provide choices Provide adequate response time Provide consistency and predictability Provide a calm, neutral approach Encourage ownership in development of plan Provide appropriate opportunities for control Work at building relationships Work at breaking down the walls Provide meaningful incentives Provide consistent and reasonable consequences

SEARCH FOR THEIR TALENTS

BUILDING BUILDING RELATIONSHIPSRELATIONSHIPS

The Hidden VariableThe Hidden Variable

Protective FactorsProtective Factors

Attributes or assets than when Attributes or assets than when present protect the child from present protect the child from developing harmful, destructive, and developing harmful, destructive, and ineffective behaviors. ineffective behaviors.

External Protective FactorsExternal Protective Factors Care and Support a. close bonds

b. positive role models c. support of friends

Setting High Expectations providing supports to achieve high expectations

Encouraging Meaningful Roles a. valued for accomplishments

b. genuinely needed c. given meaningful roles

Internal Protective FactorsInternal Protective Factors

Social SkillsSocial SkillsProblem Solving SkillsProblem Solving SkillsSelf-ControlSelf-ControlSelf-EfficiencySelf-EfficiencyOptimism Optimism

Building Community is Building Community is About RelationshipsAbout Relationships

What is a true friend?Developing the rulesDignity and mutual respectConsequence should teach and restore What do we do when we get angry?Learning how to compliment othersLearning how to care through modeling

Ross Greene’s Ross Greene’s Three Basket MethodThree Basket Method

Three goals with this method:

1. To maintain adults as authority figures.

2. Teach skills of flexibility and frustration

tolerance.

3. Awareness of the child’s limitations.

Three basket method: How it Three basket method: How it worksworks

Behaviors are divided into three baskets. Basket ABasket A-are non-negotiable behaviors- usually fall into the

safety and rights of others category. These behaviors are those that are important enough to endure

a “meltdown” over. Child must be capable of successfully exhibiting this behavior

on a fairly consistent basis.Basket BBasket B- These behaviors are important but can be worked on

over time. They are not behaviors worth inducing a “meltdown” over.

Basket CBasket C-These behaviors are those that could be ignored without any significant repercussions.

Advantages of this Advantages of this Treatment ApproachTreatment Approach

Breaks behaviors down into three approachable categories.

Emphasizes communication and problem solving techniques over rewards and punishments.

Teaches frustration tolerance.Absolves blame while keeping the child’s

self-esteem in tact.

Limitations of the 3-basket Limitations of the 3-basket methodmethod

It is ideal to make this work that all parties; teachers, parents, support staff be able to work together.

Dr. Greene is careful to point out that even though there are some issues that the non-medical approach addresses more effectively than the medical approach there are indeed some factors medicine addresses better than the non-medical approach. – For those children who need medication it will make it more

difficult to teach frustration tolerance when there is also an organic matter.

Life-Spaced Crisis Life-Spaced Crisis InterventionIntervention

Presented by Lisa CobbPresented by Lisa Cobb

Life-Spaced Crisis Life-Spaced Crisis InterventionIntervention

The needs of the troubled and troubling youth we serve today are greater than ever.  

LSCI is a multitheoretical model integrating Psychoeducational, Cognitive, Behavioral, and Pro-Social theories into a dynamic and comprehensive therapeutic strategy.  

It is based in the reality of the young person's immediate circumstances and the patterns that lead repeatedly lead them into crisis situations.  It is initiated by staff whom the youth know, providing excellent opportunities to build or enhance meaningful therapeutic relationships. 

It is clinically powerful and professionally teachable.

LSCI is a time-tested technique for helping troubled and troubling children and youth who are in crisis in their homes, schools, and communities.

Life Space Crisis Intervention is a refreshing alternative to traditional techniques and provides effective alternatives to punishment. LSCI uses crisis as an opportunity for insight and behavior change.

Most staff working with troubled and troubling children and youth have the heart and the experience so necessary for their work. What they often lack are tools:

Knowing what to do when a student:

- refuses to accept responsibility and blames others

- swears at or threatens adults

- gets pleasure out of bringing pain to others

- is manipulated into false friendships

- engages in endless power struggles.

Life Space Crisis Intervention skills empower school staff to intervene effectively when confronted with repetitive patterns of self-defeating behavior common in troubled and troubling students.

Training in LSCI is a five-day intensive experience. Participants will view video taped sequences of actual crisis situations and will see the skills of LSCI effectively demonstrated and analyzed. The training includes much opportunity for skills practice through realistic role plays, activities and exercises.

This intervention is based on twenty-seven specific skills needed to respond successfully to a student's crisis.

These concepts are anchored in supporting, caring relationships between the student and the staff.

There are three possible outcomes of crisis:

Staff student relationship is improved

The staff student relationship is unchanged

The staff student relationship is damaged

How To Use Life Space Interviewing

1.  Intervene.

2.   Listen to the involved parties in a nonjudgmental manner.

3.   Analyze the situation and determine whether this incident is an isolated happening or part of recurring theme.

4.   Choose a specific LSI approach.

5.   Implement the selected approach while being polite, attentive, and concerned.

6.   Change or combine approaches as necessary.

There are five different types of emotional first aid. Which one you use will depend

upon the situation encountered.

1. Reality Rub

The teacher helps the student to realize that s/he has misinterpreted or refused to recognize certain information pertinent to an incident.  The student is made aware that his or her perceptions are not correct, and s/he is informed as to the truth of the situation under discussion.

2.  Value Repair and Restoration

The teacher attempts to awaken dormant values such as respect, empathy, trust, etc.  Many students are unable, at present, to display emotions which represent vulnerability.  They tend to act out aggression, nonchalance, and anger most often.  The teacher attempts to "massage" the numb value areas and help develop appropriate emotional responses to certain situations.

3.  Symptom Estrangement

Some students don't realize that their behavior is inappropriate or bizarre in the eyes of others.  The teacher brings the student's attention to the specific behavior and how it is viewed by others.  It is hoped that the student will come to realize the problem and talk about other ways to meet his or her needs.

4.  New Tool Salesmanship

In this interview, the student is helped to improve his/her ability to react in a problem solving situation.  "Tools" or ways of solving problems are taken from past experience and applied in new situations.

5.  Manipulation of the Boundaries of the Self

This interview is used with two types of students: those who allow themselves to be "used" by others, and those who victimize or take advantage of others.  The student is made aware of his/her behavior pattern in an attempt to make him/her more receptive to interventions.    

Individual Positive Behavior Individual Positive Behavior Supports and Functional Supports and Functional

AssessmentAssessment

““If you know If you know why, you can why, you can figure out figure out how….”how….” W. Edward W. Edward DemingDeming

Finding out why:

Is a journeyIs a journey

Is an investmentIs an investment

Isn’t about blamingIsn’t about blaming

Is a team effortIs a team effort

Is about trustIs about trust

Is about collaborationIs about collaboration

Is about behavioral legitimacyIs about behavioral legitimacy

Functional Assessment or Functional Assessment or Investigating the BehaviorInvestigating the Behavior

Just like the name:Just like the name:

An opportunity to assess the function of the An opportunity to assess the function of the behaviorbehavior

Why is the behavior occurring?Why is the behavior occurring? What is the child getting because of the What is the child getting because of the

behavior?behavior? What are environmental issues that effecting What are environmental issues that effecting

the behaviorthe behavior

Functional Assessment or Functional Assessment or Investigating the BehaviorInvestigating the Behavior

Your opportunity to play Columbo– Ask questions– Collect as much information about the

behavior as possible– Not a time for judgment – right or wrong.

JUST THE FACTS– Be objective

““Just the facts, mam.”Just the facts, mam.”

Individual Child Individual Child BehaviorBehavior

Functional Assessment (FA)Behavior Intervention Plan (BIP)

The Function of RAD,ODD, The Function of RAD,ODD, and CD Behaviorsand CD Behaviors

NeedsNeedsAttention Escape/AvoidancePower and Control SeekingAnger/FrustrationSensory StimulationTangible

Behavior PlanBehavior Plan

Proactive StrategiesReinforcement StrategiesReactive StrategiesMethod for taking Data

Reinforcement Reinforcement StrategiesStrategies

VerbalProximity/AttentionSocialMaterialActivitiesEdibles

ConsequencesConsequences Decrease the efficiency of the target behavior

while maintaining dignity and an atmosphere of caring

Never degrade or humiliate Logically relate to the target behavior Do not cause more of a problem than the problem

they are addressing Establishes conditions for learning alternative

skills Decreases the frequency, duration, and/or intensity

of the target behavior

Positive Behavioral SupportsPositive Behavioral Supports&&

Balanced & Restorative JusticeBalanced & Restorative Justice

“P“Providing Consequences that Teach roviding Consequences that Teach and Restore”and Restore”

Typical reactive responsesTypical reactive responses

Zero tolerance policiesSecurity guards, student uniforms, metal

detectors, video camerasSuspension/expulsionExclusionary options (e.g., alternative

programs)Retributive JusticePunishment

Parallels to School-based and Parallels to School-based and Community-based Retributive Community-based Retributive

JusticeJustice

MAISD/Beach PBS Team: 2003MAISD/Beach PBS Team: 2003

Parallels to School-based and Community-based Retributive

J usticeBoth are retributiveBoth are exclusionaryBoth provide little concern for the victimBoth are contraindicated by researchBoth have high rates of recidivism for serious offensesBoth have little community restorative elements

Balanced and Balanced and Restorative JusticeRestorative Justice

(BARJ)(BARJ)

View behavioral errors as View behavioral errors as opportunities to teachopportunities to teach

Consequences that restoreConsequences that teach

What is BARJ?What is BARJ?

Philosophy Philosophy Repair the harmRepair the harm Victim, Offender, CommunityVictim, Offender, Community Offence against people vs breaking the rulesOffence against people vs breaking the rules AccountabilityAccountability SafetySafety CompetencyCompetency

Restoration teaches self control Restoration teaches self control through modeling, mediation, and through modeling, mediation, and

community restoration community restoration

Punishment teaches external control Punishment teaches external control through punishment, loss, and exclusion. through punishment, loss, and exclusion.

Behavioral offences are Behavioral offences are wounds…wounds…

Consequences should healConsequences should heal

Restorative Justice in School Restorative Justice in School CommunitiesCommunities

Traditional Misconduct defined as breaking

the rules Focus on establishing blame Conflict represented as

impersonal and abstract Attention given to rules broken School represented by member

of staff dealing with situation Accountability defined as

receiving punishment

Restorative Misconduct defined as behavior

affecting others Focus on problem solving Conflict recognized as

interpersonal with value for learning

Attention given to broken relationships

Total school community involved in facilitation restoration – empowerment

Accountability

References and other References and other Resources to ConsiderResources to Consider

Nurtured Heart ApproachNurtured Heart Approach- Howard Glasser- Howard Glasser Discipline, Love & LogicDiscipline, Love & Logic- Jim Fay- Jim Fay 18 Step Treatment Approach18 Step Treatment Approach-Russel Barkley-Russel Barkley Understanding the Defiant ChildUnderstanding the Defiant Child-Russel Barkley-Russel Barkley Attachment and LossAttachment and Loss-John Bowlby-John Bowlby When Love is Not EnoughWhen Love is Not Enough-N.L.Thomas-N.L.Thomas Conduct Disorder in Childhood and AdolescenceConduct Disorder in Childhood and Adolescence-A.E. Kazdin-A.E. Kazdin 1-2-3 Magic1-2-3 Magic -Thomas Phelan -Thomas Phelan Lost BoysLost Boys-James Garbarino-James Garbarino Raising CainRaising Cain-Dan Kindlon , Michael Thompson -Dan Kindlon , Michael Thompson The Explosive ChildThe Explosive Child- Ross Green- Ross Green Discipline with DignityDiscipline with Dignity-Richard Curwin-Richard Curwin Changing LensesChanging Lenses-Howard Zehr-Howard Zehr A Blueprint for School-wide Positive Behavior SupportA Blueprint for School-wide Positive Behavior Support- R. Horner & G. Sugai - R. Horner & G. Sugai Life Space Intervention-Life Space Intervention-Mary Wood & Nicholas LongMary Wood & Nicholas Long Talking With Students in Conflict:LSCITalking With Students in Conflict:LSCI - - Long, Wood, and FecserLong, Wood, and Fecser

Question and Answer TimeQuestion and Answer Time

Wendy, Lisa, and Steve

EvaluationsEvaluations

““If you treat an individual If you treat an individual as he is, he will stay as he as he is, he will stay as he is, but if you treat him as is, but if you treat him as if he were what he ought if he were what he ought to be and could be he will to be and could be he will become what he ought to become what he ought to

be and could be.”be and could be.” Wolfgang GoetheWolfgang Goethe