Adhd Training Needs Assessment Questionaire - PowerPoint by vsh20797

VIEWS: 0 PAGES: 63

More Info
									    Behaviour Disorders in
   Adolescents: Clinical and
Psychopathological Assessment
    Mª.C. Ballesteros (Hospital Clínico
             Universitario de Valladolid)
         J.L. Pedreira (Hospital Infantil
       Universitario Niño Jesús, Madrid)
Behaviour Disorders and International
Systems of Mental Disorders
Classification/1

• DSM-III (1980): Basic conditions are
  sociabilization:
  – Undersocialized, aggressive or not aggressive
  – Socialized, aggressive or not aggressive
• DSM-III-R (1987): Basic conditions are
  individual or grupal behaviour disorder or
  aggressiveness
Behaviour Disorders and International
Systems of Mental Disorders
Classification/2
• DSM-IV (1994): Basic conditions are disocial
  behaviour and age:
  – Aggression on people and animals
  – Destruction of property
  – Deceitfulness or theft and serious violations rules
• ICD-10 (1992-94): Basic condition is context of
  disocial disorder:
  –   Disocial disorder only on family context
  –   Disocial disorder undersocialized children
  –   Disocial disorder socialized children
  –   Oppositional defiant disocial disorder
HOLLISTIC AND COMPREHENSIVE
   CLINICAL ASSESSMENT IN
  BEHAVIOUR DISORDERS IN
        ADOLESCENCE

Vulnerability
     +           Symptoms            Pronogsis           Tretment
Risk factors
                Clinical diagnosis
                                                 Therapeutic and
                                                 Preventive Interventions
      GLOBAL AND DEVELOPMENTAL
       ASSESSMENT OF BEHAVIOUR
       DISORDERS IN ADOLESCENCE

VULNERABILITY + RISK FACTORS               SYMPTOMS               PROGNOSIS



•Genetic factors     * Unspecific        *Developmental          * Clinical
•Temperament         * Especific:          symptoms               features
                     - Sex               *Clinical               * Protective
mediators            - Family             symptoms                factors
Personality traits   - School            - Diagnostic            * Temperament
Cognitive patterns     - Social            criteria
Neuropsychology                          - Subtypes
Neurophysiology                            - Comorbidity
Neurotransmission
                             Mª C. Ballesteros-Alcalde & J.L. Pedreira-Massa (1999)
   Comprehensive and Developmental
  Assessment of Behaviour Disorders in
            Adolescence/2
            Vulnerability
• Genetic and Temperament factors as mediators
  – Personality traits:
     •   Aggressiveness
     •   Socialization disorders
     •   Impulsiveness
     •   Hyperactivity
  – Cognitive patterns:
     •   Hostile attributions
     •   Egocentric
     •   Low and inconsistent problem-solving skills
     •   Inadequate aims
 Comprehensive and Developmental
 Assessment of Behaviour Disorders
         in Adolescence/3
• Vulnerability: Genetic and Temperament factors
  as mediators
  – Neuropsychology:
     • Low IQ
     • Language disorders
     • Attention disorders
  – Neurophysiology:
     • Low dermal conductivity
     • Loe cardiac rating
  – Neurotransmissions:
     • Dopamine, noradrenaline
     • Serotonine
Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/3
              Risk Factors
• Parental Factors:
  – Antisocial and criminal behaviour
  – Alcoholism
  – Untoward parent-child interaction:
     •   Harsh punishment
     •   Inconsistent punishment
     •   Poor supervision
     •   Coercitive exchanges (escalted aversive interactions)
     •   Less parental warmth, support and comunication with
         children
Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/4
              Risk Factors

• Family Factors:
  –   Marital discord
  –   Large family size
  –   Birth order
  –   Older siblings with antisocial behaviour
  –   Few family activities
  Disruptors of effective parenting
                         Family Demographics
                                Income
                           Parent education
                            Neighborhood
                             Ethnic group


 Grand parental Traits      Parental Traits                    Disrupted
  Antisocial behaviour    Antisocial behaviour             family-management
Poor family management   Susceptible to stressors               practices


                                                    Child antisocial behaviour
                           Family Stressors
                           Unemployement
                            Marital conflict
                              Divorce               B. Lahey & R. Loeber (1994)
Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/5
              Risk Factors
• Child Factors:
  – Child temperament
  – Neuropsychological deficits (in verbal and
    executive” functions)
  – School (academic deficiencies, attendance, peers and
    teacher relationship)
  – Signs of antisocial behaviour: Early onset,
    frequency (number of episodes), diversity (range of
    different antisocial behaviours), breadth across situations,
    seriousness
      A visual heuristic describing the
        developmental levels model

           Advanced CD

                               Mug Truant
                               Cruel Steal
                             Force sex Run away
                                    Break, enter
Intermediate CD
                          Use weapon Lie
                          Bully       Vandalize
                           Fight       Set fires
Oppositional              Hurt animals
                         Temper tantrums Irritable
                         Defiant        Spiteful
                         Blame others      Annoy others
                         Angry         Argumentative
                                                 B. Lahey & R. Loeber (1994)
Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/6
              Risk Factors

• Social Risk Factors:
  –   Poverty
  –   Unemployed
  –   Marginal behaviours or life styles
  –   Migration
  –   Low culture
Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/7
               Symptoms



• Diagnostic criteria (symptoms: type, number and
  frequency)
   – DSM-IV
   – ICD-10
Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/8
           Clinical Symptoms

• The subtypes of the Disorders
  –   Subtypes based on age at onset
  –   Subtypes based on aggression
  –   Subtypes based on socialization
  –   Subtypes based on comorbid conditions
Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/9
           Clinical Symptoms

• Subtypes based on age at onset
  – Childhood onset vs. Adolescence onset
    (Longitudinal follow-up study: Farrington, 1979; Dunedin
    Longitudinal Study; Moffit, 1990 & McGee, 1992)
  Hollistic and Developmental Assessment
 of Behaviour Disorders in Adolescence/10
             Clinical Symptoms
• Subtypes based on aggression
  – Overt vs. Covert (1st Bipolar Dimensional Type;
    Loeber et al, 1985)
  – Destructive vs. Nondestructive (2nd Bipolar
    Dimensional Type; Frick et al., 1993)
  – Proactive vs. Reactive (theoretical model based;
    dichotomy; Dodge et al., 1991)
  – Affective vs. Predatory (connection with
    Autonomous/neurotransmission; Vitello et al., 1990)
  – Constraint
 Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/11
            Clinical Symptoms


• Subtypes based on Sociabilization
  – Socialized vs. undersocialised (Biological functioning
    is different; Quay et al., 1987)
 Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/12
            Clinical Symptoms

• Subtypes based on Comorbid Conditions
  – ADHD
  – Cognoscitive Disfuctions
  – Emotional Disorders
 Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/13
            Clinical Symptoms
• Comorbidity
  –   ADHD
  –   Impulse-control Disorders
  –   Alcohol or Drug abuse
  –   Anxiety, Depression
  –   Sociabilization Disorders
 Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/14
                Pronogsis
• Clinical Features associated with bad
  pronogsis:
  – Age at onset: Childhood
  – Subtypes of aggression
     • Destructive
     • Proactive
     • Predatory
  – Sociabilization: Undersocialized
  – Comorbid conditions: ADHD and/or Cognitive
    Disfuctions
 Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/15
                Pronogsis
• Protective Factors:
  – Higher self-esteemand locus of control
  – Family support and supervission
  – Continuity in therapeutic intervention
  – Early diagnosis and therapeutic intervention
  – Good accessibility to Child and Adolescent
    Psychiatric Services
  – Social support (peer and social context)
  – School support
 Hollistic and Developmental Assessment
of Behaviour Disorders in Adolescence/16
                Pronogsis

 • Individual Factors:
   – Temperament
   – Personality traits
   – Perception disorder by himself/herself
  Assessment of Behaviour Disorders in
            Adolescence/1

• Diagnostic Assessment:
     –   Obtain patient’s history
     –   Obtain family history
     –   Interview with patient
     –   School information
     –   Physical evaluation


AACAP (1997)
MªC. Ballesteros; JL Alcázar; JL Pedreira & A de los Santos (1998)
 Assessment of Behaviour Disorders in
           Adolescence/2
• Diagnostic Formulation:
     – Identify ICD-10/DSM-IV target symptoms
     – Biopsychosocial stressors, enviromental and
       developmental factors
     – Subtype of the Behaviour Disorders
     – Comorbidity


AACAP (1997)
MªC. Ballesteros; J.L. Alcázar; J.L. Pedreira & A. De los Santos (1998)
  Assessment of Behaviour Disorders in
            Adolescence/3
• Obtain patient’s history:
     – Prenatal ahd birth history (substance abuse by
        mother, maternal infections or medications)
     – Developmental history (attachment diosrders e.g.
        Parental depression, substance abuse; temperament,
        oppositionality, aggression, attention, socialization,
        impulse control)
     – Physical/sexual abuse history
     – History of symptoms development (impact on
        family and peer relationship, academic problems)
     – Medical history (CNS pathology, chronic illnesses,
        somatizations)
AACAP (1997); MªC. Ballesteros; J.L. Alcázar; J.L. Pedreira & A. De los Santos (1998)
  A developmental progression for
        antisocial behavior
                              Rejection by
                              normal peers



 Poor parental      Child                  Commitment
   discipline      conduct                   to deviant      Deliquency
and monitoring    problems                  peer group


                                Academic
                                 failure

                                                          Late Childhood
Early Childhood              Middle Childhood             and Adolescence
  Multidimensional causal models:
        Longitudinal model

                    Prior Delinquent
                       Behaviour
                                                  +
Family   -


                                                      Delinquent
             Delinquent Peers                         Behaviour
                                         +


         -
School

              Elliot, Huizinga & Ageton (1985) (Condensed & adapted)
Median Age of Onset Reported by Parent of Symptoms of
oppositional Defiant Disorder and Conduct Disorder ª
                                   ª This combines retrospective and prospective ages of onset over four annual
B. Lahey & R. Loeber (1994)        assessment in the Developmental Trends Study.

       Median age      Oppositional defiant disorder               Conduct disorder


          3.0          Stubborn
          3.5
          4.0
          4.5
          5.0          Defies adults, temper tantrums.
          5.5
          6.0          Irritables, argues.
          6.5          Blames others.
          7.0          Annoys others.
          7.5          Spiteful.
          8.0          Angry.                                      Lies.
          8.5                                                      Fights.
          9.0                                                      Bullies, sets fires.
          9.5          Swears.                                     Uses weapon.
          10.0                                                     Vandalizes.
          10.5                                                     Cruel to animals.
          11.0
          11.5                                                     Physical cruelty.
          12.0                                                     Steals, runs away from home.
          12.5                                                     Truant, mugs. Breaks and enters.
          13.0                                                     Forces sex.
       The families of adolescents:
            The “strop cycle”

                 Harsh criticism from others


Identity definition
  by opposition



                       Precarious self-esteem


                                                P. Hill (1992)
   Assessment of Behaviour Disorders in
             Adolescence/4

• Obtain family history:
    – Family coping style, stressors, resources -
       socioeconomic status, social support/isolation, problem-
       solving skills, conflict-resolution skills, parenting skills,
       limit-setting, abuse/neglect, permissiveness,
       inconsistency, management child’s aggression, parent’s
       and patient’s coercitive interaction cycles leading to
       reiforcement of noncompliance


AACAP (1997)
MªC. Ballesteros; J.L. Alcázar; J.L. Pedreira & A. De los Santos (1998)
    Assessment of Behaviour Disorders in
              Adolescence/6
• Interview patient (may precede parental interview):
     – Capacity for attachment, trust and empathy
     – Tolerance for and discharge of impulses
     – Capacity for showing restraint, accepting
       responsability for actions, experiencing
       guilt,user anger constructively, acknowleding
       negative emotions
     – Cognitive functioning

AACAP (1997); MªC. Ballesteros; J.L. Alcázar; J.L. Pedreira & A. De los Santos (1998)
    Assessment of Behaviour Disorders in
              Adolescence/7
• Interview patient/2 (may precede parental interview):
     – Mood, affect, self-esteem, suicide potencial
     – Peer relationship (loner, popular, drug-, crime-, or
        gang oriented friends)
     – Disturbances of ideation (suggestibility, disociation)
     – History of early, persistent use of tabacco,
       alcohol or other substances
     – Psychometric self-report instruments might
       provide

AACAP (1997); MªC. Ballesteros; J.L. Alcázar; J.L. Pedreira & A. De los Santos (1998)
    Assessment of Behaviour Disorders in
              Adolescence/8
• School information:
     – Functioning (IQ, achievement test data, academic performance and
        behaviour)
     – Standard parent and teacher rating scales of the
       patient’s behaviour
     – Referral for IQ, speech and language and learning
       disability and neuropsychiatric testing if available test
       data are nor sufficient
     – Data may be obtained inperson, by phone or though
       written reports from appropiate staff, such as school
       principal, psychologist, teacher and nurse

AACAP (1997); MªC. Ballesteros; J.L. Alcázar; J.L. Pedreira & A. De los Santos (1998)
                 Cross-Sectional model

Parental Monitoring                    -

                                                                   Deviant
                                   -                                Peers

Behaviour problems/                    +a
                                                                         +
 Social Competence
                                                                Delinquent
                                                                Behaviour

                                            -
    Academic Skills
                                                       Patterson & Dishion (1985) (adapted)

a: High behaviour problems and low social competence
    Assessment of Behaviour Disorders in
              Adolescence/9

• Physical examination:
     – Collaboration with family doctor, paediatrician or other
       health care providers
     – Vision and hearing screening
     – Evaluation of medical and neurological conditions (e.g.
        Head injury, chronic illness)
     – Urine and blood drugs screening as indicated, especially
       when clinical evidence suggest substance use

AACAP (1997); MªC. Ballesteros; J.L. Alcázar; J.L. Pedreira & A. De los Santos (1998)
Selected Measures of Behaviour Disorders
            in Adolescents/1

• In order to discriminate clinical and no clinical
  people: High discriminant reliability
   –   Child Behavior Checklist, Achenbach, 1978
   –   Revised Behavior Problems Checklist, Quay, 1983
   –   Eyberg Child Behavior Inventory, Eyberg, 1978
   –   Conners Rating Scales (Parents and Teachers)
     Achenbach-Connors-Quay Questionnaire
        (ACQ) delinquent and aggressive
             behaviour dimensions
Delinquent behavior                    Aggressive behaviour


Cheats                                 Argues
Doesn’t feel guilty                    Brags
Hangs around kids who get in trouble   Bullies; is mean to others
Lies                                   Destroys others’ things
Runs away from home                    Demands attention
Sets fires                             Destroys own things
Steals at home                         Disobedient at school
Steals outside home                    Jealous
Swears; uses obscene language          Irritable
Talks or thinks about sex too much     Loud
Truancy                                Physically attacks people
Uses alcohol                           Screams
Uses drugs                             Shows offor clowns
Vandalizes older kids                  Stars fights
                                       Stubborn
                                       Sudden mood changes
                                       Talks too much
                                       Teases other kids
                                       Temper tantrums
                                       Threatens
Selected Measures of Behaviour Disorders
            in Adolescents/2
• In order to evaluate the treatment impact: High
  predictive reliability
  – Child Behavior Checklist, Achenbach, 1978
  – Eyberg Child Behavior Inventory, Eyberg, 1978
  – Conners Rating Scales (Parents and Teachers)
• In order to require shortness or treatment
  evaluation or developmental impact: Short Scales
  – Short’s Conners Rating Scale
  – Iowa-Conners Teacher Rating Scale
  – Eyberg Child Behavior Inventory
Selected Measures of Behaviour Disorders
            in Adolescents/3
• In order to assess behaviour competences or
  adolescent behaviour profile:
   – Child Behavior Checklist, Achenbach, 1978


• In order to consider the setting:
   – Child and Adolescent Psychiatric Services, or
     comorbidity screening: ABC, CBC, TBP and Conners
     Scales
   – Behaviour specific setting: Eyberg Child Behavior
     Inventory
    Family Assessment of Behaviour
      Disorders in Adolescents/1
• Parenting Profiles:
  – Parenting Scale (Arnold, 1993)
  – Parent Practices Scale (Stayhom & Widman, 1998)
  – Alabama Parenting Questionaire (Frick, 1991)
• Parent and Teacher Social Cognitions:
  – Parenting sense of Competende Scale (Johnston, 1989)
  – Cleminshaw-Guidubaldi Parent Satisfaction Scale
    (1985)
  – Parental Locus of Control Scale (Campis et al., 1986)
     Family Assessment of Behaviour
       Disorders in Adolescents/2
• Parental perceptions of personal and marital
  adaptation or emotional state: Screening of
  depressive and mood psychopathology, disocial
  behaviour and substance or alcohol abuses
• Family Stress:
   – Parenting Daily Hassles (Greener, 1990)
   – Parenting Stress Index (Abidin, 1995)
• Parental functioning in extrafamily context:
   – Community Interaction Checklist (CIC, Wahler, 1979)
       Family Assessment of Behaviour
         Disorders in Adolescents/3

• Parent conflicts:
   –   O’Leary-Porter Scale (1980)
   –   Conflict Tactics Scale (Partner-Strauss, 1979, 1990)
   –   Parenting Alliance Inventory (Abidin, 1988)
   –   Child Rearing Disagreements (Jouriles et al., 1991)
   –   Parents Problems Checklist (Dadds & Powell, 1991)
• Parental satisfaction with treatment procedures:
   – Parent’s Consumer Satifaction Questionaire
     (Forehandy & McMahon, 1981; mcMahon, 1984)
Diagnostic Formulation of the Adolescents
      with Behaviour Disorders/1
• Identify ICD-10/DSM-IV target symptoms
• When suggests BD consider the following:
   – Biopsychosocial stressors (sexual and physical abuse, divorse or
     death or key attachment figures)
   – Educational potential, disabilities, achievement
   – Peer, sibling and family problems and strengths
   – Enviromental factors (disorganized home, lack of psychiatric
      illness or drug or alcohol abuse in parents, enviromental neurotoxins e.g.
      Lead)
   – Adolescent or Child ego development, especially ability to
     form and maintain relationships

AACAP (1997)
Diagnostic Formulation of the Adolescents
      with Behaviour Disorders/2

• The subtype of the disorder:
   –   Childhood onset vs. Adolescent onset
   –   Overt vs. Covert versus authority
   –   Under-restrained vs. Over-restrained
   –   Socialized vs. Undersocialized


AACAP (1997)
Diagnostic Formulation of the Adolescents
      with Behaviour Disorders/3
• The syndromes may be confused or cuncurrent
  with:
   –   ADHD                                Organic Brain and seizure disorder
   –   ODD                                 Specific developmental disorder
   –   Intermittent explosive disorder     Schizophrenia
   –   Substance use disorder              Paraphilias
   –   Mood disorder (bipolar and depressive)
   –   PTSD and Disociative disorder       Mental retardation
   –   Borderline personality disorder
   –   Somatization disorder               Narcisistic personality disorder
   –   Adjustment disorder

AACAP (1997)
   Dimensional Assessment of Behaviour
       Disorders in Adolescents/1
• Individual dimensions:
   – Developmental preocess and moral development
   – Aggressiveness’ subtypes
   – Self-esteem and self-likeness
   – Empathy and impulse control
   – Comorbility
   – Poor interpersonal relations
   – Cognitive and atttributional processes: Deficits and disttorsions in
     cognitive problem-solving skills, atributions or hostile intant to others,
     resentment and suspiciousness illustrate
   – Risk factor and vulnerability
   – Temperament
   – Clinical features (specially with sign of antisocial behaviour)

AACAP (1997)
   Dimensional Assessment of Behaviour
       Disorders in Adolescents/2
• Family dimensions:
   – Parenting and attachment styles
   – Psychopathology (including drug and alcohol abuses)
   – Untoward parent-child interactions (physical and sexual
     abuses)
   – Poor or inconsistent supervision
   – Marital conflicts
   – Other family members with antisocial behaviour
   – Family risk factors
   – Genetic factors

AACAP (1997)
                  Disruptors of effective
                       parenting
                              Family Demographics
                                     Income
                                Parent education
                                 Neighborhood
                                  Ethnic group


 Grandparental Traits            Parental Traits             Disrupted
  Antisocial behaviour         Antisocial behaviour      family-management
Poor family management        Susceptible to stressors        practices



                                 Family Stressors              Child antisocial
                                 Unemployement                   behaviour
                                  Marital conflict
B. Lahey & R. Loeber (1994)
                                    Divorce
   Dimensional Assessment of Behaviour
       Disorders in Adolescents/3
• School dimensions:
   – Acedemic deficiencies
   – Neuropsychological deficits (in verbal and “executive”
     functions)
   – Behaviour disorder in preschooler’s level
   – Peer’s relationship and perception of behaviour
   – Teacher’s supervision and authority



AACAP (1997)
   Dimensional Assessment of Behaviour
       Disorders in Adolescents/4
• Social and contextual dimensions:
   –   Identification with a subculture or group
   –   Alienation of the individual from the wider social group
   –   Delinquency areas
   –   Poverty and marginalization behaviour
   –   Legal problems
   –   Social support


AACAP (1997)
                   Cross-Sectional model
Neighborhood Disorder
 Criminal Subculture

                                                                    +
                                    +
    Neighborhood                                 School
     organization
                               -a                               -              Severe
                                                                              Delinquent
    Neighborhood                                                              Behaviour
                          -a                                        +
      Stability
                                        -       Delinquent
        Family                                    Peers
       Stability                                                    -
                                            +
                                                          Simcha-Fagan & Schwartz (1986)
           Age                                            (condensed and adapted)

a: These parameters are counterintuitive and probably sampling and measurement limitations
                  Potential                             Yourself    Teacher       Clinical      Peers and
                                         Parents
                   sources                               scales      scales      interview       Social
                                          scales
                   of data                                                                       scales

                  Initial                               1
                                              yes              Any scales in
                  screem                                                            no
                                                              Clinical range?                 Conclusion:
                                        Is deviance                                           No evidence of
                                    3                                                         clinical deviance.
                                        confined to the                                  2
                                        same syndrome                                         check key items,
                              yes       in all sources?       no                              e.g. Suicidal
          4                                                                                   behaviour
                                                                                    no
               Conclusion:                           5          Are the same
Differential   Child’s problems                              syndrome deviant       Does child’s
               correspond to a                                                                           7
 diagnosis                                     yes             in all sources?      behaviour
               single Syndrome                                                      actually differ
               e.g. aggresive       Conclusion:                                     much among
                                                                       yes
                                    Child’s problems                                contexts?                no
Taxonomic                       6
                                    comprise multiple
decision tree for                   syndrome or             Conclusion:
                                                            Different behaviours             Conclusion:
using quantitative                  profile pattern
                                                            may have to be                   Some informants’
multi-informant                                      8      targeted for changes             Perceptions may
data to make                                                in different contexts            Have to be
categorical                     Achanbach (1993)                                    9        Targeted for change
decisions                       (modified)
    Treatment of Behaviour Disorders in
              Adolescents/1
• General aims:
   – Treatment shold be provided in a continuum of care that allows flexible
     application of modelities by a cohesive treatment team
   – Outpatient’s treatment includes intervention in family, school and peer
     group
   – The predominance of externalizing symptoms in multiple domains of
     functioning call for interpersonal psychoeducational modalities
   – As a chronic condition requires extensive treatment and long-term
     follow-up
   – Patients with severe BD are likely to have comorbidities that requiare
     treatment


AACAP (1997)
    Treatment of Behaviour Disorders in
              Adolescents/2

• Treat comorbid disorders
• Family interventions include parent guidance,
  training and family therapy:
   – Identify and work with parental strengths
   – Train parents to stablish consistent positive and negative
     consequences and well-defined
   – Arrange for treatment of parental psychopathology


AACAP (1997)
    Treatment of Behaviour Disorders in
              Adolescents/3
• Individual and group psychotherapy with
  adolescent:
   – Technique of intervention (supportive vs. behavioural)
     depends on patient’s age, processing style and ability to
     engage in treatment
   – A combination of behavioural and explorative approaches is
     indicated, especially when there are internalizing and
     externalizing comorbidities
• Psychosocial skill-building training should
  supplement therapy
AACAP (1997)
                    Conclussions/1
• Behaviour disorder refers to instances when children
  or adolescent evince a pattern of antisocial behaviour,
  when there is significant impairment in everyday
  functioning at home or school, or when the
  behaviours are regarded as unmanageable by
  significant others
• BUT:
   – When are the behaviour problems a normal developmental
     variations? Or
   – Are the behaviour disorders an clinical syndrome with different
     clinical features and developmental expressions? And
   – When are the behaviour problems, the clinical symptom of
     disocial behaviour or antisocial personality disorder?
                 Conclussions/2

• Behaviour disorder is multifaceted and symptomatic
  complex in so far as it includes many symptoms and
  effects many domains of functioning
• Although the disorder is discussed as a constellation
  of symptoms within the child, there are parent and
  family features often associated with the disorder
• The nature of the disfunction has important
  implications for assessment and intervention both in
  the context of clinical work and research
              Conclussions/3
• Behaviour disorder represents a special
  challenge given the multiple domains of
  functioning that are affected
• It is meaningful to consider alternative
  constellation of symptoms, various subtypes
  and developmental paths and trajectories
• Research identified differences among
  subtypes: Aggressive and delinquent types
  and childhood onset vs. Adolescent onset
  receiving major attention
                    Conclussions/4
• We need longitudinal follow-up research based on
  developmental psychopathology methodology, in
  order to clarify the continuity vs. Discontinuity of
  the behaviour disorders
• Understanding the confluence of multiple factors
  (children’s characteristics, features of behaviour disorder,
  parent and family functioning and contextual influences)
• Peer influences have been implicated in the onset
  and maintenance of antisocial behaviours including
  substance use and abuse and deliquency
• Poor bonding to home and school were related to
  subsequent bonding to deviant peers
                 Conclussions/5

• Assessment issues:
  – Assessment involves different sources of
    information, the challenges for research and clinical
    work consist to integrate multi-informant data
  – Although parents are in an excellent position to
    report on their children’s behaviour, the evaluation
    cannot be assumed to be free from systematic
    influences or basis
  – It is useful to mention the specificity of performance
    because in many cases symptoms are restricted to
    once or a few situations
                 Conclussions/6
• Assessment issues/2:
  – The BDs are the “open door” in order to develop
    other psychopathological disorder
  – Evaluation of a symptom and set of symptoms needs
    to be developmentally based
  – In our opinion the assessment process includes an
    hollistic and comprehensive procedures:
    Vulnerability and risk factors, symptoms and clinical
    features and pronogsis in order to develop the
    treatment (therapeutic and preventive interventions)
               Conclussions/7

• The assessment of risk and protective factors
  has been relied upon to develop both
  therapeutic and preventive interventions
• Advances in understanding behaviour
  disorders have derived from trying to move
  to understanding the interrelation of factors
  and how they operate on a day-to-day basis
  in producing antisocial behaviour and its
  legal and/or ideological implications

								
To top