WORN OUT, FAILURE, TIRED: PARENTING AND DISRUPTIVE BEHAVIORS

Transcription

1 WORN OUT, FAILURE, TIRED: PARENTING AND DISRUPTIVE BEHAVIORS

2 THANK YOU Who am I? Father and husband. Two children ages 10 (girl) and 8 (boy) years old. Licensed Clinical Social Worker (LCSW) Graduated from BSU in 2007 with a Bachelors in Psychology Graduated from BSU in 2011 with Masters in Social Work Worked in Oregon from for Curry Community Health Development of Children s Mental Health Program Adult and Child Mental Health Therapist Emergency Mental Health Evaluator (local hospital and jail) Civil Commitment Investigator Work at St. Luke s Children s Center for Neurobehavioral Medicine since 2014 Recently started a private part time practice in Eagle, ID. Outdoor enthusiast

3 TAKE AWAY I. IDENTIFY DISRUPTIVE BEHAVIORS II. UNDERSTAND FACTORS THAT CONTRIBUTE TO AND SUSTAIN DISRUPTIVE BEHAVIORS III. LEARN CONCEPTS AND TOOLS UTILIZED TO REDUCE OR CHANGE DISRUPTIVE BEHAVIORS IV. IDENTIFY AVAILABLE RESOURCES AND GAPS IN SERVICES FOR DISRUPTIVE BEHAVIORS

4 I. DEFINITION OF DISRUPTIVE BEHAVIORS Disruptive behaviors include a range of uncooperative and aggressive behaviors that interfere with the development of healthy interpersonal and social relationships.

5 TYPES OF DISRUPTIVE BEHAVIORS INCLUDE BUT ARE NOT LIMITED TO MINOR Active defiance Arguing Blames others for personal mistakes Intentionally annoys others Lying Easily looses temper Refusal SEVERE Antisocial behaviors Bullying Fighting Fire Starting Revenge seeking Stealing Vandalism Yelling/Name Calling

6 DSM V CLASSIFICATION Disruptive, Impulse-Control, and Conduct Disorder Oppositional Defiant Disorder-Prevalence est. 3.3% in general population. Higher in males than females. Intermittent Explosive Disorder-Prevalence 2.7% in general population. Higher rates in younger individual <35. Conduct Disorder-Prevalence 4% in general population. Higher in males than females. Pyromania-Prevalence 1.13% in general population. Kleptomania-Prevalence.3-.6 % in general population. Higher in females than males. Neurodevelopmental Disorder Attention-Deficit/Hyperactivity Disorder-Prevalence 5% Children, 2.5% Adults in general population. Higher in males than females. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

7 Oppositional Defiant Disorder (ODD) A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months, at least four of the following symptoms and exhibited during interaction with at least one individual who is not a sibling. Angry/Irritable Mood 1. Often loses temper. 2. Is often touchy or easily annoyed. 3. Is often angry and resentful. Argumentative/Defiant Behavior 4. Often argues with authority figures or for children and adolescents, with adults. 5. Often actively defies or refuses to comply with requests from authority figures or with rules. 6. Often deliberately annoys others. 7. Often blames others for his or her mistakes or misbehavior. Vindictiveness 8. Has been spiteful or vindictive at least twice within the past 6 months. Note: For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months unless, otherwise noted. For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months.

8 CONDUCT DISORDER (CD) A repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months: Aggression to People and Animals 1. Often bullies, threatens, or intimidates others. 2. Often initiates physical fights. 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun). 4. Has been physically cruel to people. 5. Has been physically cruel to animals. 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery). 7. Has forced someone into sexual activity. Destruction of Property 8. Has deliberately engaged in fire setting with the intention of causing serious damage. 9. Has deliberately destroyed others property (other than by fire setting). Deceitfulness or Theft 10. Has broken into someone else s house, building, or car. 11. Often lies to obtain goods or favors or to avoid obligations (i.e., cons others). 12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery). Serious Violations of Rules 13. Often stays out at night despite parental prohibitions, beginning before age 13 years. 14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period. 15. Is often truant from school, beginning before age 13 years. B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

9 Attention-Deficit/Hyperactivity Disorder (ADHD) A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2): 1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months a. Often fails to give close attention to details or makes careless mistakes b. Often has difficulty sustaining attention in tasks or play c. Often does not seem to listen when spoken to directly d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace e. Often has difficulty organizing tasks and activities f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort g. Often loses things necessary for tasks or activities h. Is often easily distracted by extraneous stimuli i. Is often forgetful in daily activities 2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months a. Often fidgets with or taps hands or feet or squirms in seat b. Often leaves seat in situations when remaining seated is expected c. Often runs about or climbs in situations where it is inappropriate. d. Often unable to play or engage in leisure activities quietly e. Is often on the go, acting as if driven by a motor f. Often talks excessively g. Often blurts out an answer before a question has been completed h. Often has difficulty waiting his or her turn i. Often interrupts or intrudes on others

10 WHAT WE KNOW THAT CONTRIBUTES TO AND SUSTAINS DISRUPTIVE BEHAVIORS.

11 II. FACTORS CONTRIBUTING TO DISRUPTIVE BEHAVIORS 1. Emotional regulation Physiological reactivity Behavioral observation 2. Temperamental Reactivity Negative emotionality, Surgency, Effortful Control 3. Maternal/Caregiver Control Authoritarian, Authoritative, Inconsistent and Permissive 4. Social/Family norms Violence, antisocial behavior, substance abuse 5. Exposure to Adverse Childhood Events (ACE s) Abuse, trauma, significant life loss 6. Mental Health Anxiety, depression, Bipolar, psychosis, TBI

12 Developmentally Expected Behavior It is developmentally expected to see an increase and peak of disruptive behaviors such as tantrums, saying no, pushing, grabbing and taking things in early toddlerhood (around the age of 2). However, it is expected in subsequent years that the frequency and intensity of these disruptive behaviors begin to decline. DEGNAN, K. A., CALKINS, S. D., KEANE, S. P., & HILL-SODERLUND, A. L. (2008). PROFILES OF DISRUPTIVE BEHAVIOR ACROSS EARLY CHILDHOOD: CONTRIBUTIONS OF FRUSTRATION REACTIVITY, PHYSIOLOGICAL REGULATION, AND MATERNAL BEHAVIOR. CHILD DEVELOPMENT, 79(SEP-OCT), 5TH SER., RETRIEVED JUNE & JULY, 20017, FROM

13 EMOTIONAL REGULATION Ability or inability to regulate physiological and emotional arousal in response to external or internal stressors. External stressors arouses physiological response which can be measured by the Respiratory Sinus Arrhythmia (increased heart and respiratory rate) and indicates a withdrawal of the parasympathetic nervous system on the Vagus nerve. External stressors arouse behavioral response such as crying, yelling, holding breath, hitting self or others etc. Difficulty matching size of response with size of the problem. Degnan, K. A., Calkins, S. D., Keane, S. P., & Hill-Soderlund, A. L. (2008). Profiles of disruptive behavior across early childhood: Contributions of frustration reactivity, physiological regulation, and maternal behavior. Child Development, 79(Sep-Oct), 5th ser., Retrieved June & july, 20017, from

14 TEMPERAMENTAL REACTIVITY Defined as constitutionally based individual differences in reactivity and selfregulation, in the domains of affect, activity, and attention. Temperament is thought to be relatively stable and to closely parallel personality types (extraversion, agreeableness, openness, conscientiousness, and neuroticism). Difficult Temperament is thought to be associated with negative emotionality, surgency, effortful control as a result of genetics and neurobiological factors (highly sensitive nervous system that over reacts to environmental, social, emotional or physiological stimuli). Children with higher levels of difficult temperament due to negative emotionality, surgency, effortful control are more susceptible to both positive and negative parenting. Slagt, M., Dubas, J. S., Deković, M., & van Aken, M. A. G. (2016, August 11). Differences in Sensitivity to Parenting Depending on Child Temperament: A Meta-Analysis. Psychological Bulletin. Advance online publication.

15 MATERNAL/CAREGIVER CONTROL POSITIVE FACTORS Caring Open Accepting Engaging Consistent Involved Emotionally in control Rule/expectations NEGATIVE FACTORS Punitive Inconsistent Nagging Spanking Aggression Emotionally following Uninvolved Few or no expectations Parents can be an effective agent for change when they are able to effectively monitor child's whereabouts, discipline for antisocial behavior, utilize problem solving skills and teach prosocial skills. Patterson, G. R., Stouthammer-Loeber, M. (1984). The correlation of family management practices and delinquency. Child Development, 55,

16

17 EXPOSURE TO ADVERSE ENVIRONMENTAL EVENTS AND OTHER FACTORS Exposure to frequent arguing, domestic violence and substance abuse. Exposure to abuse, trauma or significant life loss. Anxiety, Autism, Bipolar, Chronic medical condition, Depression, Psychosis, TBI.

18 III. STRATEGIES FOR REDUCING OR CHANGING DISRUPTIVE BEHAVIORS 1.Change perspective a) Recognize skill deficits and developmental delays. b) Recognize physiological, emotional and temperament differences. c) Consider the ask... You can be strict, but that doesn t mean you have to be unfair. B.B. d) Differentiate between actual and expected developmental ability. 2.Turn the negative cycle around a) Make time for Purposeful Positive Activity on weekly basis. b) Find and focus on Child s interests and strengths. c) Set time aside daily for relationship building (Special Time). d) Give clear instructions, provide opportunity for success and practice. Continued

19 STRATEGIES FOR REDUCING OR CHANGING DISRUPTIVE BEHAVIORS CONTINUED 3. When and when not to talk a) Provide positive, specific and genuine praise for desired behavior. b) Use Collaborative Problem Solving, What s up phrase. c) Give clear instructions, provide opportunity for success and practice. d) Don t nag, learn when to ignore. 4. Teach skills a) Model emotional regulation skills. b) Set expectations, prosocial skills, positive opposite behaviors. c) Learn anger management and mindfulness skills. d) Teach problem solving skills.

20 STRATEGIES FOR REDUCING OR CHANGING DISRUPTIVE BEHAVIORS CONTINUED 5. Understand the behavior and set appropriate consequence a) A-B-C s Antecedent, Behavior, Consequence. b) What is the skill deficit. c) What are identified strengths. d) Difference between reinforcement and punishment. 6. Use punishment effectively a) Time outs. b) Assigning undesirable chore. c) Removal of desirable activity/freedom. d) Be consistent.

21 IV. Resources Boise Self Rescue Manual- The Kazdin Method for Parenting the Defiant Child- By Dr. Alan Kazdin with Carlo Rotella The Explosive Child- By Dr. Ross Greene Buck 2011 Documentary About the life of Buck Brannaman Attitude Magazine- Primary Care Physician

22 Gaps In Resources 1. Lack of insurance coverage for parent education, skill building and support groups 2. Insufficient school support and communication 3. Limited access to quality/affordable evidenced based mental health treatment 4. Poor public understanding and education on disruptive behaviors 5. Multiple levels of care needed to meet the child and family needs

23 BUCK BRANNAMAN QUOTES (REPLACE HORSE WITH CHILD) 1. One of the biggest challenges of a horsemen is to be able to control your emotions. B.B. 2. Give him a job, learn how to build on the horse s pride. Make him feel good about himself and I wasn t just talking about the horse. B.B. 3. You can be strict, but that doesn t mean you have to be unfair. B.B. 4. Gentle in what you do, Firm in how you do it. B.B. 5. I don't believe in waiting for a horse to do the wrong thing and then punishing him after the fact. You can't just say no to a horse. You have to redirect a negative behavior with a positive one, something that works for both of you. It's as though you're saying - instead of doing that, we can do this together. - B.B. 6. It is all about the quality of the communication, not the quantity. - B.B. 7. Discipline isn't a dirty word. Far from it. Discipline is the one thing that separates us from chaos and anarchy. Discipline implies timing. It's the precursor to good behavior, and it never comes from bad behavior. People who associate discipline with punishment are wrong: with discipline, punishment is unnecessary. -B.B.

24 REFERENCES American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Degnan, K. A., Calkins, S. D., Keane, S. P., & Hill-Soderlund, A. L. (2008). Profiles of disruptive behavior across early childhood: Contributions of frustration reactivity, physiological regulation, and maternal behavior. Child Development, 79(Sep-Oct), 5th ser., Retrieved June & july, 20017, from Liddle, H. A., Rowe, C., Diamond, G. M., Sessa, F. M., Schmidt, S., & Ettinger, D. (2000). Toward A Developmental Family Therapy: The Clinical Utility of Research on Adolescence. Journal of Marital and Family Therapy, 26(October), 4th ser., Patterson, G. R., Stouthammer-Loeber, M. (1984). The correlation of family management practices and delinquency. Child Development, 55, Shaw, D.S., Lacourse, E., & Nagin, D.S. (2005). Developmental trajectories of conduct problems and hyperactivity from ages 2 to 10. Journal of Child Psychology and Psychiatry, 46:9, Slagt, M., Dubas, J. S., Deković, M., & van Aken, M. A. G. (2016, August 11). Differences in Sensitivity to Parenting Depending on Child Temperament: A Meta-Analysis. Psychological Bulletin. Advance online publication. Stormshak, E. A., Bierman, K. L., McMahon, R. J., & Lengua, L. J. (2000). Parenting Practices and Child Disruptive Behavior Problems in Early Elementary School. Journal of Child Psychology, March(29), 1st ser., Retrieved 2017, from