Conduct Disorders: A Framework for Understanding and Intervention in Schools and Communities

A Randomized Study of a Mobile Behavioral Parent Training Application

Background/Introduction: Never before have parents had such immediate access to parenting support. The extension of the Internet to smartphones, offers the opportunity to provide families with the highest-quality information at the time and place that it can be the most useful. However, there remain considerable barriers to getting the right information to the right people at the right time.

MATERIALS AND METHODS

This study includes the initial feasibility testing of a smartphone application "ParentNet" that attempts to deliver on the potential of empirically supported therapy by connecting family members with specific behavioral goals and outcomes in real time. Participation was solicited from community parenting support groups and through online social media. Data were collected from 73 parents and 88 children on child behavior (adult only) and satisfaction.

RESULTS

Data analyses showed positive satisfaction and utilization results: (1) users rated the ParentNet app very positively (i.e., 85% of caregivers and 88% of youth would recommend the app to others), and (2) parenting behavior was improved with a small/moderate effect-size.

DISCUSSION AND CONCLUSIONS

Findings from this initial testing are reviewed along with future development possibilities to be considered. Limitations of small pilot sample and brief administration period could have reduced effects. Further study would include a more robust sample.

Current Test Usage by Practicing School Psychologists: A National Survey

A random sample of members of the National Association of School Psychologists was surveyed to examine the assessment activity of practicing school psychologists. Test-usage estimates and importance ratings for well-established standardized instruments, newly revised or released instruments, and informal procedures such as interview and curriculum-based assessment were examined. Estimates of time involved in various service delivery activities also were obtained. Results indicated that assessment activities still account for about 50% of the practice hours of school psychologists, followed by consultation (20%) and treatment (19%). School psychologists reported frequent use of intellectual, behavior-social-emotional, achievement, and perceptual assessment methods, but were less likely to be involved in vocational or preschool assessment. Familiar instruments, such as the Wechsler scales, the Woodcock-Johnson Psycho-educational Battery-Revised, the Wide Range Achievement Test-Revised, the Bender-Visual Motor Gestalt, the Beery Developmental Test of Motor Integration, and the Vineland Adaptive Behavior Scales, were the most used tests. However, in the social-emotional domain, direct assessment methods, such as interview and observation, were more frequently used and rated as more important than standardized measures. These results, and the limitations of the study, are discussed.

Avoiding the Special Education Trap for Conduct Disordered Students

School personnel often misclassify a Conduct Disordered student as Severely Emotional Disturbed following a serious offense. Educators must remember, however, that mislabeling a child in order to obtain services, to prevent a child from being expelled, or to remove the stu dent to a special classroom is both inappropriate and unethical. What, then, should school administrators do?

Influence of Family Adversity on School-Related Behavioural Problems among Multi-Ethnic High School Students

This study examines the influence of family adversity indicators on school-related behavioural problems among Hawaiian and non-Hawaiian adolescents. Questionnaire data from 2787 students were linked to school information, including grade point average (GPA), absences, suspensions and conduct infractions. Logistic regression analyses were performed. The cumulative effect revealed higher increases in the odds ratios for school-related behavioural problems among non-Hawaiians. Surprisingly, there was no cumulative effect of family adversity among Hawaiian adolescents. Given their high rates of adversity and behavioural problems, any family adversity may significantly impact this group. The family environment must be considered in the prevention and intervention of school-related behavioural problems.

Conduct Problems and Treatment across Home and School: A Review of the Literature

Treatment of conduct problems in the home setting has received much attention in the literature, and there are well established, empirically derived treatment programs that have been demonstrated to be effective. However, treatment for conduct problems in the classroom has not received a comparable amount of attention, and the intervention programs are diverse, occasionally lacking empirical support, and often not consistent with strategies used in the home setting. As past research has demonstrated that conduct problems in multiple settings is related to poorer prognosis, it is logical to suggest that interventions should focus on as many of the settings as possible in which a child displays the behaviour problems. This paper reviews the literature on the effects of conduct problems in the classroom, on teacher managerial skills, and on interventions across the home and school settings. It is concluded that classroom management of conduct problems could be improved by providing a hierarchical system of intervention strategies.

Validation of the symptoms and functioning severity scale in residential group care

Tests that measure the emotional and behavioral problems of children and youth are typically not normed and standardized on youth diagnosed with disruptive behavior, particularly those youth in residential care. Yet professional standards mandate that before instruments are used with a specific population the psychometric properties need to be studied and re-established: specifically, psychometric properties, including validity, need to be evaluated (AERA, APA, and NCME, The standards for educational and psychological testing. AERA, Washington, DC, 1999). The purpose of the present study was to assess the validity characteristics of the Symptoms and Functioning Severity Scale (SFSS; Bickman et al., Manual of the Peabody Treatment Progress Battery, Vanderbilt University, Nashville, TN, 2010), a widely used test developed for use in outpatient clinics, with youth in a residential care program. The convergent validity of the SFSS was established with the large correlations (0.78-0.86) with the CBCL. Several binary classification analyses including specificity, area under the receiver operating characteristic curve, positive and negative likelihood ratios, and the Youden Index supported the validity of the SFSS. However, the sensitivity index was somewhat low indicating the test may produce a high level of false negatives. Limitations, future research and implications are discussed.

Aggression and disruptive behavior disorders in children and adolescents

Aggression is a common symptom of many psychiatric disorders including attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, Tourette's disorder, mood disorders (including bipolar disorder), substance-related disorders, alcohol-related disorders, mental retardation, pervasive developmental disorders, intermittent explosive disorder and personality disorders (particularly antisocial personality disorder). Many forms of organic brain disorders may present with aggressive behavior. Aggression is common in some epileptic patients and some endocrinological diseases (e.g., diabetes and hyperthyroidism) may be associated with aggressive behavior. Physicians need to rule out many medical and psychiatric disorders before diagnosing aggressive behavior. A thorough diagnostic work up is the most important step in determining the nature of comorbid disorders associated with the behavioral problem. Structured interviews and rating scales completed by patients, parents, teachers and clinicians may aid the diagnosis and provide quantification for the change process related to treatment. The integration of medication, individual and family counseling, educational and psychosocial interventions including the school and community, may increase the effectiveness of interventions. Due to the common association of aggression and disruptive behaviors with attention deficit hyperactivity disorder, psychostimulants including new generation long-acting medications and other nonstimulant medications are considered the drug of choice for managing aggressive behavior and disruptive behavior disorders. Severe aggressive behavior not responding to these medications may require the single or combined use of mood regulators including lithium and/or antispychotic medications. Drugs such as risperidone (Risperdal, Janssen-Cilag) have documented effectiveness and safety in children and adolescents, and can be used in treatment.

Development of a school-wide behavior program in a public middle school: an illustration of deployment-focused intervention development, stage 1

School-wide behavior management systems can improve academic performance and behavior in middle schools, and they should have positive effects on students with ADHD. Unfortunately, evidence-based, school-wide behavior management systems have not been widely adopted because of problems with feasibility, acceptability, and sustainability. The Deployment-Focused Model of Intervention Development and Testing has been proposed as a promising method of bridging the gap between research and practice settings. A key aspect of the model is to involve the persons most likely to deliver the service (e.g., teachers) in the intervention development process from the very beginning. To illustrate this process, the authors describe the planning and implementation of a school-wide program designed to improve behavior in a public middle school.

Psychopharmacology in the Treatment of Conduct Disorder Children and Adolescents: Rationale, Prospects, and Ethics

The rationale for psychopharmacological treatments of conduct disorder (CD) in children and adolescent is discussed with reference to the presumed neurophysiological basis of the disorder. Specific psychopharmacological treatments for children with CD are identified and briefly evaluated in terms of their empirical foundations. The lack of a secure knowledge base on the biochemical basis of CD and the efficacy of psychopharmacological treatments with children and adolescents suggests the need for caution in the wide use of pharmacotherapy with these populations. Psychopharmacological treatments with children and adolescents with CD are particularly indicated for reactive aggression, and CD with comordid conditions. Conceptual and methodological improvements in use of psychotropic medications with children and adolescents are discussed as well as the associated ethical considerations.