Improvement of Disruptive Behavior Disorders: Implications for Prevention Treatment

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Arrangement for Presentation. What are Disruptive Behavior Disorders?Why are DBD problematic?What causes DBD?Who has DBD?What are suggestions for counteractive action

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Improvement of Disruptive Behavior Disorders: Implications for Prevention & Treatment Marcia Jensen, Ph.D., NCSP 3/2/2010

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Plan for Presentation What are Disruptive Behavior Disorders? Why are DBD dangerous? What causes DBD? Who has DBD? What are suggestions for counteractive action & treatment of DBD?

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What are Disruptive Behavior Disorders? Consideration Deficit/Hyperactivity Disorder Oppositional Defiant Disorder Conduct Disorder Disruptive Behavior Disorder, NOS

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Attention-Deficit/Hyperactivity Disorder (ADHD) ADHD-I : > 6 indications of distractedness happening regularly for 6+ months bringing on noteworthy debilitation in social, scholastic, or word related fxning ADHD-H-I : > 6 side effects of hyperactivity-impulsivity for 6+ months creating critical hindrance ADHD-C : > 6 manifestations of mindlessness & > 6 side effects of hyperactivity-impulsivity with weakness Below formative level and a few side effects before age 7

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Oppositional Defiant Disorder (ODD) > 4 criteria happening frequently for 6+ months bringing about huge disability in social, scholarly, or word related fxning Loses temper Argues with grown-ups Actively resists/declines to follow grown-ups' solicitations/controls Deliberately pesters individuals Blames others for claim botches/conduct Touchy/effortlessly irritated by others Angry/angry Spiteful/noxious

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Conduct Disorder (CD) > 3 criteria happening in 12 months, > 1 in recent months creating huge impedance in social, scholastic, or word related fxning Aggression to individuals/creatures Often spooks, undermines, or scares others Often starts physical battles Used a weapon than can bring about genuine physical mischief to others Has been physically unfeeling to individuals Has been physically savage to creatures Stolen with showdown Forced somebody into sexual action Destruction of property Fire setting with expectation to bring about genuine harm Destruction of property other than discharge setting Deceitfulness or burglary Broken into somebody's home, building, or auto Often deceives get merchandise/favors (i.e., cons others) Stolen things of nontrivial incentive without encounter Serious infringement of principles Stays out throughout the night regardless of parent denial (before age 13) Run far from home overnight > twice or once for long period Often truant (before age 13) Childhood onset if > 1 side effect preceding age 10; Adolescent onset if no criteria before 10; Unspecified if time of onset obscure

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Why are DBD risky? High relationship with comorbid psychiatric conclusion High relationship with negative life course results

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Comorbidity of DBD Ollendick et al., 2008

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Life Course Outcomes of DBD Higher rates of brutality, capture/conviction, substance mishandle/reliance, unemployment Poor school execution, low instructive accomplishment Problems with companions, social separation Mental & physical medical issues Violent, coercive child rearing Children with issue practices De Genna et al., 2007; Farrington, 1991; Jaffee et al., 2006; Offord & Bennett, 1994; Offord, Boyle, & Racine, 1991; Temcheff et al., 2008

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What Causes DBD? Physiological impacts Genes Temperament Neurological working Environmental impacts Risk elements Protective elements

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Developmental Trajectory of Self-Control

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Theories on Developmental Trajectory of Aggressive Behavior 2 pathways to later guiltiness Early onset; life-course relentless Later onset; youthfulness restricted Patterson, DeBaryshe, Ramsey, 1989; Moffitt, 1993 5 pathways 2 life-course persevering gatherings Early onset w/ADHD Middle adolescence onset w/o ADHD 2 constrained length animosity assembles High hostility dies down in center youth "" late adolescents 1 late onset aggregate Loeber & Stouthamer-Loeber, 1998

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Developmental Trajectory & Outcomes Schaeffer et al., 2003

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Genetic Biomarkers of DBD? Hereditary reviews assess fundamental impacts of qualities (G), condition (E), and GxE connections Conclusive confirmation of primary impacts for E Some proof of principle impacts for G Within serotonin & dopamine transmitting frameworks, however a long way from authoritative markers to dependably analyze or foresee treatment results Some confirmation of communication impacts for GxE Polymorphism on MAOA quality conservatives effect of adolescence abuse Moffitt et al., 2008

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Gender Differences in DBD Few contrasts in rate of direct issues amid early stages/toddlerhood Males display more lead issues than females between the ages of 4 & 13 and post-pubescence Smaller contrasts between guys & females around pubescence Males more prone to be on LCP direction; comparative pervasiveness for AL direction Lahey et al., 2006

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Gender Differences in DBD Differences in early youth direct issues might be aftereffect of differential mingling reactions from grown-ups Keenan & Shaw, 1997 Differential reaction designs by guys & females to same experience Girls move from physical to social hostility Crick & Zahn-Waxler, 2003 Insufficient proof to make female-particular indicative criteria for CD Moffitt et al., 2008

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Synthesis of Developmental Models DBD related with expanded hazard for negative life-course results LCP = psychopathology & is generally remarkable (3-16%) Worst visualization for high stable animosity, issues related with low & direct stable animosity LCP versus AL display applies to guys and females, however DBD & LCP more common in guys Trajectory dictated by a mix of hereditary & natural impacts There might be both principle impacts & cooperation impacts for G & E impacts

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Bronfenbrenner's Ecological Theory

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Risk & Protective Factors

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Risk & Protective Factors Bloomquist & Schnell, 2002

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Social Information Processing Theory PEER EVALUATION & RESPONSE Database Adapted from Crick & Dodge, 1994

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Social Info Processing & Aggression Hostile attribution predisposition: forceful youngsters more inclined to credit threatening purpose to unbiased associations; connected to receptive animosity Deficits accordingly determination: forceful kids produce less reactions, have & pick more forceful & less prosocial reactions ≈ 40% of kids have SIP issues, young men and African Americans at more serious hazard Lansford et al., 2006

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Who has DBD? Offspring of reprobate guardians Children of substance mishandling guardians Low SES related with expanded hazard for DBD Racial/ethnic contrasts not watched when SES controlled More pervasive in young men than young ladies; young men age 14-17 have more extreme increment in reprobate conduct than young ladies Girls may show in various ways (e.g., social hostility) Note: These announcements are compressed from information exhibited crosswise over many reviews.

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Prevention & Treatment Universal Entire populace preceding onset; $ Selected At-hazard populace; $$ Indicated/Intensive High hazard people giving early cautioning suggestions; $$$ Treatment/repeat counteractive action Individuals who have officially exhibited issue to decrease manifestations/repeat; $$$$

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Effective Prevention Strategies Should be founded on hypothesis about formative course of a condition Analyze issue Develop intercession to upgrade defensive components or limit chance elements Test, assess, & refine Dumka et al., 1995

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Why DBD are a decent possibility for avoidance? We have a ton of data about formative directions, hazard, & defensive components Largely impacted by ecological variables Many, costly, antagonistic life-course results related with DBD

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Prevention of DBD through RTI Logic Level IV Special Education IEP Determination HIGH Level III Intensive Interventions Level II Selected Interventions Intensity of Treatment Level I Universal Interventions LOW Degree of Unresponsiveness to Intervention HIGH

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Targeted/Intensive (High-chance understudies) Individual Interventions (3-5%) Selected (At-hazard Students) Classroom & Small Group Strategies (10-20% of understudies) Multiple Tiers of Behavior Support Universal (All Students) Schoolwide, Culturally Relevant Systems of Support (75-85% of understudies) Adapted from: Sprague & Walker, 2004

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Tier 3 Menu: Assessment-based Behavior Intervention Plan Replacement Behavior Training IN AN IDEAL WORLD : Menu of a continuum of confirmation based backings Targeted/Intensive (High-chance understudies) Individual Interventions (3-5%) Tier 2 Menu: Behavioral Contracting Self Monitoring School-Home Note Mentor-Based Program Differential Reinforcement Positive Peer Reporting Selected (At-hazard Students) Classroom & Small Group Strategies (10-20% of understudies) Tier I Menu: Schoolwide PBS SEL Curriculum Good Behavior Game Proactive Classroom Management Universal (All Students) School/classwide, Culturally Relevant Systems of Support (75-85% of understudies)

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Tier 1 for All: Recommended Complementary Services Schoolwide Positive Behavior Support Teach, show, and strengthen behavioral desires in all settings Social Emotional Learning Curriculum Teach self-administrative practices and open understudies to huge picture ideas Peer Mediation Program Teach understudies to decrease interpersonal clash through intercession procedures Proactive Classroom Management Seating, rules, instructional exercises, moves, proactive methodology Good Behavior Game Classroom-based conduct administration framework

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Good Behavior Game as "Behavioral Vaccine" Provides a vaccination against the improvement of physical, mental or conduct issue e.g., germicide hand washing to lessen childbed fever High requirement for minimal effort, boundless technique as straightforward as sterile h