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Introduction to Behavioral Pediatrics

Introduction to Behavioral Pediatrics

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Introduction to Behavioral Pediatrics

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  1. Introduction to Behavioral Pediatrics Jodi Polaha, Ph.D. Assistant Professor, Pediatrics Munroe-Meyer Institute University of Nebraska Medical Center

  2. Overview • Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) • Background • Assessment • Treatment

  3. ODD • Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures.

  4. ODD • Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures. • Does not involve major antisocial violations.

  5. ODD • Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures. • Does not involve major antisocial violations. • Frequently confused with ADHD.

  6. ODD DSM-IV Criteria • Loses temper • Argues with adults • Actively defiant or refuses to comply • Deliberately annoys people • Blames others for own mistakes • Touchy or easily annoyed • Angry or resentful • Spiteful or vindictive

  7. ODD • Enduring pattern. • Early behavioral intervention very successful. • No medication treatment.

  8. ODD Coercive Family Processes (Patterson)

  9. ODD Coercive Family Processes (Patterson) Child escalates gets his way Pattern of two-way negative reinforcement Parent gives in Gets peace and quiet

  10. ODD • Assessment • Of 10 commands…?

  11. ODD • Assessment • Of 10 commands…? • Routines: eating, sleeping, public.

  12. ODD • Assessment • Of 10 commands…? • Routines: eating, sleeping, public. • Eyberg Child Behavior Inventory

  13. ODD

  14. ODD • Assessment • Of 10 commands…? • Routines: eating, sleeping, public. • Eyberg Child Behavior Inventory • In-clinic observation • Formal • Informal

  15. ODD • What behavioral skills?

  16. ODD • What behavioral skills? • Self-quieting • Anger management • Following instructions, rules • Independent play • Social skills

  17. ODD • What behavioral skills? • Self-quieting • Anger management • Following instructions, rules • Independent play • Social skills

  18. ODD • Thinking time question #1: • How to improve skill of self-quieting?

  19. ODD • Self-quieting • Predictablility • Repetition/Practice • High contrast or “big difference”

  20. ODD • Parent-Child Interaction Therapy • Sheila Eyberg (1990s) • Forehand & McMahon (1980s) • Hanf (1960s)

  21. Part 1. Child’s Game “CDI” Part 2. Parent’s Game “PDI” ODD

  22. Part 1. Child’s Game “CDI” To establish the parent’s positive attention as a reinforcer. Part 2. Parent’s Game “PDI” ODD

  23. ODD CDI Do:Don’t: Describe Command Praise Reprimand Touch Question

  24. ODD CDI • 5-10 min. per day. • Bug in the ear. • Work to criteria. • Feedback in subsequent sessions.

  25. Part 1. Child’s Game “CDI” GOAL To establish the parent’s positive attention as a reinforcer. Part 2. Parent’s Game “PDI” ODD

  26. Part 1. Child’s Game “CDI” GOAL To establish the parent’s positive attention as a reinforcer. Part 2. Parent’s Game “PDI” GOAL To establish “instructional control” ODD

  27. ODD PDI Do: Don’t: Good commands Nag, etc. Consistent response Vascillate

  28. ODD PDI Compliance training Time-Out

  29. ODD Time-Out (my version) Misconceptions: • Must be quiet/still • Must be sorry • Must understand why • Length

  30. ODD Time-Out (my version) Definition:

  31. ODD Time-Out (my version) Definition: no access to attention or anything fun

  32. ODD Time-Out (my version) • 1-3 min in chair • Noncompliance and aggression • Daily reward

  33. ODD Time-Out (my version) IMPORTANT TOPICS: • Extinction burst/training time-out chair • Pick your battles

  34. ODD Job Card Grounding

  35. ODD Job Card Grounding • Rules • Odd Jobs (Job Cards) • Incentives

  36. ODD Three types of consequences: • Natural

  37. ODD Three types of consequences: • Natural • Related

  38. ODD Three types of consequences: • Natural • Related • Unrelated

  39. ODD Thinking time question #2: • How to get child to stay in car seat?

  40. ODD Thinking time question #3: • How to decrease disruptive behavior in church?

  41. ODD Thinking time question #4: • How to get family to keep their “things” out of main areas of house?

  42. CD • Persistent pattern of behavior that is not socially acceptable • May violate rights of others.

  43. CD • DSM IV • Aggression to people and animals • Often bullies threatens or intimidates • Often initiates physical fights • Has used a weapon/can cause harm • Has been physically cruel • Has stolen with confrontation • Has forced someone into sexual activity

  44. CD • DSM IV • Aggression to people and animals • Destruction of property • Has deliberately engaged in fire-setting to cause damage • Has deliberately destroyed others’ property

  45. CD • DSM IV • Aggression to people and animals • Destruction of property • Deceitfulness or theft • Has broken into someone else’s house, building or car • Often lies to obtain goods/avoid obligation • Has stolen items of nontrivial value w/o confrontation

  46. CD • DSM IV • Aggression to people and animals • Destruction of property • Deceitfulness or theft • Serious violation of the rules • Often stays out at night despite parental prohibitions before age 13 • Has run away from home overnight at least twice. • Often truant from school before age 13.

  47. CD • Treatment Options • Job Card Grounding • Problem-Solving/Negotiating • Residential Treatment