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Adolescent Externalizing Behaviors. Joshua Leblang, Ed.S., LMHC Division of Public Behavioral Health and Justice Policy.

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Adolescent externalizing behaviors
Adolescent Externalizing Behaviors

Joshua Leblang, Ed.S., LMHC

Division of Public Behavioral Health and Justice Policy


Socrates c 470 399 bc

Our youth now love luxury. They have bad manners, contempt for authority, they show disrespect for their elders … they contradict their parents…and tyrannize their teachers."

Socrates (c. 470-399 BC)


The number of boy burglars, boy robbers and boy murderers is so astoundingly large as to alarm all good men."

New York Times editorial in 1857


Disruptive disorders, such as oppositional defiant disorder and conduct disorder, are characterized by antisocial behavior.

It presents as collection of behaviors rather than a coherent pattern of mental dysfunction. As such, there is no “magic bullet” to fix the problem.


Normal adolescent development aacap 2005
Normal Adolescent Development and conduct disorder, are characterized by antisocial behavior.(AACAP, 2005)

  • Movement towards independence

  • More cohesive sense of identity

  • Ability to think ideas through

  • Conflict with parents begins to decrease

  • Increased ability for delayed gratification and compromise

  • Increased concern for others

  • Peer relationships important and take an appropriate place among other interests


Morals, Values, and Self-Direction and conduct disorder, are characterized by antisocial behavior.

  • Greater capacity for setting goals

  • Interest in moral reasoning

  • Capacity to use insight

  • Increased emphasis on personal dignity and self-esteem

  • Social and cultural traditions regain some of their previous importance


For adolescents that you may encounter
For adolescents that you may encounter and conduct disorder, are characterized by antisocial behavior.

  • It is rare that an adolescent self-refers themselves to counseling.

  • Externalizing youth are rarely interested in “insight”

  • Engagement with the youth is important, but equally important is parent/caregiver—

    • Ensure attendance at sessions.

    • Reinforcing any new behaviors

    • Provider of “reliable” information about behaviors.


What evidence matters
What Evidence matters??? and conduct disorder, are characterized by antisocial behavior.


Why do we need to know what works
Why do we need to know what works? and conduct disorder, are characterized by antisocial behavior.

  • First, many programs, despite their good intentions, are either ineffective or actually do more harm than good.

  • Second, ineffective or harmful programs are a waste of scarce resources.

Blueprints for Violence

Prevention


Biases against evidence based practices
Biases against Evidence-based Practices and conduct disorder, are characterized by antisocial behavior.

“They are too rigid and cookbook”

“Doesn’t apply to real world kids with real world, multi-problem histories”

“Developed in some lab”

“Overly simplistic”

“Too difficult to implement in community setting”

“Just a band-aid and doesn’t address underlying issues and concerns”

“Another passing fad”

“My training and expertise are not valued”


Why use ebt s
Why use EBT’s and conduct disorder, are characterized by antisocial behavior.

Interventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective.

  • National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and Deployment, 2001),

  • Office of the Surgeon General (1999, 2004),

  • President’s New Freedom Commission on Mental Health (2003)


Rationale for using evidence based practices
Rationale for Using Evidence-based Practices and conduct disorder, are characterized by antisocial behavior.

Programs that are integrative in nature (practice, research, theory) and use systematic clinical protocols ”clinical maps”

Manual driven

Model congruent assessment procedures

Focus on adherence and treatment fidelity

Clinically responsive and individualized to unique “outcome” needs of the client/family

Models that have strong science/research support


Family factors that promote resiliency national resilience resource center
Family Factors that Promote Resiliency and conduct disorder, are characterized by antisocial behavior.(National Resilience Resource Center)

􀂾 Parent and family connectedness

􀂾 Parent/Adolescent activities

􀂾 Parental presence

􀂾 Parental school expectations

􀂾 Parents involvement and awareness of sexual behaviors

􀂾 Limit access to substances and weapons

􀂾 Seek help for parental and familial problems/concerns

􀂾 Seek support from other parents

􀂾 Know community resources


Program characteristics that support positive youth development
Program characteristics that and conduct disorder, are characterized by antisocial behavior.support positive youth development

1. Comprehensive, time-intensive

2. Earliest possible intervention

3. Timing is important

4. High structure is better

5. Fidelity to model is key to effectiveness


Positive youth development con t
Positive Youth Development (con’t) and conduct disorder, are characterized by antisocial behavior.

6. Need adult involvement

7. Active, skills-oriented programs are more effective

8. Programs that target multiple systems are most effective

9. Programs that are sensitive to the individual’s community and culture are best

10. Programs based on strong theoretical constructs and proven effective by evidence are best

Connecticut Center for Effective Practice (From meta-analysis published in 2005)


3 treatments top the list for adolescents
3 Treatments top the list for adolescents and conduct disorder, are characterized by antisocial behavior.

ALL focus on family/ caregivers

  • Functional Family Therapy

  • Multidimensional Treatment Foster Care

  • Multisystemic Therapy


What is functional family therapy
What is Functional Family Therapy? and conduct disorder, are characterized by antisocial behavior.

  • Focus is to improve family communication and supportiveness while decreasing the intense negativity so often characteristic of these families.

  • Many of the targeted interventions, therefore, emphasize communication skills, family interaction, problem-solving and promoting constructive behaviors

  • Intervention ranges from, on average, 8 to 12 one-hour sessions up to 30 sessions of direct service for more difficult situations


What is functional family therapy1
What is Functional Family Therapy? and conduct disorder, are characterized by antisocial behavior.

  • Conducted both in clinic settings as an outpatient therapy and as a home-based model

  • A treatment technique that is appealing because of its clear identification of specific phases, which organize intervention in a coherent manner, thereby allowing clinicians to maintain focus in the context of considerable family and individual disruption

  • Each phase includes specific goals, assessment foci, specific techniques of intervention, and therapist skills necessary for success


Functional family therapy a treatment technique
Functional Family Therapy and conduct disorder, are characterized by antisocial behavior.A treatment technique


Multidimensional treatment foster care mtfc
Multidimensional Treatment and conduct disorder, are characterized by antisocial behavior.Foster Care (MTFC)

Program Overview:

The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement.


MTFC and conduct disorder, are characterized by antisocial behavior.

MTFC treatment goals are accomplished by providing:

Close supervision; fair and consistent limits ; predictable consequences for rule breaking ; a supportive relationship with at least one mentoring adult; and reduced exposure to peers with similar problems.

The intervention is multifaceted and occurs in multiple settings. The intervention components include:

  • Behavioral parent training and support for MTFC foster parents;

  • skills training for youth;

  • supportive therapy for youth;

  • school-based behavioral interventions and academic support;

  • and psychiatric consultation and medication management, when needed.


Multisystemic therapy
MULTISYSTEMIC THERAPY and conduct disorder, are characterized by antisocial behavior.

  • Youths’ behaviors are influenced by their families, friends, and communities (and vice versa).

  • Families are the key to success, so all aspects of treatment are designed with full collaboration from the family.

  • Change can happen quickly, but it demands daily and weekly efforts from the youth and all the important people in his/her life.

  • Families can live successfully without involvement in social service agencies.


How is mst different
How is MST Different? and conduct disorder, are characterized by antisocial behavior.

  • Discipline: Offers a combination of “best practice” treatments within a disciplined structure

  • Accountability: At all levels, providers are held accountable for outcomes through MST’s rigorous quality assurance system

  • Ecological validity: Working in the youth’s natural environment with existing family supports, thereby ensuring cultural sensitivity

  • Focus on long-term outcomes: Empowerment of caregivers to manage future difficulties; focus on sustainability


How does mst work
How Does MST “Work?” and conduct disorder, are characterized by antisocial behavior.

Intervention strategies: MST draws from research-based treatment techniques

  • Behavior therapy

  • Parent management training

  • Cognitive behavior therapy

  • Pragmatic family therapies

    • Structural Family Therapy

    • Strategic Family Therapy

  • Pharmacological interventions (e.g., for ADHD)


Why is mst successful
Why is MST Successful? and conduct disorder, are characterized by antisocial behavior.

  • Treatment targets known causes of delinquency: family relations, peer relations, school performance, community factors

  • Treatment is family driven and occurs in the youths’ natural environment

  • Providers are accountable for outcomes

  • Staff are well trained and supported

  • Significant energies are devoted to developing positive interagency relations


9 principles of mst

Finding the Fit and conduct disorder, are characterized by antisocial behavior.

Positive & Strength Based

Increasing Responsibility

Present focused, Action-orientated

Targeting Sequences

Developmentally/ Culturally Appropriate

Continuous Effort

Evaluation & Accountability

Generalization

9 Principles of MST


An ecological approach
An ecological approach and conduct disorder, are characterized by antisocial behavior.

  • Work with the entire ecology. By addressing the multiple systems, it is possible to make longer lasting changes for families.

Community

School

Peers

Family

Youth

Bronfenbrenner, 1979


Condensed longitudinal model of youth antisocial behavior
Condensed Longitudinal Model of and conduct disorder, are characterized by antisocial behavior.Youth Antisocial Behavior

Prior antisocial

behavior

Family

Low Monitoring

Low Affection

High Conflict

Antisocial

Peers

Antisocial

behavior

School

Explaining delinquency and drug use, by D.S. Elliott, D. Huizinga and S.S. Ageton. Beverly Hills, CA: Sage Publications, 1985, 176 pp

Low School Involvement

Poor Academic Performance


Individual factors
Individual Factors and conduct disorder, are characterized by antisocial behavior.

  • Antisocial behavior

  • Mental health problems

  • Low social conformity


Family
FAMILY and conduct disorder, are characterized by antisocial behavior.

  • Poor monitoring

  • Ineffective discipline

  • Low warmth

  • High conflict

  • Parental drug use/abuse


PEER and conduct disorder, are characterized by antisocial behavior.

  • Association with drug-using peers,

  • Low association with prosocial peers


School
SCHOOL and conduct disorder, are characterized by antisocial behavior.

  • Low achievement

  • Truancy

  • Low commitment to school


COMMUNITY FACTORS and conduct disorder, are characterized by antisocial behavior.

  • High crime

  • Neighbors who use drugs

  • Transience


What usually happens to youth

Meets other anti-social peers and conduct disorder, are characterized by antisocial behavior.

CYCLE CONTINUES

No changes at home

Returns home

What usually happens to youth?

Youth gets in trouble

Sent to treatment


What usually happens to youth1

Meets other drug-using peers and conduct disorder, are characterized by antisocial behavior.

CYCLE CONTINUES

What usually happens to youth?

Sent to treatment / group

Youth uses drugs

Now has greater access to negative peers, people to buy from


Case example
Case Example and conduct disorder, are characterized by antisocial behavior.

  • 16 year old male

    • Hx of truancy (missing school 2-3 days/week)

    • Runaway (usually 1-2 nights but as long as a week)

    • Defiant/oppositional –refuses to follow household rules


Case example 2
Case Example 2 and conduct disorder, are characterized by antisocial behavior.

  • 14 year old female

    • Involved with negative peers

      • Reportedly gang-involved

    • Alcohol/marijuana usage

    • Stealing/shoplifting charges


House bill 1373
House Bill 1373 and conduct disorder, are characterized by antisocial behavior.

  • …up to twenty outpatient therapy hours per calendar year, including family therapy visits integral to a child's treatment

    How can we best use this???


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