Conduct Disorders in Alternative Education · CONDUCT DISORDER WORKSHOP ANNA FREUD CENTRE 200517 7...

Anna Freud National Centre for Children and Families

Conduct Disorders in Alternative Education

Brenda McHugh

TBAP Conference 2018

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“Conduct disorders are characterised by repetitive and persistent patterns of antisocial, aggressive or defiant behaviour that amounts to significant and persistent violations of age-appropriate social expectations” NICE


MISSED OPPORTUNITIESCentre for Mental Health 2016

Three quarters of parents of children with a mental health problem seek help

One quarter of children get help

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Mental Health problems seen in specialist services1. Anxious away from care givers (Separation anxiety)

11.Extremes of mood (Bipolar disorder)

21.Family relationship difficulties

2. Anxious in social situations (Social anxiety/phobia)

12. Delusional beliefs and hallucinations (Psychosis)

22. Problems in attachment to parent/carer (Attachment problems)

3. General anxiety (generalised anxiety)

13. Drug and alcohol difficulties (Substance abuse)

23. Peer relationship difficulties

4. Compelled to do or think things (OCD)

14. Difficulties sitting still or concentrating (ADHD/Hyperactivity)

24. Persistent difficulties managing relationships with others (includes emerging personality disorder)

5. Panics (Panic Disorder) 15. Behavioural difficulties (CD or ODD)

25. Does not speak (selective mutism)

6. Avoids going out (Agoraphobia) 16. Poses risk to others 26. Gender discomfort Issues (GID)

7. Avoids specific things (Specific phobia)

17.Carer management of CYP behaviour (e.g. management of child)

27. Unexplained physical symptoms

8. Repetitive problematic behaviours (Habit problems)

18. Doesn’t go to the toilet in time (Elimination problems)

28. Unexplained developmental difficulties

9. Depression/low mood (Depression) 19. Disturbed by traumatic event (PTSD)

29.Self-care issues (includes medical care management, obesity)

10.Self-harm (Self injury or self-harm)

20.Eating issues (Anorexia/Bulimia) 30. Adjustment to health issues4


1. Anxious away from care givers (Separation anxiety)

11.Extremes of mood (Bipolar disorder)

21.Family relationship difficulties

2. Anxious in social situations (Social anxiety/phobia)

12. Delusional beliefs and hallucinations (Psychosis)

22. Problems in attachment to parent/carer (Attachment problems)

3. General anxiety (generalised anxiety)

13. Drug and alcohol difficulties (Substance abuse)

23. Peer relationship difficulties

4. Compelled to do or think things (OCD)

14. Difficulties sitting still or concentrating (ADHD/Hyperactivity)

24. Persistent difficulties managing relationships with others (includes emerging personality disorder)

5. Panics (Panic Disorder) 15. Behavioural difficulties (CD or ODD)

25. Does not speak (selective mutism)

6. Avoids going out (Agoraphobia) 16. Poses risk to others 26. Gender discomfort Issues (GID)

7. Avoids specific things (Specific phobia)

17.Carer management of CYP behaviour (e.g. management of child)

27. Unexplained physical symptoms

8. Repetitive problematic behaviours (Habit problems)

18. Doesn’t go to the toilet in time (Elimination problems)

28. Unexplained developmental difficulties

9. Depression/low mood (Depression) 19. Disturbed by traumatic event (PTSD)

29.Self-care issues (includes medical care management, obesity)

10.Self-harm (Self injury or self-harm)

20.Eating issues (Anorexia/Bulimia) 30. Adjustment to health issues

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Conditions with recognised evidence-based treatments

CONDUCT DISORDER WORKSHOP ANNA FREUD CENTRE 200517

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DSM- 5 15 Conduct Disorder Criteria in 4 Categories:

Aggression to people & animals Deceitfulness or theft

1. Often bullies, threatens or intimidates others 2. Often initiates physical fights 3. Has used a weapon that can cause serious physical harm to 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 whilst confronting a victim 7. Has forced someone into sexual activity

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 non trivial value without confronting a victim

Destruction of property Serious violations of rules

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)

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

Anna Freud National Centre for Children and Families 8


In an average class of 30 fifteen year-old pupils:

3 could have a mental disorder

10 are likely to have witnessed their parents separate

1 could have experienced the death of a parent

7 are likely to have been bullied

6 may be self-harming

Public Health England (2015)

Summary of Conduct Disorder Pathways

Paul J. Frick, Ph.D.

Conduct Disorder

Childhood-OnsetSubtype

Primarily ImpulsiveType

Callous-UnemotionalType

Summary of Conduct Disorder Pathways

Conduct Disorder

Primarily ImpulsiveType

Callous-Unemotional Conduct Disorder.

These characteristics include:Lack of empathy or sensitivity to the feelings of others and a lack of concern for others’ distress;

Lack of remorse, shame or guilt over their own behavior (unless prompted by being apprehended);

Lack of concern over poor performance in school, work, or other important activities;

Limited expression of emotions, particularly positive or loving feelings toward others, or only doing so in ways that seem shallow, insincere, or instrumental;

Relative indifference to the probability of punishment;

Strong genetic component Professor Essi Viding

• In a large (n=7374) population-based study of 7-year old twins, genetic influences on childhood-onset conduct problems were greater in those high on CU traits (81%), compared to those with normal levels (30%)

• But the environment still matters greatly including the internet. Online life for children has good & bad elements Zimbardo, 2015

CONDUCT DISORDER WORKSHOP ANNA FREUD CENTRE 200517

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Animal StudiesMichael Meaney’s animal studies

Pups experiencing High Levels Licking

Grooming

Decreased startle response

Increased open field exploration

Better adaptation to novel environments

Robust negative feedback in HPA axis

Pups experiencing Low Levels Licking

Grooming

Increased startle response

More anxious in new surroundings

Decreased HPA negative feedback


“Super highway to learning”

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Key executive function skills for learning and mental wellbeing

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mentalization

mentalization is the ability to understand the mental state, of oneself or others, that

underlies overt behaviour.

Powerful emotion

Poor mentalising

Inability to understand or even pay attention to feelings of others

Others seem incomprehensible

Frightening, undermining, frustrating, distressing or

coercive interactions

Try to control or change others or oneself

Person 1

Powerful emotion

Poor mentalising

Inability to understand or even pay attention to feelings of others

Others seem incomprehensible

Try to control or change others or oneself

Frightening, undermining, frustrating, distressing or

coercive interactions

Person 2

Vicious Cycles of Mentalizing Problems


Wingen et al., (2011)

Amygdala

Anteriorinsula

Children Soldiers

McCrory et al., (2011)

Amygdala

Cerebral cortex

(reflective thinking and reasoning)

Amygdala carries out threat assessment ‘en route’

In fight/flight/appease situation, amygdala enables ultra-rapid active/reactive thinking and bodily responses

However, it also blocks route to cortex, making reflective

thinking unavailable

Some children will have an over-reactive stress system

and have real difficulties turning off their over-

sensitive alarm systems.

Perception of events is coloured by feelings of threat

and distress, leaving no opportunity to think clearly

Impact of highly-chargedevents on brain function


Executive skills competence and attention skills training

Social information processing- mentalization

Nurtured heart techniques

Sensory processing

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Welcome to SmartGym Attention Skills

Training

Getting Started

on your circuitFitLights

Neurotracker

Cardiowall


Kiss your brains

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Stress Contagion

Staff wellbeing


Management of Stress Contagion

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Crisis support using a de-brief and re-set model using skilled senior staff or external expertise

Regular mandatory wellbeing check-in meetings for all staff using a personal or

peer support model

Staff wellbeing team established and supported to offer regular events

Staff wellbeing policy

Mental health awareness training for all staff

Staff education on Child and Family mental health

Culture of no blame and stigma for mental health needs of school community


Check-in and re-set post incident

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Toolkit for Alternative Provision

New Pupil Toolkit

- measuring and monitoring

- Pupil support

- Family approach

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Who needs help and what works?

1) Taking a snapshot of well-being across pupils

2) Identifying those who might benefit from additional support and

3) Evaluating the effectiveness of that support.

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Elements of a whole-school approach

Figure 1: High-level domains that inform measurement of mental health and wellbeing (informed by

PHE publication: Measuring Mental Wellbeing in Children and Young People)

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Prevention

Identification

Early and complementary support

Accessing specialist support

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Focus on four areas

Prevention – ideally to reduce the incidence of mental

health issues longer term and promote good health and well being.

Identification – to spot emerging issues earlier and more

accurately, facilitating good early support or/and swift referral.

Early and complementary support – to help prevent

problems escalating and/or help the management of problems to reduce adverse impact on other outcomes and avoid crisis situations.

Access to specialist support – to result in swifter access to

the right specialist support and treatment when it is needed and to support engagement in education.

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Kids want to know video

https://mindfulschools.us17.list-manage.com/track/click?u=ae4b49988af32d959531de154

Share this video with your students&id=6c9f1d4673&e=f5cec2b784

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https://mindfulschools.us17.list-manage.com/track/click?u=ae4b49988af32d959531de154

https://mindfulschools.us17.list-manage.com/track/click?u=ae4b49988af32d959531de154&id=6c9f1d4673&e=f5cec2b784

Prevention, early intervention, identification and referral

https://www.gov.uk/government/publications/mental-health-and-behaviour-in-schools--2

https://www.gov.uk/government/publications/counselling-in-schools

https://pshe-association.org.uk/resources_search.aspx

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https://www.gov.uk/government/publications/mental-health-and-behaviour-in-schools--2

https://www.gov.uk/government/publications/counselling-in-schools

https://pshe-association.org.uk/resources_search.aspx


Where can you find more information?

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http://www.youtube.com/watch?v=yyaVKvuEBkk

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http://www.youtube.com/watch?v=yyaVKvuEBkk


Useful Tools Youth Wellbeing Directory

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http://www.youthwellbeingdirectory.co.uk/

Conduct Disorders in Alternative Education · CONDUCT DISORDER WORKSHOP ANNA FREUD CENTRE 200517 7...

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