Introduction to Behavioral Pediatrics
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Transcript of Introduction to Behavioral Pediatrics
Introduction to Behavioral PediatricsJodi Polaha, Ph.D.Assistant Professor, PediatricsMunroe-Meyer InstituteUniversity of Nebraska Medical Center
Overview
Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)BackgroundAssessmentTreatment
ODD
Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures.
ODD
Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures.
Does not involve major antisocial violations.
ODD
Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures.
Does not involve major antisocial violations.
Frequently confused with ADHD.
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
ODD
Enduring pattern. Early behavioral intervention
very successful. No medication treatment.
ODD
Coercive Family Processes (Patterson)
ODD
Coercive Family Processes (Patterson)
Child escalatesgets his way
Parent gives inGets peace and quiet
Pattern of two-way negative reinforcement
ODD
AssessmentOf 10 commands…?
ODD
AssessmentOf 10 commands…?Routines: eating, sleeping, public.
ODD
AssessmentOf 10 commands…?Routines: eating, sleeping, public.Eyberg Child Behavior Inventory
ODD
ODD
AssessmentOf 10 commands…?Routines: eating, sleeping, public.Eyberg Child Behavior InventoryIn-clinic observation
• Formal• Informal
ODD
What behavioral skills?
ODD
What behavioral skills?Self-quietingAnger managementFollowing instructions, rulesIndependent playSocial skills
ODD
What behavioral skills?Self-quietingAnger managementFollowing instructions, rulesIndependent playSocial skills
ODD
Thinking time question #1:How to improve skill of self-
quieting?
ODD
Self-quietingPredictablilityRepetition/PracticeHigh contrast or “big difference”
ODD
Parent-Child Interaction TherapySheila Eyberg (1990s)Forehand & McMahon (1980s)Hanf (1960s)
ODD
Part 1.Child’s Game“CDI”
Part 2.Parent’s Game“PDI”
ODD
Part 1.Child’s Game“CDI”
To establish the parent’s positive attention as a reinforcer.
Part 2.Parent’s Game“PDI”
ODD
CDI
Do: Don’t:Describe CommandPraise ReprimandTouch Question
ODD
CDI
5-10 min. per day. Bug in the ear. Work to criteria. Feedback in subsequent
sessions.
ODD
Part 1.Child’s Game“CDI”
GOALTo establish the
parent’s positive attention as a reinforcer.
Part 2.Parent’s Game“PDI”
ODD
Part 1.Child’s Game“CDI”
GOALTo establish the
parent’s positive attention as a reinforcer.
Part 2.Parent’s Game“PDI”
GOALTo establish
“instructional control”
ODD
PDI
Do: Don’t:Good commands Nag, etc.Consistent response Vascillate
ODD
PDI
Compliance trainingTime-Out
ODD
Time-Out (my version)
Misconceptions: Must be quiet/still Must be sorry Must understand why Length
ODD
Time-Out (my version)
Definition:
ODD
Time-Out (my version)
Definition: no access to attention or anything fun
ODD
Time-Out (my version)
1-3 min in chair Noncompliance and aggression Daily reward
ODD
Time-Out (my version)
IMPORTANT TOPICS: Extinction burst/training time-out
chair Pick your battles
ODD
Job Card Grounding
ODD
Job Card Grounding Rules Odd Jobs (Job Cards) Incentives
ODD
Three types of consequences:
Natural
ODD
Three types of consequences:
Natural Related
ODD
Three types of consequences:
Natural Related Unrelated
ODD
Thinking time question #2:
How to get child to stay in car seat?
ODD
Thinking time question #3:
How to decrease disruptive behavior in church?
ODD
Thinking time question #4:
How to get family to keep their “things” out of main areas of house?
CD
Persistent pattern of behavior that is not socially acceptable
May violate rights of others.
CD
DSM IVAggression 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
CD
DSM IVAggression to people and animalsDestruction of property
• Has deliberately engaged in fire-setting to cause damage
• Has deliberately destroyed others’ property
CD
DSM IVAggression to people and animalsDestruction of propertyDeceitfulness 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
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.
CD
Treatment OptionsJob Card GroundingProblem-Solving/NegotiatingResidential Treatment