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Tuesday, July 31, 2012

Short, Stop, Close for ODD



This Behavior Modification strategy enables the child to know the expectations for his/her behavior and helps you to maintain consistent positive/negative reinforcement.

Short, Soft and Close: Delivering Effective Reprimands
There are three key parts of an effective reprimand; short, soft, and close.  When used correctly, reprimands can serve to alter behavior without encountering an angry confrontation.
•        Short—The reprimand should consist of the child’s name and one or two additional
         words of direction such as, “Mike, stop yelling.”

•        Soft—The reprimand should be audible only to the child.  This serves to keep the
         adults’ emotions in check and helps to lower the dynamic of the confrontation.

•        Close—The reprimand should be delivered from within a few feet of the child,
         preferably within reach of the child.  A soft touch on the arm or shoulder will prove  
         to make the reprimand much more effective than will shouting it from the next  
         room.  The child will have your full attention and will be more likely to stop the
         targeted behavior.

Finally, after the reprimand is delivered and the targeted behavior has stopped, try to catch the child doing something good within the next few minutes.  Praise him/her for positive behavior in order to reinforce desired, appropriate behavior.

Working with children produces greater effects when we build on the positives and not the negatives.  Children are eager to please, yet adults often only point out when a child has misbehaved.  Children with ODD are used to hearing about all of their negative characteristics.   By creating as many opportunities for positive reinforcement as possible, we set up ways for the child to experience the positive feelings associated with cooperation and praise.  As a general rule, each day children should hear more positive than negative comments about themselves.



Arnold, D. S., O'Leary, S. G., Wolff, L. S., & Acker, M. M. (1993). The Parenting Scale: A measure of dysfunctional parenting in discipline situations.Psychological assessment, 5(2), 137.

O'Leary, D. K., Kaufman, K. F., Kass, R. E., & Drabbman, R. S. (1970). The effects of loud and soft reprimands on the behavior of disruptive students. Exceptional Children, 2, 145-155.

Using a Problem Solving Hand



The problem solving hand is a simple technique that can be used by children to use in conflict situations. Problem solving techniques are incorporated and supported in many evidence based practices when working with children.  In the schools it addresses academic and behavioral problems by utilizing problem solving.  Schools also incorporate problem solving interventions within their social emotional curricula.   An example where problem solving is core to its evidence based intervention is the RTI (Response to Intervention) curriculum.  Click on the link below demonstrating the use of the problem solving hand.
  References

Joseph, G. E., & Strain, P. S. (2003). Comprehensive Evidence-Based Social—Emotional Curricula for Young Children An Analysis of Efficacious Adoption Potential. Topics in Early Childhood Special Education, 23(2), 62-73.

Knoff, H. M. (2009).  Implementing Response-to-Intervention at the School, District, and State Levels. Little Rock, AR: Project ACHIEVE Press.

A brief summary of how to administer the SASSI-A2.

by Todd


The SASSI-A2 was developed by Dr. Glenn A. Miller.  The original adult version of the SASSI was published in 1988 and quickly became one of the most widely used substance abuse screening instruments.  The SASSI-A2 was published in 1994 and became just as popular for screening clients twelve to eighteen years of age.  The SASSI-A2 boasts a 94% instrument accuracy.  However, it is not intended to prove a substance disorder diagnosis, but to be single component of a comprehensive screening process.  The self-report questionnaire takes approximately fifteen minutes to complete, and can be administered by any human service worker trained in proper administration procedures.


Coll, K.M., Juhnke, G.A., Thobro, P., Haas, R. (2003). A preliminary study using the substance    abuse subtle screening inventory: Adolescent form as an outcome measure with adolescent offenders. Journal of Addictions & Offender Counseling, 24, 11-22.

Feldstein, S.W., Miller, W.R. (2007). Does subtle screening for substance abuse work? A review of the substance abuse subtle screening inventory (SASSI). Addiction, 102, 41-50.

Juhnke, G.A., Kelly, V.A. (2005). Addictions counseling with adolescents. In Kelly, Virginia A. (Ed); Juhnke, Gerald A. (Ed). (2005). Critical incidents in addictions counseling. (p 107-112). Alexandria, VA: American Counseling Association.

Lazowski, L.E., Miller, G.A. (2007)  SASSI: A reply to the critique of Feldstein & Miller.. Addiction102, 1001-1002.

Miller, F.G., Lazowski, L.E. (2005). Substance abuse subtle screening inventory for adolescents: Second version. In Grisso, Thomas (Ed); Vincent, Gina (Ed); Seagrave, Daniel (Ed).

Miller, W.R., Feldstein, S.W. (2007). SASSI: A response to Lazowski & Miller (2007). Addiction, 102, 1002-1004.

Sweet, R.I. Saules, Karen K. (2003). Validity of the substance abuse subtle screening inventory-  adolescent version (SASSI-A). Journal of Substance Abuse Treatment, 24, 331-340.





Intervention to begin discussion for CBT with adolescents



This in an intervention I use with my clients to help them open up (a lot of them are anxious and won't talk), particularly in groups to facilitate discussion. Because about 99% of my clients have some type of anxiety disorder, we normally use CBT to treat it, and this intervention allows them to feel comfortable opening up and talking about their feelings. It also helps gather information about the client that they may not have normally told you (without the game).


References:


Masia-Warner C, Klein RG, Dent HC, et al. (2005). School-based intervention for adolescents with social anxiety disorder: results of a controlled study. J Abnorm Child Psychology, 33(6):707-722.

Verhulst F. (2001) Community and epidemiological aspects of anxiety disorders in children. In: Silverman WK, Treffers PDA, eds. Anxiety Disorders in Children and Adolescents: Research, Assessment and Intervention. Cambridge, MA: Cambridge University Press; 273-292.

Anorexia Nervosa and the Maudsley Approach to re-feeding your starving child




The Maudsley Approach is applied to adolescents 18 and under who are living with their families.  It is designed to intervene aggressively in the first stages of illness and is a short term model as short as 20 sessions or six months in duration.

The Maudsley Approach builds on evidence that family therapy approaches are superior to individual therapy approaches with younger patients.  This approach involves the family from the outset of treatment and relies heavily on patient involvement in the re-feeding of the child with an eating disorder.
Parents are empowered to help their adolescent recover from this life threatening illness, rather than having them watch passively from the sidelines.  This treatment involves compassion, yet persistent and firm expectations that your adolescent eat an amount of food that can reverse the state of starvation his or her body is in and help them to gain weight.

In the first stage of treatment, the therapist plays an active and key role in helping parents separate their child from the child’s illness.  Parents are given the task of re-feeding and removing the illness from the child.   
Re-feeding the patient begins as the patient usually has just been hospitalized and is medically compromised.  This phase focuses exclusively on the re-feeding of the patient and other psychological issues are not explored.  Parents are encouraged to set their own goals regarding their child’s weight and health, with the emphasis on physical appearance and menstruation in girls as an indicator rather than precise weight goals.

Attia, E., & Walsh, B. T. (2009). Behavioral management for anorexia nervosa.New England Journal of Medicine, 360(5), 500-506.

Couturier, J., Isserlin, L., & Lock, J. (2010). Family-based treatment for adolescents with anorexia nervosa: a dissemination study. Eating disorders,18(3), 199-209.

Wallis, A., Rhodes, P., Kohn, M., & Madden, S. (2007). Five-years of family based treatment for anorexia nervosa: The Maudsley Model at the Children's Hospital at Westmead. International journal of adolescent medicine and health,19(3), 277-284.





Stop, Watch, and Copy: A modeling technique



Stop, Watch, and Copy is a modeling technique that can be used with any child, but is particularly useful with children who have a diagnosis of autism or asperger’s syndrome.  Children with autism or asperger’s often tend to miss social cues which result in them not being able to exhibit appropriate behaviors in social situations.  Not being able to act appropriately in social situations creates added stress in the life of a child who already is dealing with the symptoms related to the autism or Aspergers syndrome.

To implement Stop, Watch, and Copy, you can use visual cue cards (like the one’s below) or verbally talk with the child about stopping when they enter a social situation, watching what is going on around them, and then copy the behaviors (positive) that they see other people doing.  It is important that the child can identify the difference between positive and negative behaviors so that they do not copy the negative behaviors that may be occurring. 


Bellini, S., & Akullian, J. (2007). A meta-analysis of video modeling and video self-modeling interventions for children and adolescents with autism spectrum disorders. Exceptional Children, 73(3), 264-287.

Charlop-Christy, M. H., Le, L., & Freeman, K. A. (2000). A comparison of video modeling with in vivo modeling for teaching children with autism. Journal of autism and developmental disorders, 30(6), 537-552.

Nikopoulos, C. K., & Keenan, M. (2004). Effects of video modeling on social initiations by children with autism. Journal of Applied Behavior Analysis, 37(1), 93-96.

Shipley-Benamou, R., Lutzker, J. R., & Taubman, M. (2002). Teaching daily living skills to children with autism through instructional video modeling. Journal of Positive Behavior Interventions, 4(3), 166-177.


The Stop Light Model: Cognitive Behavioral Therapy

by Jessica

Depression will affect between 3-8 percent of the population by mid-adolescence.  Research supports CBT to be used with significant success with mild to moderate depression.  The National Institute of Mental Health has found that when treating major depression in adolescents with medication, CBT not only aids in a faster recovery, but also provides additional safeguards for those vulnerable to suicide.

CBT gives the adolescent a way of better understanding how their negative thoughts affect how they respond to different situations, and in turn, how they feel.  With the use of specific tools to change negative thoughts, youth are able to work their way out of depression.  One of the goals of CBT is cognitive restructuring which asks the client to identify his or her negative, unrealistic or unhelpful thoughts, evaluate evidence for and against these, and generate a more positive, realistic or helpful thought based on this evidence”
 This video gives one example of a CBT tool that can be used to aid in cognitive restructuring.


Cognitive Behavior Therapy and Medication. (n.d.). Retrieved July 15, 2012, from Worry Wise Kids:www.worrywisekids.org/treatments/med_thrpy.html

Friedburg, R. D. (2009). Self-Instructional and Cognitive Restructuring Methods. In Cognitive Behavioral Therapy Techniques for Children and Adolescents (pp. 121-128). New York: The Guilford Press .

Gledhill, J., & Hodes, M. (2011). The Treatment of Adolescents with Depression. Current Medical Literature - Psychiatry 22(1) , 1-7.

Labbe, C. (2007). Depressed Adolescents Respond Best to Combination Treatment. Retrieved July 15, 2012, from National Institutie of Mental Health: www.nih.gov/news/pr/oct2007/nimh-01.htm

Rapport Building Developmental Assessment



The video demonstrates the use of drawing "Face Circles" and "Family Circles" in order to conduct a developmental assessment of a child while also building rapport.  Completing a developmental assessment allows an interviewer to later tailor questions to a particular child's competence and overall functioning, including motor skills, language, and cognitive skills.  This will aide in collecting the most reliable information from the child during later interviews.

Drawings can assist in building rapport with a child because drawing, typically, is an engaging activity and is an appropriate tool of communication with all ages of children.
The video also demonstrates the skill of inviting narrative from the child while both are engaged in drawing.  This allows the child to practice answering in narrative form while discussing neutral or positive topics.

References:

Anderson, J., Ellefson, J., Lashley, J., Lukas Miller,  A., Olinger, S., Russell, A., Stauffer, J., & Weigman, J. (2010). The CornerHouse Forensic Interview Protocol: RATAC®. The Thomas M. Cooley Journal of Practical and Clinical Law, 12(2). 193-331.  Available at: www.ncjrs.gov/App/Publications/abstract.aspx?ID=258656

Hiltz, B. & Bauer, G. (2003). Drawings in forensic interviews of children. American Prosecutor's Research Institute, 16(3). Available at: www.ndaa.org/pdf/update_vol16_no3.pdf