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Listen to thisWhat interventions are available for children with behavioural and emotional problems? Most authors feel that behavioural and cognitive-behavioural methods have so far been shown to be the most effective in treating antisocial behaviour (Kazdin, 2002; Macdonald & Roberts, 1995). These interventions tend to have been more rigorously evaluated and have stood up to the evaluation process, giving, on the whole, positive results. Such intervention may be child-focused or parent-focused.
Child-focused interventions include Social Skills Training and Cognitive Skills Training since it is felt that children who exhibit antisocial behaviour have deficient social skills and problem-solving skills (Dumas, 1989).
Parent-focused interventions include Parent Management Training, which is founded on several important ground rules or strategies. It emphasises the importance of developing rules or boundaries for acceptable behaviour within the family so that their children are able to develop a framework within which they can assess their own behaviour (Macdonald & Roberts, 1995). Parents are also enabled to recognise which behaviours can be reasonably expected from their children.
Parent Management Training involves teaching parents certain techniques such as how to give clear unambiguous instructions. Parents are also given training in contingency management skills so that they can learn to recognise and reinforce desired behaviour and reduce or extinguish undesired behaviour.
Many studies have demonstrated the effectiveness of Parent Management Training with a wide range of child behaviour problems (Barlow & Parsons, 2002; Barlow & Stewart-Brown, 2000; Brestan & Eyberg, 1998; Richardson & Joughin, 2002).
It is not, however, successful in all cases. Parent Management Training is also unlikely to succeed in families in which many complex problems are present (Macdonald & Roberts, 1995; British Medical Association, 1999). Such problems include poor parental adjustment, in particular maternal depression; maternal stress and poor socioeconomic status; maternal social isolation; parental discord and poor parental perception of the significance and severity of the emotional and behavioural problems of their children (Dumas, 1989; Macdonald & Roberts, 1995). These same problems appear to overlap with the risk factors for the development and maintenance of behavioural problems in children described earlier.
Solution Focused Brief Therapy is an approach to counselling and consultation that was developed by Steve de Shazer at the Brief Family Therapy Centre in Milwaukee in the 1980s (de Shazer, 1994). It evolved when de Shazer started questioning clients about exceptions to their problem behaviours; for example, behaviours such as depression. From this it was possible to start constructing solution behaviours with the exceptions forming the basis of the solutions (George, Iveson, & Ratner, 1999a). Solution Focused Brief Therapy is very much client-directed and makes much use of positive reinforcement by the therapist of the client's problem-free, successful behaviour. Evaluations of Solution Focused Brief Therapy appear to be positive (George, Iveson, & Ratner, 1999b).
In this study, Solution Focused Brief Therapy was used in conjunction with Parent Management Training.
References
Barlow, J., & Parsons, J. (2002). Group based parent-training programmes for improving emotional and behavioural adjustment in 0-3 year old children (Cochrane Review). The Cochrane Library (Issue 2). Oxford: Update Software.
Barlow, J., & Stewart-Brown, S. (2000). Behaviour problems and parent-training programs. Journal of Developmental and Behavioural Pediatrics, 21, 356-370.
Brestan, E. Y., & Eyberg, S. M. (1998). Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. Journal of Clinical Child Psychology, 27, 180-189.
British Medical Association (1999). Growing up in Britain: Ensuring a healthy future for our children. A study of 0-5 year olds. London: BMJ Books.
de Shazer, S. (1994). Words were originally magic. New York: W. W. Norton and Company.
Dumas, J. E. (1989). Treating antisocial behavior in children: child and family approaches. Clinical Psychology Review, 9, 197-222.
George, E., Iveson, C., & Ratner, H. (1999a). Problem to solution: Brief therapy with individuals and families London: Brief Therapy Press.
George, E., Iveson, C., & Ratner, H. (1999b). Solution Focused Brief Therapy: Course notes. London: Brief Therapy Practice. (Reprinted with corrections 2000)
Kazdin, A. E. (2002). The state of child and adolescent psychotherapy research. Child and Adolescent Mental Health, 7, 53-59.
Macdonald, G., & Roberts, H. (1995). What works in the early years. Ilford: Barnardo's.
Richardson, J., & Joughin, C. (2002). Parent-training programmes for the management of young children with conduct disorders. London: Royal College of Psychiatrists.
Brown, E. A. & Dillenburger, K. (2004) An Evaluation of the Effectiveness of Intervention in Families with Children with Behavioural Problems within the Context of a Sure Start Programme. Child Care in Practice, Vol. 10, No.1, January 2004, pp. 65-66
