Professor Matthew Sanders FAPS and Dr James Kirby MAPS, Parenting and Family Support Centre, University of Queensland and University of Southern Queensland

Childhood behavioural disorders are characterised by an intensity of externalising problems typically seen in primary school aged children, however, can also be found in children as young as two years of age. Typically children with behaviour disorders will demonstrate problems with self-control, anger and frustration, temper tantrums and non-compliance, and display physical and aggressive behaviours towards other children, objects and parents.

Childhood behavioural disorders can have devastating and pervasive impacts on children and their families without intervention. Parents can become depressed, anxious and stressed, and consequently rely on coercive or authoritarian parenting approaches that often result in a perpetuation of the presenting problems. Children with behavioural disorders typically have difficulty making friends, regulating their emotions and following rules, and are at risk of learning and conduct problems at school. The negative effects of childhood behavioural disorders can have long-term consequences on their mental health and can impact their capacity to cope with a spectrum of major life events.

The worldwide prevalence rate of child behavioural problems is approximately 20 per cent (WHO, 2005), and in Australia the estimated prevalence rate of childhood behavioural disorders is 14 per cent (Sawyer et al., 2000).

General principles of psychological assessment

Assessment of behavioural disorders often takes a multi-method and biopsychosocial approach, with family interviews being of importance as well as individual interviews with the child, parents and teachers. Behavioural observations are also an important source of information that can be conducted at the child’s home, at school and in other settings where there are identified behavioural difficulties. Important information to obtain is the frequency, intensity, duration and in which settings the problem disruptive behaviours occur.

Parent self-report measures such as the Strengths and Difficulties Questionnaire, the Eyberg Child Behaviour Inventory, and the Child Behaviour Behaviour Checklist are useful to administer in order to identify the clinical significance of the child’s problems, as normative data exist for these measures.

Beyond clinical assessment, population surveys are also necessary to determine the prevalence rates of child behavioural disorders and parenting practices that contribute to the development or maintenance of problem behaviours.

Evidence-based psychological treatment guidance

  • Evidence-based parenting programs (EBPPs) have Level 1 evidence for the treatment of childhood behavioural disorders, and are a recommended pathway to both preventing and treating childhood behavioural problems. EBPPs achieve this through enhancing the knowledge, skills and confidence of parents in managing children’s behaviour. Numerous meta-analyses of parenting programs based on social learning theory, and cognitive behavioural principles have demonstrated the efficacy of positive parenting programs in changing children’s behaviour (e.g., The Triple P-Positive Parenting Program; Incredible Years; Parent-Child Interaction Therapy; Parent Management Training Oregon Model). Given the importance of the family, specifically the impacts of parenting, in treating childhood behavioural disorders, it is vital that funded programs enable parents to access EBPPs as a frontline option.
  • Cognitive behaviour therapy (CBT) interventions have Level 1 evidence in the treatment of conduct disorder and oppositional defiant disorder in children. CBT programs typically focus on anger management training, assertiveness training, problem skills learning, or social skills training. Typically in CBT interventions children learn strategies, for example, problem solving for dealing with anger-provoking social situations, and they practice appropriate social responses and self-statements in response to different problem situations, by behavioural rehearsal of the situations with feedback for correct responses.

Emerging treatment directions for the future

More efforts with a preventive population focus are required, such as the approach of creating nurturing environments that are critical in ensuring the prevention and treatment of early onset conduct problems in children. The distinguishing features of nurturing environments include: (a) minimising biologically and psychologically toxic environments; (b) promoting and reinforcing prosocial behaviours such as self-regulatory skills; (c) reducing the opportunities for problem behaviour; and (d) encouraging psychological flexibility of individuals. Therefore, the family is of highest priority when building nurturing environments for children. Adopting such an approach requires a public health perspective, targeting children and parents at a whole-of-population level, utilising a blend of universal and targeted interventions.

Key reading and information sources

  • The critical role of nurturing environments for promoting human wellbeing (Biglan et al., 2012)
  • Evidence-based psychotherapy for children and adolescents: Data from the present and a model for the future (Weisz & Gray, 2008)
  • Development, Evaluation, and Multinational Dissemination of the Triple P-Positive Parenting Program (Sanders, 2012)
  • Parent-training/education programmes in the management of children with conduct disorders (National Institute of Clinical Excellence and Social Care, 2006)

References

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms and Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.
  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  • Biglan, A., Flay, B. R., Embry, D. D., & Sandler, I. N. (2012). The critical role of nurturing environments for promoting human well-being. American Psychologist, 67, 257-271. doi: 10.1037/a0026796.
  • Eyberg, S., & Pincus, D. (1999). Eyberg Child Behavior Inventory and Sutter-Eyberg Student Behavior Inventory-Revised: Professional Manual. Odessa, FL: Psychological Assessment Resources.
  • Fernandez, M., & Eyberg, S. (2009). Predicting treatment and follow-up attrition in parent-child interaction therapy. Journal of Abnormal Child Psychology, 37, 431–441. doi:10.1007/s10802-008-9281-1
  • Forgatch, M. S., & Patterson, G. R. (2005). Parents and adolescents living together: Family problem solving (2nd ed., Vol. II). Cham- paign, IL: Research Press.
  • Goodman, R., (1999). The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. Journal of Child Psychology and Psychiatry, 40, 791-799.
  • National Institute of Clinical Excellence and Social Care. (2006). Parent-training/education programmes in the management of children with conduct disorders. London: Author.
  • Sanders, M. R. (2012). Development, Evaluation, and Multinational Dissemination of the Triple P-Positive Parenting Program. Annual Review of Clinical Psychology, 8, 1-35. doi: 10.1146/annurev-clinpsy-032511-143104
  • Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J. (2014). The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support. Clinical Psychology Review, 34, 337-357. Doi: 10.1016/j.cpr.2014.04.003
  • Sawyer, M. G., Arney, F. M., Baghurst, P. A., Clark, J. J., Graetz, B. W., Kosky, R. J., et al. (2000). The mental health of young people in Australia. Canberra, Australia: Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care.
  • United Nations Office Drugs & Crime [UNODC]. (2009). Guide to implementing family skills training programmes for drug abuse prevention. New York: United Nations.
  • Webster-Stratton, C. (1998). Preventing conduct problems in Head Start children: Strengthening parenting competencies. Journal of Consulting and Clinical Psychology, 66, 715–730. doi:10.1037/0022-006X.66.5.715.
  • Weisz, J.R., & Gray, J.S. (2008). Evidence-based psychotherapy for children and adolescents: Data from the present and a model for the future. Child and Adolescent Mental Health, 13, 54-65. Doi: 10.111/j.1475-3588.2007.00475.x
  • World Health Organisation [WHO]. (2005). Child and adolescent mental health policies and plans. Geneva: WHO.

InPsych October 2014