Working with children with conduct problems and their families 28th November 2013 10.30am-12.00pm AEDT.

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Working with children with conduct problems and their families 28th November 2013 10.30am-12.00pm AEDT Slide 2 PRESENTERS: Professor Mark R Dadds Director of the Child Behaviour Research Clinic, Professor of Psychology, University of New South Wales Dr Sophie Havighurst Senior Lecturer and Clinical Psychologist University of Melbourne Facilitator: Bella Saunders, Senior Psychologist APS Slide 3 Love and eye contact in the aetiology and treatment of early-onset conduct problems. Mark R Dadds Slide 4 Why study conduct problems? problems? Slide 5 Conduct disorders & operant/attachment theory Slide 6 My experience of 20 years of Child & Family CBT -Triple P -Move from single techniques to big therapies -Manuals and commercial dissemination -Everything works at about 50% -Can we learn from our failures? Slide 7 Aims Design assessments and interventions that are sensitive to childspecific causal variables. Slide 8 Heterogeneity in conduct problem children Hot CD emotional/anxious - high susceptability to environments - normal aggression. Cold CD- callous/unemotional (measured through parent-teacher report) - low susceptability to environment - abnormal aggression. Slide 9 Viding, Blair, Moffitt & Plomin (2005) Slide 10 Slide 11 Attention in emotion processing Increasing evidence that various forms of psychopathology are associated with deficits in processing emotions Relevant genotypes differently associated with amygdala activity to threatening faces Psychopathy associated with specific deficits in fear recognition and low amygdala response Anxiety/depression/hot aggression associated with increased fear recognition and high amygdala response Slide 12 Correlations between CU, Antisocial and accuracy of emotion recognition Dadds MR et al (2006). Look at the eyes: Fear recognition in child psychopathy. British Journal of Psychiatry, 189, 180-181. Slide 13 Munoz et al (2009) Journal of the American Academy of Child & Adolescent Psychiatry, 48, 5 554-562 Blair et al (2002) vocal cues. Slide 14 Language of the eyes (super-stimuli) Amygdala and attention, social gaze Ralph Adolphs work Slide 15 Fear stimulus Aversive threatInformation about environment from following others gaze Observer Idea 1: Fear perception and theory of mind Slide 16 Slide 17 Mean accuracy of facial fear recognition for boys high and low on CU traits under three Gaze conditions: no instruction, instruction to focus on eyes, instructed to focus on mouth. Significant interaction between Gaze and CU category, F(2,55) = 5.149, p =.009. Error bars represent standard errors of the mean. Slide 18 Eye Gaze Hotspots Cold conduct problems Healthy boys Hi CU boys Dadds et al. (2008) J Amer Acad Child Adolesc Psych. Slide 19 So? Does it happen in the real world? With attachment figures? Slide 20 Copyright restrictions may apply. Jones, W. et al. Arch Gen Psychiatry 2008;65:946-954. Example visual scan-paths and fixation time summaries for 3 toddlers watching the same video of an actress playing the role of a caregiver Slide 21 Study 1: Slide 22 Slide 23 Slide 24 But......... No control group Age spread Expensive coding Inappropriate tasks And.WARMTH! Slide 25 Study 2: Slide 26 Method Participants N = 24 children between 3 and 8 years of age; n = 12 with Oppositional Defiant Disorder (ODD) n = 12 comparison group. The LOVE interaction Slide 27 Slide 28 Healthy dyad: The Eye-Love-You Game Slide 29 Slide 30 Interpretations 1.Low eye contact is just another marker of low empathy 2.Low eye contact drives the development of low empathy and low susceptibility to parenting 3.Arguments: 1.Shaw et al (2005) early versus late amygdala damage 2.The primacy of parent-child eye contact 3.Newman et al. And Dadds et al. on attentional manipulations Slide 31 OXYTOCIN Oxytocin......... whos important to me, who Id die for, who Im pair- bonded with, who will take care of me, (Thomas Insel) Slide 32 Oxytocin and vasopressin levels after interaction with mothers Slide 33 Reading the Mind in the Eyes Test jealous panicked arrogant hateful Slide 34 Guastella A, Dadds MR, & Mitchell PB. (2009) Oxytocin increases gaze to the eye-region of human faces. Biological Psychiatry. Slide 35 Slide 36 Slide 37 Conclusions: CU traits are associated with an impairment in attention to emotional cues: These cues usually function as super-stimuli through development, provoking and consolidating important neural system that scaffold the development of affective contagion through to empathic concern; An error that in the system driving attention to these stimuli could lead to cascading errors across the development of empathic concern; While we cannot exclude environmental input, this impairment in the attachment system - genetic and epigenetic variations in the oxytocin receptor system. Slide 38 OXT (/SERT) systems Contagious affect Attention to emotional stimuli Pubertal transition Moral conscience Quality of parenting - reciprocated love Slide 39 Implications for future treatments Specific parenting strategies need to be refined in terms of specific emotional attention proclivities of the child. e.g. Eye contact with hot versus cold problem children Behavioural experiments with eye contact (love and attachment) Emotion attention/recognition training Biobehavioural manipulations of the OXT system Slide 40 Dadds, Cauchi, Wimalaweera, Hawes, & Brennan. Psychiatry Research (in press). Slide 41 Thanks to Sydney: David Hawes, John Brennan, Caroline Moul, Subodha Wimmalaweera, Dave Pasalich, Jasmin Jambrak, Avril Cauchi London: Stephen Scott, Jen Allen, Bonamy Oliver, Nathan Faulkner, Kat Legge, Caroline Moul, Matt Woolgar Thank YOU! Slide 42 Written by Sophie Havighurst and Ann Harley Working with Children with Conduct Problems: The Tuning in to Kids program Dr Sophie Havighurst Slide 43 Overview of Tuning in to Kids Slide 44 Tuning in to Kids (TIK) is an evidence- based program that helps parents teach their children about emotions while building a close and supportive relationship. Slide 45 What is the TIK program? Six session, parenting group program Focus on emotions in parents and children Parents become aware of their childs emotions and coach their child in being able to understand and regulate emotions Parents become aware of and regulate their own emotions when parenting In children - prevents problems from developing, or reduces problems that exist Can be used in individual therapy Slide 46 Theoretical Basis Based on the theory about the role of parent emotion socialization practices in shaping childrens emotional and behavioural competence. Targets emotional communication in parent- child relationships Draws on aspects of social learning theory, attachment theory, mindfulness and emotion coaching Slide 47 Emotion Coaching To emotion coach your child you: Become aware of their emotion, especially if it is of a lower intensity (such as disappointment or frustration) View their emotion as an opportunity for intimacy and teaching Communicate your understanding and acceptance of the emotion empathy Help them use words to describe what they feel If necessary, help them to solve problems. You may also communicate that all wishes and feelings are acceptable, but some behaviours are not. Adapted from Gottman, J. M. & DeClair, J. (1997). The Heart of Parenting: Raising an Emotionally Intelligent Child. New York: Simon & Schuster. Slide 48 TIK Theoretical Model Parenting: Attitudes/beliefs Emotion coaching Mindfulness Responsiveness Child Emotion Competence Emotionality Emotion Regulation Emotion Knowledge Child Factors Temperament Neurophysiology Gender Cognition/language Social/Cultural Factors Child Outcomes Behaviour Social Skills Academic Health Family of Origin experience with emotion Parent Functioning Emotion awareness Emotion wellbeing Family Functioning: Emotion climate Parent Meta- Emotion Philosophy Tuning in to Kids Program Slide 49 Why TIK with children with behaviour problems? Diverse approaches are needed Strategies for increasing attachment and building close connections between parents and children Assist parents to shift from automatic patterns in parenting Put developmental theories about emotional intelligence/competence into action Understand the emotional needs that lie behind challenging behaviours A complement for behavioural techniques (such as Triple P) or a different approach altogether. Slide 50 TIK Research Evidence Slide 51 Research on TIK and program variants Tuning in to Toddlers Pilot study (2010-2012) - MA student Michelle Lauw TIK Preschool Research Studies: pilot study (2000-2002) RCT community efficacy trial (2006-2009) Case studies with anxious children (2008-2010) PhD student Galit Hasen RCT clinical efficacy trial (2006-2009) RCT community effectiveness trial (2010-2011) DADS TIK pilot study (2011) DADS TIK RCT efficacy trial (2012-2014) TIK School Aged Research Studies RCT with conduct problem children - CASEA (2008-2013) - PhD student Melissa Duncombe RCT clinical sample children with chronic illness (2012-2014) - PhD student Wai Wai Yang Trauma-focused pilot study (2009-2013) - with Australian Childhood Foundation Tuning in to Teens Pre-adolescents and adolescents TINT (pre-adolescent) pilot study (2007) TINT (pre-adolescent) efficacy trial RCT (2009-2012) PhD student Christiane Kehoe TINT (pre-adolescent) qualitative study (2009-2012) MA for Ann Harley TINT (adolescent) efficacy trial RCT (2013 2017) Slide 52 Research Publications Duncombe, M. E., Havighurst, S. S., Holland, K. A., Frankling, E. J., Kehoe, C., & Stargatt, R. (under review). A randomized controlled comparison of an emotion- and behavior-focused group parenting program for children at risk for conduct disorder. Journal of Child and Adolescent Psychology. Havighurst, S. S., Harley, A., & Prior, M. (2004). Building preschool children's emotional competence: A parenting program. Early Education and Development, 15(4), 423-448. Havighurst, S. S., Wilson, K. R., Harley, A. E., & Prior, M. R. (2009). Tuning in to kids: An emotion-focused parenting program - initial findings from a community trial. Journal of Community Psychology, 37(8), 1008-1023. Havighurst, S. S., Wilson, K. R., Harley, A. E., Prior, M. R., & Kehoe, C. (2010). Tuning in to Kids: Improving emotion socialization practices in parents of preschool children findings from a community trial. Journal of Child Psychology and Psychiatry, 51(12), 1342-1350. Havighurst, S. S., Wilson, K. R., Harley, A. E., Kehoe, C., Efron, D., & Prior, M. R. (2013). Tuning in to Kids: Reducing young childrens behavior problems using an emotion coaching parenting program. Child Psychiatry & Human Development, 44(2), 247-264. Havighurst, S. S., & Harley, A. E. (2013). Tuning in to Kids: Emotion coaching for early learning staff. Belonging: Early Years Journal, 2(1), 22-25. Havighurst, S. S., Kehoe, C. E., Harley, A. E., & Wilson, K. R. (in Press). Tuning in to Kids: An emotion focused parenting intervention for children with disruptive behaviour problems. Child & Adolescent Mental Health (Occasional Paper). Slide 53 Research Publications continued Havighurst, S.S., Duncombe, M., Frankling, E., Holland, K., Kehoe, C., & Stargatt, R. (under review). An Emotion-Focused Early Intervention for Children with Emerging Conduct Problems. Journal of Abnormal Child Psychology. Kehoe, C. E., Havighurst, S. S., & Harley, A. E. (Early View). Tuning in to Teens: Improving parent emotion socialization to reduce youth internalizing difficulties. Social Development. doi: 10.1111/sode.12060 Kehoe, C. E., Havighurst, S. S., & Harley, A. E. (under review). Somatic complaints in early adolescence: The role of parents' emotion socialization. Journal of Early Adolescence. Lauw, M. S. M., Havighurst, S. S., Wilson, K., Harley, A. E., & Northam, E. A. (in press). Improving parenting of toddlers emotions using an emotion coaching parenting program: A pilot study of tuning in to toddlers. Journal of Community Psychology. Murphy, J. L., & Havighurst, S. S. (under review). Trauma-focused Tuning in to Kids: A pilot study. Journal of Traumatic Stress. Wilson, K. R., Havighurst, S. S., & Harley, A. E. (2012). Tuning in to Kids: An effectiveness trial of a parenting program targeting emotion socialization of preschoolers. Journal of Family Psychology, 26(1), 56-65. Wilson, K., Havighurst, S. S., & Harley, A. E. (in press). Dads Tuning in to Kids: Piloting a new parenting program targeting fathers emotion coaching skills. Journal of Community Psychology. Slide 54 Research trials of TIK with children with behaviour problems Clinical/sub-clinical trials Preschool RCT with children with clinical presentations to RCH with behaviour problems (RCH trial) School-aged RCT with 5-9 yr olds with emerging conduct disorder (CASEA trial) Pilot study of Children who have experienced complex trauma (Australian Childhood Foundation trial). Community RCTs Preschool efficacy trial Pre-adolescent efficacy trial. Slide 55 The use of an emotion coaching parenting program as part of an early intervention for children with emerging conduct disorder Child and Adolescent Mental Health Service Slide 56 Research Method Prep-Grade 3 children from 48 schools Randomized by school into two intervention conditions (Tuning in to Kids or Triple P) or 12 month waitlist control Assessment baseline and 10 month follow-up Parent/teacher Questionnaires plus direct child assessment School-wide universal intervention, parent and child groups and referral on as needed Slide 57 Participant Demographics VariableInterventionControl n 91113 Child Gender (% Male) 68 (74.7)83 (73.5) Age in years M (SD) 7.1 (1.3)7.0 (.9) Pro-Rated Full Scale IQ M (SD) 92.5 (15.1)90.3 (14.5) Eyberg Child Behavior Inventory Intensity Score - M (SD) 144.93 (40.09)140.47 (40.09) Gross Annual Income (% Low Income


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