Treatment of Child/Adolescent

Disorders

Autism Spectrum Disorders (ASDs)

ASDs include Autistic disorder, Asperger syndrome, and Pervasive Developmental Disorder not otherwise specified.

Based on research, behavioral therapies that help children with ASDs provide structure, direction, and organization for the child. Family participation in therapy is also necessary for success.

Behavioral therapies for ASDs should start as early as possible.

Behavioral therapies for ASDs

Behavioral therapies help children with ASDs build language, social and play skills.

Applied behavioral analysis (ABA) is frequently used for children with ASDs and research shows that it can be very effective in helping children with ASDs.

ABA involves identifying the behaviors that need to be reduced and the ones that need to be built.

In ABA the child practices skills repeatedly and the therapist constantly provides positive reinforcements for the child. The program is highly individualized based on the child’s interests, abilities and behavior.

Applied Behavioral Analysis (ABA)

ABA is a general intervention approach that can be adapted to different circumstances and settings. ABA can be used in combination with other psycho-educational and behavioral strategies.

In ABA, the skills and behavior of each child are assessed, and appropriate functional skills to be taught are chosen with respect to the child’s ability.

The teaching environment is is set up to emphasize classroom structure, to adapt instructional activities, and to develop meaningful curriculum.

Early Intensive Behavioral Intervention (EIBI)

Early intensive behavioral intervention (EIBI) in contrast to ABA, is a much more prescriptive, manualized program that integrates components of ABA.

Children in an EIBI program have therapy approximately 40 hours per week over the course of up to two years.

It is recommended that the child start therapy before the age of three.

Two manualized EIBI programs are the University of California, Los Angeles (UCLA)/Lovaas model and the Early Start Denver Model (ESDM). Both programs involve high intensity instruction using ABA techniques but have several differences.

The UCLA/Lovaas method uses one-on-one therapy sessions and discrete trial teaching.

The ESDM uses ABA principles with developmental and relationship-based approaches for young children.

Other interventions for ASDs

Cognitive behavioral therapy- CBT is used to teach children with ASD to monitor and manage their own behaviors through changing their perceptions, self-understanding and beliefs. Change is more likely to take place when a child is actively involved in their own behavior management. CBT is only appropriate for children with some degree of self-understanding and self- awareness and are therefore mostly used with school-age children and adolescents with High Functioning Autism and Asperger’s Disorder.

Social Skills Interventions – Peer-mediated intervention is used to encourage specific social skills and to also encourage broader interactions and relationships (Rogers, 2000; McConnell, 2002). In this type of intervention, children without ASD are taught how to initiate, elicit, prompt and reinforce social behaviors of children with ASD (Odom, Chandler, Ostrosky, McConnell, & Reaney, 1992). Parents can also be taught to train siblings to use peer-mediated approaches at home to improve child-sibling interactions (Strain, Kohler, Storey & Danko, 1994).

Childhood Schizophrenia

Treatment should include family education and ongoing family intervention so that the family is in the best position to provide support to the child.

Individual treatment with the adolescent must take into account the child’s developmental level.

Due to likely social skills deficits, social skills training should be an integral part of the treatment.

 These sessions teach kids the coping mechanisms and communication skills that will help them go to school and socialize with their peers.

Cognitive behavioral therapy is also commonly recommended to help children manage their symptoms; it’s been shown to reduce both severity of symptoms and the risk of relapse.

Psychoeducational Family Therapy

A psychoeducational approach helps families learn skills and gain resiliency to handle chronic problems/illnesses that affect a member of the family.

Traditional family therapy techniques are used: joining, establishing an alliance with family members, maintaining neutrality, and assessing how to gain positive outcomes.

Combining medication management and a family psychoeducational intervention offers families a therapeutic package aimed at reducing family stress and preventing symptomatic relapse in the schizophrenic member.

When family members are not being blamed for the development of the disorder in one of their members it is easier to engage and retain them into treatment programs, thus increasing the likelihood of improved treatment compliance.

Their willingness to work with the therapist is also increased if they understand that efforts will help them reduce the family’s level of emotional intensity so that relapse in the schizophrenic might be delayed or reduced in severity.

Because schizophrenia can be considered a chronic disorder, a medical family therapy can also be utilized as an intervention.

Medical family therapy consists of a coordinated effort by an interdisciplinary team to treat a disorder. The focus is helping families to cope better with a chronic illness, manage medication, communicate better with providers, and accept that the illness may not be cured.

This model for family therapy replaces the traditional medical model that focuses exclusively on a sick individual receiving care to one in which the family becomes a key component to the caregiving system.

It seeks to draw out the family’s strengths so as to enhance coping.

Therefore, both psychosocial factors and biological interventions play an important role in improving outcomes for the family member with schizophrenia and the family.

Childhood Eating Disorders-Anorexia and Bulimia

Treatment includes: Adequate nutrition, reducing excessive exercise, and stop-ping purging behaviors.

For less severe eating disorder cases individual therapy and medication are effective for many eating disorders. However, in more chronic cases, specific treatments have not yet been identified.

Treatment plans often are tailored to individual needs and may include one or more of the following: 1. Individual, group, and/or family psychotherapy, 2. Medical care and monitoring, 3. Nutritional counseling, 4. Medications.

Individual therapy should focus on resolution of distorted cognitions, body image and self-image issues, and treatment of mood and anxiety disorders.

Family therapy should focus on education, addressing communication, family relationships, and individuation issues.

Some patients may also need to be hospitalized to treat problems caused by mal-nutrition or to ensure they eat enough if they are very underweight.

Anorexia Nervosa

Treating anorexia nervosa involves three components: Restoring the person to a healthy weight, treating the psychological issues related to the eating disorder, reducing or eliminating behaviors or thoughts that lead to insufficient eating and preventing relapse.

Different forms of psychotherapy, including individual, group, and family-based, can help address the psychological reasons for the illness.

In a therapy called the Maudsley approach, parents of adolescents with anorexia nervosa assume responsibility for feeding their child. This approach appears to be very effective in helping people gain weight and improve eating habits and moods.

Bulimia Nervosa

To reduce or eliminate binge-eating and purging behaviors, nutritional counseling and CBT can be effective.

CBT helps a patient focus on his or her current problems and how to solve them. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize, and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly.

CBT that is tailored to treat bulimia nervosa is effective in changing binge-eating and purging behaviors and eating attitudes. CBT can be individual or group-based.

Behavioral Disorders- ADHD, Conduct Disorder and Oppositional Defiant Disorder

Evidence-based Psychosocial Treatment for ADHD - Treatment for ADHD should include a psychosocial component.

Research on the treatment of ADHD supports that there are two treatments that have scientific evidence for short-term effectiveness: behavioral psychosocial treatments—also called behavior therapy or behavior modification—and stimulant medication. Behavior modification is the only nonmedical treatment for ADHD with a large scientific evidence base.

Children with ADHD have problems in daily life functioning in many areas including academic performance and behavior at school, relationships with peers and siblings, disobedience with adults, and relationships with their parents.

How a child with ADHD will do in adulthood is best predicted by three things—(1) whether his or her parents use effective parenting skills, (2) how he or she gets along with other children, and (3) his or her success in school.

Behavioral treatments must focus on these things and teach skills to parents, teachers, and children with ADHD.

ADHD is a chronic condition, therefore teaching skills that will be valuable to the child as they get older is really critical.

Behavior Modification for ADHD

Behavior modification is a form of therapy in which parents, teachers, and children are taught skills by a therapist.

Parents and teachers use those skills in their daily interactions with the child with ADHD to improve the children’s functioning, the child with ADHD uses the skills they learn in their interactions with other children.

Behavior modification can be thought of as the ABCs—Antecedents (things that happen before behaviors that influence them), Behaviors (things the child does that parents and teachers want to change), and Consequences (things that happen after behaviors that influence them).

In behavioral programs, adults are taught to modify antecedents (e.g., how they give commands to children) and consequences (e.g., how they follow-up if a child obeys or disobeys a command) to change the child’s behavior (that is, the child’s response to the command). By consistently changing the ways that they respond to children’s behaviors, adults teach the children to learn new ways of behaving.

There are three parts of effective behavioral interventions for ADHD children—parenting training, school interventions, and child-focused treatments.

Teaching parents more effective ways of dealing with their children is the most important aspect of psychosocial treatment for ADHD.

Parent, teacher, and child interventions must occur simultaneously in order to achieve the best results.

Parent Training

Behavioral approach Focus on parenting skills, child behavior in the home and

neighborhood, and family relationships (e.g., getting along with siblings, complying with parent requests)

Parents are taught skills by therapists and instructed to implement them at home

Typically group-based, weekly sessions with therapist initially (8 to 12 sessions); then faded to booster sessions

Continually evaluate and modify what is being done to identify what works best

Plan for what will be done if parents or child regressReestablish contact with a therapist for major

developmental transitions (e.g. start of middle school)

School Intervention

Behavioral approach Focus on classroom behavior, academic performance, and peer

relationships Teachers are taught classroom management skills by a therapist,

school psychologist or counselor Two to 10 hours of training are necessary depending on the

teacher’s prior knowledge and skills and the child’s severity and responsiveness

Continually evaluate and modify what is being done to identify what works best and maintain it as long as necessary

Plan for what to do if child and plan regress Integrate with school-wide plans, and required, school-based

programs Reestablish contact with therapist/counselor for major

developmental transitions ( entry to middle school)

Child Intervention

Behavioral approach Focus on teaching academic, recreational, and

social/behavioral competencies, decreasing aggression, developing close friendships, and building self-efficacy

Can include, individual sessions, clinic-based weekly group sessions, after-school or Saturday sessions

Intensive treatment is necessaryMonitor and modify as needed based on what works best;

provide as long as necessary (multiple years or when deterioration occurs)

Plan for what to do when child regressesIntegrate with school and parent treatments Reestablish contact with therapist for major developmental

transitions ( middle school entry)

Conduct Disorder and ODD-Treatmentsthat have been shown to work

Multisystemic Therapy (MST)- an integrative, family-based treatment for youth with serious antisocial and delinquent behavior. Interventions last 3-5 months and focus on improving psychosocial functioning for youth and families.

CBT-emphasizes problem solving skills and anger control/coping strategies.

Parent training programs- focus on teaching and practicing parenting skills with parents or caregivers.

CBT & Parent Training combined