Download Oppositional Defiant and Conduct Disorder

Oppositional Defiant and Conduct
Disorder
James H. Johnson, Ph.D.
University of Florida
© James H. Johnson, Ph.D. 2008
The Nature of Conduct Disorder
• The term conduct disorder has
traditionally been used to
characterize children who display a
broad range of behaviors that bring
them into conflict with their
environment.
• These include behaviors that are
probably best described as coercive
or oppositional;
– temper tantrums,
– defiance,
The Nature of Conduct
Disorder
• Also included under this general
heading have been behaviors of a
more serious nature (e.g.,
cruelty to people or animals,
aggressiveness, stealing) .
• These are more serious in that
they
– represent a greater threat to those
the child interacts with and/or
– have the potential of bringing the
Empirical Support for the
Construct of Conduct Disorder
• Empirical support for conduct
disorder, as a meaningful dimension
of psychopathology, has come from
many factor analytic studies.
• Characteristics like the one’s listed
here are often found to occur
together in child and adolescent
samples.
• The clinical significance of this
problem is highlighted by the fact
that conduct disordered behavior is
one of the more common reasons for
Types of “Conduct” Problems
• Although clinicians have used the
term “conduct disorder” to refer to a
general pattern of disruptive
behaviors, like those cited here, it
has also been been used for purposes
of classification.
• For example, in DSM IV, features
usually associated with the general
label of conduct disorder are
subdivided in order to provide for the
diagnosis of two specific patterns of
behavior;
Oppositional Defiant Behavior as
A DSM IV Diagnostic Category
• Oppositional Defiant Disorder
(ODD), is defined as "a recurrent
pattern of negativistic, defiant,
disobedient, and hostile behavior
toward authority figures".
• The disorder is reflected in
behaviors such as frequent temper
tantrums, arguing, defiance, noncompliance, externalizing blame,
vindictiveness, and a range of
Specific DSM IV ODD Criteria
• For at least 6 months, shows defiant, hostile, negativistic
behavior; (4 or more of the following):
-Losing temper
-Arguing with adults
-Actively defying or refusing to carry out the rules or requests of
adults
-Deliberately doing things that annoy others
-Blaming others for own mistakes or misbehavior
-Being touchy or easily annoyed by others
-Being angry and resentful
-Being spiteful or vindictive
DSM IV ODD Criteria
• The symptoms:
– cause clinically significant distress or impair work, school or
social functioning.
– do not occur in the course of a Mood or Psychotic Disorder.
– do not fulfill criteria for Conduct Disorder.
• If older than age 18, the patient does not meet criteria
for Antisocial Personality Disorder.
• Coding Note – Symptoms do not presently have to be found across situations;
although it is being suggested that perhaps DSM V should require presence of symptoms
across situations (First, 2007)
• *Characteristics should occur more often than expected
for age and developmental level.
Conduct Disorder as a DSM IV
Diagnostic Category
• The essential features of Conduct
Disorder (CD) involve "a repetitive
and persistent pattern of behavior in
which the basic rights of others or
major age-appropriate societal norms
or rules are violated“, resulting in
a clinically significant impairment
in functioning.
• This includes
– aggressive behaviors,
– behaviors that result in property loss or
damage,
– deceitfulness or theft,
– other serious rule violations (e.g.,
running away from home, truancy).
DSM IV Conduct Disorder
Criteria
• For 12 months or more has repeatedly violated rules, ageappropriate societal norms or the rights of others.
• Shown by 3 or more of the following, with at least one of the
following occurring in the past 6 months:
•
Aggression against people or animals
–
–
–
–
–
–
–
Frequent bullying or threatening
Often starts fights
Used a weapon that could cause serious injury
Physical cruelty to people
Physical cruelty to animals
Theft with confrontation
Forced sex upon someone
DSM IV Conduct Disorder
Criteria
• Property destruction
-Deliberately set fires to cause serious damage
-Deliberately destroyed the property of others (except firesetting)
Lying or theft
-Broke into building, car or house belonging to someone
else
-Frequently lied or broke promises for gain or to avoid
obligations ("conning")
-Stole valuables without confrontation (burglary, forgery,
shoplifting)
DSM IV Conduct Disorder
Criteria
• Serious rule violation
- Beginning by age twelve, frequently stayed out at night
against parents' wishes
- Runaway from parents overnight twice or more (once if
for an extended period)
- Frequent truancy before age 13
• These symptoms cause clinically important job, school or
social impairment.
• If older than age 18, the patient does not meet criteria for
Antisocial Personality Disorder.
DSM IV Conduct Disorder
Criteria
• Childhood-Onset Type: at least one problem with conduct
before age 10
• Adolescent-Onset Type: no problems with conduct before
age 10
•
Note. Age of onset subtypes have been supported using trajectory analyses in longitudinal cohorts by
finding that those with childhood-onset type typically continue to meet criteria up to their late 20’s
(Mofitt, 2007)
• Severity:
– Mild (both are required):
There are few problems with conduct more than are
needed to make the diagnosis, and Problems cause little
harm to others.
– Moderate. Number and effect of conduct problems is
between Mild and Severe
– Severe. Many more conduct symptoms than are needed to
make the diagnosis, or
Symptoms cause other people considerable harm.
Support for the CD/ODD
Distinction
• While there is some empirical
support for the distinction
between CD and ODD
– this categorization may fail to
capture the patterning of conduct
disordered features found in the
clinical population.
• Most relevant to this issue are
the results of an ambitious study
conducted by Lahey, Frick, Loeber,
Tannenbaum, Van Horn, and Christ,
Empirically Defined Dimensions
of Conduct Disordered Behavior
• These authors conducted a meta-analysis
of 64 factor analytic studies involving
23,401 children/adolescents on whom data
had been obtained regarding substance
use & oppositional defiant/conduct
disorder symptoms.
• Subjecting this data to multidimensional
scaling techniques resulted in the
extracting of an initial bipolar scale
where
– oppositional defiant and aggressive
characteristics were located on one end of
the dimension (overt symptoms).
– Substance use and other non-aggressive
Empirically Defined Dimensions
of Conduct Disordered Behavior
• These results are generally consistent
with the findings of earlier studies,
highlighting the distinction between
overt/covert conduct disordered
behavior.
• Subsequent analyses also resulted in the
extraction of a second bipolar
dimension.
– Symptoms on one end of this second dimension
related to the presence of destructive
behavior directed toward property or persons.
– Those on the other end were reflective of
non-destructive behaviors (e.g., status
Empirically Defined Dimensions
of Conduct Disordered Behavior
• These findings provide general support for
the distinction between oppositional
defiant and conduct disorder.
• They also suggest that conduct problems may
be more meaningfully grouped into four,
rather than two, general categories.
• These include
– "overt & nondestructive behaviors reflecting
symptoms of ODD;
– overt & destructive symptoms of aggression;
– covert & destructive behaviors, such as lying and
stealing; and
– covert & nondestructive behaviors such as truancy
and running away from home (status offenses)
Four Dimensions of Conduct
Disordered Behavior
•
•
•
•
•
•
OVERT/DESTRUCTIVE
OVERT/NONDESTRUCTIVE
(Aggressive
(Oppositional Features)
Fights
Annoys
Bullies
Defies
Assault
Stubborn
Spiteful
Angry
Behaviors)
•
•
COVERT/DESTRUCTIVE
COVERT/NONDESTRUCTIVE
•
(Property
(Status Offenses)
•
Cruel
Runaway
•
Vandalism
Violations)
to
Animals
Relevance of Dimensions for the
Juvenile Justice System
• These four categories of conduct
disordered behavior appear to
correspond to categories of
antisocial behavior often used by
the Juvenile Justice system.
• They are also consistent with
other systems for classifying
conduct disordered and delinquent
behavior (e.g., oppositional
behavior, aggressive behavior,
property violations, status
On the Breadth of the Conduct
Disorder Construct
• However defined, the general term
conduct disorder refers to a
heterogeneous group of problem
behaviors.
• Some are aversive, disruptive and
problematic for parents and
teachers.
• Others involve aggression toward
property or persons.
• Others involve actual violations of
the law which might result in the
child being labeled as delinquent
if the behavior were to come to the
Prevalence of Oppositional
Defiant and Conduct Disorder
• Epidemiological studies of children
displaying more general conduct
disordered features have suggested
that somewhere between 3.2 and 6.9%
of the general child/adolescent
population may be affected .
• When children meeting specific DSM
criteria for diagnoses of ODD and
CD are considered together,
research suggests general
population prevalence rates of
somewhere between 8 and 12%
Sex Ratio of ODD/CD
• Generally sex differences in
disruptive behavior disorders do not
emerge prior to age 6.
• At later ages, however, males
referred for disruptive behavior
disorders significantly outnumber
females anywhere from 4:1 to 6:1.
• These children account for somewhere
between one-third and two-thirds of
all child mental health referrals.
Comorbidity of ODD/CD
• As with ADHD, children with ODD and
CD frequently display other types
of problems.
– Between 34.7 and 48 % of children and
adolescents with ODD/CD also show
evidence of ADHD.
– Comorbidity estimates ranging from 12
to 17.6 % have been found for
depressive disorders.
– As many as 19% of children/adolescents
with ODD/CD qualify for a diagnosis of
anxiety disorder.
Comorbidity of ODD/CD
• While findings of multivariate
studies have provided some support
for making a distinction between
Oppositional Defiant and Conduct
Disorder, it is interesting to
note that
– over half of children with ODD appear
to meet criteria for a diagnosis of
CD,
– almost half of children with CD also
meet criteria for a diagnosis of ODD.
The Course of Disruptive Behavior
Disorders
• Conduct disorders are usually not
diagnosed prior to school entry
• However, non-compliance, defiance and
other symptoms of ODD may begin during
the preschool years.
• These less severe disruptive behavior
disorder features are can be the
precursors of full blown conduct disorder
symptoms - although most with ODD do not progress to CD (Moffitt,
2007).
• The suggested sequence of progression in
children who develop early symptoms and
go on to develop more serious disruptive
behavior disorders is suggested by
cross-sectional research conducted by
Achenbach and Edelbrock.
The Course of Disruptive Behavior
Disorders
• These investigators studied 2,600
children age 4 and 16 whose mothers
provided data (Child Behavior Checklist:
CBCL) on conduct disordered behavior
displayed at different ages.
• The youngest children tended to display
characteristics such as a tendency to
argue, stubbornness and temper tantrums
- followed by other oppositional
behaviors.
• At later ages there was an increase in
behaviors such as stealing and fire
setting.
• These were followed by other serious
The Course of Disruptive Behavior
Disorders
• This type of developmental
progression is consistent with
that often seen when working with
older conduct disordered children
and adolescents.
• It fits with the generally
accepted view that oppositional
defiant behavior often (but not
always) precedes the development
of more serious conduct disordered
behavior.
Relationship of ODD to CD
• Some research findings suggest the risk of CD is
four times higher in children with ODD than in
children without prior ODD (Cohen & Flory,
1998).
• It’s unclear, however, if ODD represents as much of
a stepping stone to CD for girls, as late onset of CD
is more common females.
• It’s deems likely that many girls with a late onset do
not have a history of ODD
• For girls there may be an alternate pathway to the
development of Conduct Disorder.
Prognosis:
Who is at greatest risk?
• Not all children with early
disruptive behavior problems, like
ODD, develop more serious conduct
disorders.
• Some do not develop more serious
antisocial behavior.
• The poorest outcome are for
children who show high levels of
conduct disordered behavior at an
early age.
• This type of information highlights
the importance of secondary
prevention efforts (e.g., PCIT)
Prognosis of Conduct Disorder
• Robins, et al. (1991) found that
71% of children who displayed
severe conduct disorder (eight or
more symptoms) at age 6 showed
evidence of antisocial personality
disorder in adulthood.
• 53 % of children whose symptoms
began between the ages of 6 and 12
displayed antisocial personality
disorder in adulthood.
• 48 % of those who developed
symptoms after age 12 showed
evidence of this disorder as
What is Antisocial Personality
Disorder?
• “Pervasive pattern of disregard for, and
violation of, the rights of others that begins
in childhood or early adolescence and
continues into adulthood.”
• For diagnosis, must have a history of some
Conduct Disorder symptoms before age 15.
• Not actually diagnosed prior to age 18.
What is Antisocial Personality
Disorder?
• Three or more of the following:
– Failure to conform to social norms (behaviors warranting
arrest)
– Deceitfulness (lying, conning, deceit)
– Impulsivity
– Irritability and aggressiveness
– Reckless disregard for safety of others or self
– Consistent irresponsibility
– Lack of remorse (indifference or rationalization)
Prognosis of Conduct Disorder
• In general, the literature
suggests that
– children who develop conduct
disordered behavior later in
childhood have a somewhat better
prognosis.
– the severity and variety of early
antisocial behavior is a powerful
predictor of serious antisocial
behavior in adulthood.
– the prognosis may be worse for those
who also have comorbid disorders.
Etiological Factors in
Childhood Conduct Disorder
• While the etiology of Conduct disorder
is not fully understood it has been
shown to be related to a range of
psychosocial factors including;
– living in environments with high crime
rates.
– marital conflict & broken homes,
– dysfunctional and rejecting family
environments,
– inconsistent and severe discipline,
– Physical and sexual abuse
– social learning experiences (e.g., the
learning of problem behavior through
observation and/or its reinforcement by
parents, siblings and others).
Coercive Family Behavior and
Conduct Problems
• Conduct problems can evolve from
ongoing patterns of coercive parent-child
interactions that are characterized by;
– Escalating parent and child demands,
– Escalating negative consequences
– Where the person who dispenses the
most negative consequence “wins”.
– Problems with “winning the battle”
while “losing the war”.
Biological Factors in
Childhood Conduct Disorder
• Genetics:
– Some support for a genetic contribution to aggression
and the development of disruptive behavior disorders.
– Difficult to disentangle the genetics from
environmental factors.
• Frontal Lobe Involvement:
– Frontal lobe damage associated with aggression
– Decreased glucose metabolism in frontal lobes
associated with violent behavior (lower levels of
activation).
• Neurotransmitters:
– High levels of blood serotonin related to aggression in
adolescence
– As serotonin is related to mood regulation the link
with aggression may have to do with its impact on
executive functions and behavioral dysregulation.
Biological Factors in
Childhood Conduct Disorder
• Underarousal of the Autonomic Nervous System
– Individuals with conduct disorders often display general
physiological underarousal (e.g., lower heart rate).
– Low heart rate is associated with adolescent antisocial behavior.
– Lower skin conductance associated with disruptive behavior in
males.
• Prenatal and Perinatal Problems
– Maternal smoking predicts CD in boys, including early onset .
– A range of pregnancy and birth complications have also been
shown to be related to behavior problems.
Biological Factors in
Childhood Conduct Disorder
• Neurotoxins
– High lead levels in children are related to higher parent/teacher ratings
of aggressiveness and higher delinquency scores on teacher rating
scales.
• Child Temperament
– Difficult child temperament may contribute to maladaptive parenting
which may facilitate the progression from simple behavior problems to
CD
– Early temperament (negative mood, intense responding, inflexibility)
has been found to be predictive of externalizing problems in childhood
– Inhibited temperament is associated with fewer externalizing
problems.
Etiological Factors in
Childhood Conduct Disorder
• While a range
implicated in
disorders, no
determined to
of factors has been
the development of conduct
one factor has been
be “the cause”.
• Each of the factors listed here may
contribute to conduct disordered and
delinquent behavior in some instances.
• It’s likely that there are numerous
possible combinations of contributing
variables that can result in the
clinical manifestations of these
disorders.
Treatment of Oppositional
Defiant and Conduct Disorders
• Although both insight-oriented and
client-centered approaches have been
employed with conduct disordered
children, the current most popular
approach is behavioral in nature.
• The work of Patterson and colleagues is
most representative of this basic
approach.
• The approach involves training parents to
pinpoint problem behaviors (e.g.
aggressive responses, noncompliant
responses) as well as more appropriate
modes of responding, & to utilize various
child behavior management techniques to
decrease problem behavior and increase
Treatment of Oppositional
Defiant and Conduct Disorders
• Included among these behavioral procedures is
– the reinforcement of appropriate behaviors,
– the use of extinction (withdrawal of
reinforcement) and/or
– time out procedures for dealing with undesirable
behavior
– the reinforcement for incompatible behavior
• School personnel may be involved in order to
deal with the child's behavior in that setting
as well (School/Home Behavior Report Card).
• This multifaceted approach has been shown to
be highly effective in treating a range of
conduct problems.
• This approach is considered an EmpiricallySupported/Well Established treatment for
conduct problems (Eyberg, Nelson and Boggs,
2008).
Treatment of Oppositional
Defiant and Conduct Disorders
• Other psychosocial approaches have been used
to deal with specific behaviors (or classes
of behaviors) displayed by behavior
disordered children.
• Indeed, Eyberg, Nelson, and Boggs (2008) have
highlighted 16 evidence based psychosocial
treatment, 15 of which were designated
probably efficacious.
• Examples involves group videotaped parent
and child training approachs (Incredible
Years Parent and Child Training) by WebsterStratton and Reid (2003), developed at the
University of Washington and the work of
Forehand & McMahon (1981) with non-compliant
children at Georgia.
• Of special note is the work of Eyberg and
Boggs with Parent-Child Interaction Therapy,
that is designed to modify
Treatment of Oppositional
Defiant and Conduct Disorders
• Kazdin (1993) has also developed
another more cognitively oriented
approach, Problem-Solving Skills
Training, also appears to hold promise.
• This approach focuses on the
modification of cognitions such as
attributions of hostile intent, which
may precipitate aggressive behavior,
and maladaptive self-statements which
may mediate other expressions of
antisocial behavior.
• An additional focus is on helping the
child learn and use effective problem
solving skills in dealing with
Treatment of Oppositional
Defiant and Conduct Disorders
• While such cognitive-behavioral
procedures have been shown to be
somewhat effective in dealing with
older conduct disordered children,
questions still remain regarding the
clinical significance of observed
treatment effects and the precise
nature of those variables that
contribute to effectiveness.
Brief Commentary on Juvenile
Delinquency
• Some children not only
show oppositional
defiant behavior and
features of conduct
disorder – they also
come into conflict with
the juvenile justice
system.
• The term “delinquency”
may be applicable to
such children and
adolescents.
Delinquency: A Definition
• Delinquency is a legal term rather than a psychological
construct.
• It refers to a juvenile (usually under 18 years) who is brought
to the attention of the juvenile justice system for committing
a criminal act or displaying a variety of other behaviors not
specified under criminal law.
• These "other behaviors", are usually referred to as status
offenses.
• They include truancy, curfew violations, running away from
home and the use of alcohol.
• These are only violations of the law as a result of the child's
age and his/her status as a minor.
Delinquency and Conduct
Disorders
• Considered within the context of DSM IV, the
concept of delinquency overlaps with the broader
spectrum of conduct disorders.
– While many delinquents do meet criteria for a diagnosis of
conduct disorder
– Many youths who come into contact with the juvenile
justice system do not show the pattern of seriously
antisocial behavior associated with the diagnosis of
conduct disorder.
– Likewise, many conduct disordered youth are never
considered delinquent as their illegal behaviors escape
detection.
The Classification of
Delinquency
• Given that juvenile delinquency is essentially a “legal”
category used to designate those who have committed
any of numerous offenses, one might expect
delinquents to represent a very heterogeneous group.
• In spite of this, research studies have often focused on
the causes, correlates, and treatment of delinquency
without taking this variability into account.
• This tendency to treat delinquency as a unitary
construct has often led to unreplicated findings and
inconclusive results.
Assessing Dimensions of
Delinquency
• As a result of the observed variability within this
group, some researchers have considered the
possibility that various dimensions of delinquency
may exist and have attempted to assess and study
correlates of these dimensions.
• Most prominent in this regard is the work of Herbert
Quay (1964; 1987b), who is generally credited with
developing the most widely cited, empirically
based, classification scheme for delineating
dimensions of delinquent behavior .
Empirically Dimensions of
Delinquency
• In this early research, factor analyses of ratings of
behavioral traits obtained from the case histories of
institutionalized male delinquents yielded four
independent groupings:
–
–
–
–
socialized-subcultural delinquency,
unsocialized-psychopathic delinquency,
disturbed-neurotic delinquency, and
inadequate-immature delinquency
Dimensions of Delinquency:
Characteristics
• Socialized-subcultural - Delinquents who
scored high on the socialized-subcultural
dimensions were defined by such traits as
having strong allegiance to selected peers,
being accepted by delinquent subgroup,
having bad companions, staying out late at
night, and having low ratings on shyness
and seclusiveness.
Dimensions of Delinquency:
Characteristics
• Unsocialized-psychopathic – These
delinquents, in contrast, were described as
solitary rather than group-oriented
delinquents who were rated high on such
traits as inability to profit from praise or
punishment, defiance of authority,
quarrelsomeness, irritability, verbal
aggression, impudence, and assaultiveness.
Dimensions of Delinquency:
Characteristics
• Disturbed-neurotic - These delinquents
were described as unhappy, shy, timid and
withdrawn, and prone to anxiety, worry, and
guilt over their behavior.
Dimensions of Delinquency:
Characteristics
• Inadequate – Immature - Quay (1987b)
characterized this fourth group of youngsters
as being relatively inadequate in their
functioning and often unable to cope with
environmental demands because of a poorly
developed behavioral repertoire.
• Not usually accepted by delinquent peers,
passive and preoccupied, picked on by others,
and easily frustrated.
Dimensions of Delinquency
• Although, often given different labels by various
researchers, these four dimensions have been
replicated in a number of more recent factor
analytic studies of delinquent behavior, using
various measures, with data obtained obtained in
various ways, and with both males and females.
• While there have been some studies that have
documented significant differences between these
groups there is still too little research that considers
the variability in the delinquent population.
Treatment of Delinquents
• Treatment of children and adolescents
who have become involved in actual
delinquent activities has frequently
been carried out in institutions or
within community based programs.
• Research suggests that treatment within
the context of standard institutional
programs is often unsuccessful, with as
many as 70 to 80 per-cent being
rearrested within a year or so after
release.
• Despite these discouraging results,
there are data to suggest that the
inclusion of well-conceived
Institutionally Based Treatments
• Illustrative of such an approach is the
Cascadia Project, conducted in Tacoma,
Washington by Irwin Sarason and his
colleagues at the University of
Washington.
• In this “skills based” program residents
were provided with modeling and
role-play/discussion experiences where
they were taught a variety of adaptive
skills which were thought to decrease the
likelihood of future delinquent behaviors.
• Among these were learning how to resist
temptation from peers, to delay
Institutionally Based Treatments
• Not only did those in treatment show gains
at post treatment but, at five year follow
up, recidivism rates for treated subjects
was less than half that of residents who
did not receive treatment.
• These findings suggest that skills-based
treatments that are designed to provide
skills that promote a pro-social lifestyle
may
be
of
value
in
decreasing
the
likelihood of future delinquency.
• Despite the positive findings, since some
residents
showed
evidence
of
later
delinquency.
• It would seem desirable that such programs
provide booster-sessions after release so
Community Based Treatments
• An good example of community,
rather that institutionally, based
program is the Teaching Family
Model (Achievement Place) which was
developed at the University of
Kansas.
• Residents in this program live in a
home-like setting with up to seven
or eight other residents and two
house parents who are trained in
Community Based Treatment:
Family Teaching Model
• Residents attend school and have a
variety of work responsibilities.
• An extensive token economy program
serves as the basic focus of
treatment.
– Here, residents are rewarded for
engaging in appropriate behaviors (e.g.,
completing homework assignments,
increased academic performance,
improving conversational skills with
adults, modifying aggressive statements,
improving problem solving skills with
parents)
– Or fined for showing inappropriate
Community Based Treatment:
Family Teaching Model
• Reinforcement is with points which can
be cashed in for a wide variety of
back-up reinforcers (e.g., allowance,
snacks, TV viewing.
• The overall focus is on using the token
economy to increase non-delinquent modes
of responding.
• Attention is given to insuring that
behaviors
generalize
to
the
general
environment
so
that
they
will
be
maintained
after
release
from
the
program.
• A number of controlled studies have
provided
support
for
the
general
effectiveness of this program, although
Multisystemic Treatment
• Another non-institutional approach to treatment is
Multisystemic Therapy (MST), which is designed to
address the role of multiple, interconnected systems
in which the adolescent is embedded (Henggeler &
Lee 2003).
• This approach recognizes
– the effects of family, school, work, peer, community and
cultural institutions on the adolescents functioning and in
the initiation and maintenance of delinquent behavior
– and seeks to intervene therapeutically on multiple levels,
as needed.
Multisystemic Therapy
• The length of MST is between 13 and 17 sessions.
• It is based on family-systems and social-ecological models of
behavior
• Therapists employ empirically based treatment procedures to
tailor interventions to the needs and strengths of each family
member (a good example of flexibility of manualized treatment efforts.
• Although specific therapeutic techniques are flexible,
therapists abide by a number of clearly defuned treatment
principles, such as “Focus on systemic strengths, and
“Interventions should be developmentally appropriate, etc.
Multisystemic Therapy
• In contrast to many past intervention approaches in
which treatment gains have not held at follow-up, MST
has been shown to result in long-term reduction in
delinquent activity.
• For example, in a longitudinal investigation of
treatment efficacy with chronic juvenile offenders,
MST improved family cohesion, reduced the number
of incarcerations at a 59-week follow-up, and
significantly reduced peer-related aggression.
• Re-arrest rates were also reduced at a 2.4 year followup.
Multisystemic Therapy
• In another study, MST was found to reduce violent and
criminal activity at a 4-year follow-up ,
• Other promising aspects of this treatment include its
documented efficacy with ethnic minority populations, and
its cost-effectiveness in comparison to incarceration.
• This, family-and home-based treatment for serious juvenile
offenders, appears to be one of the most promising,
empirically supported treatment approaches for this
extremely hard to treat population.
• This approach has been designated a probably efficacious
treatment by Eyberg, Nelson, and Boggs (2008).
MST Brief Overview
Group Based Treatments of
Delinquency
• Still other community-based
programs have also been used.
• These have usually involved the
use of group treatment approaches
in modifying delinquent behaviors
(e.g., Reality Therapy, Guided
Group Interaction).
• Less research related to these
program has been done and their
effectiveness is less well
documented.
That’s all Folks!