Academic journal article Education & Treatment of Children

Data-Based Clinical Decision Making in the Treatment of an Adolescent with Severe Conduct Problems

Academic journal article Education & Treatment of Children

Data-Based Clinical Decision Making in the Treatment of an Adolescent with Severe Conduct Problems

Article excerpt

Abstract

This case illustrates the contributions of continuous data monitoring to clinical decision making in the treatment of an adolescent with severe conduct problems. Treatment began with a comprehensive point system that required the continual monitoring of a range of target behaviors. Beginning each session with a review of graphs of the monitored behaviors helped keep the sessions focused and rewarded the client and his parents with visual feedback of their progress. A subjective rating system was also implemented in which the client's parents quantified their evaluations of his overall behavior on a daily basis. This system enhanced the clients parents' sensitivity to the relationship between his observable behavior and their subjective evaluations of him. It also helped the therapists determine when the point system had reached the peak of its effectiveness and conclude that a familybased treatment approach was needed. As part of family-based treatment, a rating scale was developed that assisted the therapist s in conducting family problem-solving training and allowed for continued evaluations of the family's progress in learning key skills.

The antisocial behaviors comprising conduct disorders (e.g., aggression, stealing, destruction of property, serious rule violations) pose a significant challenge for mental health professionals. Such conduct problems account for some 30% to 50% of all child and adolescent mental health clinic referrals (Herbert, 1987). Left untreated, these behaviors remain stable over the course of development and predict a number of poor adult outcomes, such as psychopathology and criminality (Loeber) 1982; Patterson, 1982). Given the prevalence and predictive power of antisocial behaviors, it is sobering to find that treatment attempts are most often unsuccessful (Kazdin, 1987). One of the more promising available treatment approaches appears to be behavioral family-based interventions (Kazdin, 1987). Behavioral family-based interventions typically take the form of parent training and are based on the assumption that parenting skills deficits (and sometimes excesses) are implicated in the development and/or maintenance of the child's conduct problems. Parents are given instruction in basic behavioral principles (e.g., reinforcement, punishment) and procedures (e.g., differential reinforcement, time out, response cost), and taught how to use these principles and procedures to decrease the rates of antisocial behaviors and increase the rates of prosocial behaviors exhibited by their child.

Although parent training appears to be effective with young children, much less is known about its efficacy with adolescents. Patterson and his colleagues offer one of the few parent-training interventions specifically adapted for use with adolescents (Forgatch & Patterson, 1989; Patterson & Forgatch, 1987). Specific adaptations include the parental monitoring of a wider range of behaviors, especially those that put the adolescent at increased risk for further delinquency (e.g., curfew violations), increased overall parental monitoring and supervision (e.g., knowing "who, where, what, when"), and increased involvement of the adolescent in the treatment process (Patterson & Forgatch, 1987). The second phase of the intervention involves teaching the parents and adolescent new ways to deal with problem behaviors and conflict through the use of family problem solving and negotiation (Forgatch & Patterson, 1989).

The present case study describes the application of the Patterson and Forgatch intervention in the treatment of a 15 year-old male exhibiting severe conduct problems. A single-subject design evaluation of this case can be found in Nangle, Carr-Nangle, & Hansen (1994). The purpose of the present paper is to illustrate' the contributions of continuous data monitoring to our clinical decision-making. As will be illustrated by this case, the use of ongoing data collection described by Hawkins & Mathews (1999) as "Level 1" research is actually a fundamental aspect of the Patterson and Forgatch intervention (Forgatch & Patterson, 1989; Patterson & Forgatch, 1987). …

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