From the NYU CHILD STUDY CENTER: ASK THE EXPERT
What Treatment is Needed for Children with Behavior Problems?
By Glenn S. Hirsch, M.D.
Children come into this world with different temperamental styles; some are easy going and some have more difficulty with the rhythms of every day life. A subgroup of children with difficult temperaments may go on to develop oppositional behaviors. These behaviors include arguing, defying rules, having temper tantrums and becoming easily annoyed and irritated.
While many children, and even adults, can manifest these behaviors occasionally, for some these behaviors are a frequent occurrence and may include other characteristics such as inflexibility, blaming others for their mistakes, and being oppositional to those in authority. When the symptoms are frequent and interfere with a child’s overall functioning at home, school, or with social outlets then a diagnosis of Oppositional Defiant Disorder (ODD) may be appropriate. Children with this disorder often have other problems such as ADHD, anxiety, or mood problems. Up to 25% will develop a serious conduct disorder in adolescence that can be extremely difficult to treat and can result in delinquent behavior leading to trouble with police.
Parents whose children have ODD find that their customary and common sense child-rearing practices that may have worked with another child with an easy temperament is not working for this child. The result is increasing frustration and anger on the part of parents who may at times feel overwhelmed and even dislike their child.
In order to treat this oppositional behavior problem parents often need to learn new techniques and different parent practices that may not come intuitively. While there are literally tons of self-help parenting books, they often do not address the unique issues for an individual family, and the recommendations they make are often difficult to implement without support. Historically children with ODD may have been placed in play therapy. This form of therapy emphasizes working with the child, not working with the parents. It should come as no surprise that play therapy has not been shown to be useful with children with ODD.
The last two-and-a-half decades have seen a virtual explosion in the field of psychotherapy. Therapies have been developed for a wide range of psychiatric conditions. The primary characteristics of these therapies include a component that helps the patient build new skills, and the treatment has been carefully researched to insure that it is effective for treating the problem.
One therapy that has been found to be extremely helpful with children who have ODD has been Parent Child Interaction Training (PCIT). Dr. Steven Kurtz, who leads our PCIT program at the NYU Child Study Center, reports that he has found PCIT to be one of the most effective treatments devised for children with oppositional behaviors.
PCIT involves several components: it works with both the parent and child; it is based on teaching positive parenting skills in a supportive environment; and it is carefully individualized. Teaching is followed by ongoing coaching in the use of those skills. What makes the coaching so unique is that, unlike most therapies in which skills are taught in the office and then the family goes home to practice, in this therapy the practice is done in the presence of the therapist. The therapist gives live, ongoing coaching, advice, and encouragement to the parents through a transmitter worn in the parent’s ear. These new skills are practiced, reviewed, and mastered in the office. Parents who have gone through this program report positive and dramatic changes in their child and in their home life.
This monthly column provides educators, parents and families with important information about child and adolescent mental health issues. Please submit questions for ASK THE EXPERT to Glenn S. Hirsch, M.D., Medical Director at the NYU Child Study Center at glenn.hirsch@med.nyu.edu. To subscribe to the ASK THE EXPERT Newsletter or for more information about the NYU Child Study Center, visit www.AboutOurKids.org or call 212-263-6622.
