Topic 2: Working with Parents and Teachers {by 6/12}

There are three readings due this week:  Parts of Mash & Barkley Chapters 2 and 3 – focusing on working with parents and teachers, and Friedberg & McClure Ch. 14 – Working with Parents.  Address the following two discussion points:  (1) Simply share your thoughts and feelings about working with parents and teachers when providing therapy to youth;  (2) Within each of the readings, the Barkley and Patterson approaches are discussed.  Identify what you believe are the strengths and weaknesses of each approach.  Do you have a preference?  You may also feel free to pose a question to the class.  Your original post should be posted by the beginning of class 6/12.  Have your two replies no later than 6/14.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

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53 Comments (+add yours?)

  1. Becca Boisvert
    Jun 08, 2014 @ 22:17:01

    Personally, I think that one of my greatest (if not the greatest) apprehension of working with children is the parent/family aspect of the “deal” that is attached to the child. I find it incredibly frustrating to see a child that is struggling, and to know that it is a result of a dysfunctional family. More often than not, the child has so much potential to succeed; however their familial environment has a tremendous negative impact on their life, which consequently triggers the issues within the child. The challenge is to help the entire family unit, which is significantly harder than helping just one child. Understandably, parents may not like being told that their methods of parenting need to be altered, and issues may arise as a result. However, without all involved, the treatment for the child will likely fail.
    After reading Chapter 14 in Friedberg & McClure, and Chapters 2 & 3 in Mash & Barkley, I think that Barkley’s strategies when working with parents and developing behavior management/modification plans for children are the most comprehensive, clear, and easily understandable for both parent and therapist. Barkley provides many examples for a variety of developmental and behavioral situations; however, one strategy that is provided which I think is crucial when implementing an effective behavior modification plan is the importance of giving explicit and understandable directions to the child during every aspect of the behavior plan. As stated in the text, many parents who have difficulty with their children assume that they should know how to complete a task, or they should know that they aren’t allowed to behave in a certain way. Barkley notes that this often is not the case (especially in children with disabilities), and typically results in adult frustration, and child behavior issues (not necessarily in that order). When developing a behavior plan, Barkley emphasizes that the child should be explicitly clear about what is expected of him/her so there can be no misunderstandings that create an obstacle between the misbehavior and the target goal behavior. As an accompaniment to this important strategy, Barkley and Patterson note that any instruction that is given must be enforced and reinforced (immediately and repeatedly) by the parent in order for the behavior plan to work. In other words, once the directions are made clear, the parent must be ready and willing provide the child with both reinforcement and consequence as a result of their behavior (which should also be explicitly explained to the child).
    One aspect of Barkley and Patterson’s strategies that I find slightly disagreeable is the aspect of the token economy which allows for points to be removed if the youth does something that goes against the behavior plan (once the target behavior has been established). Although this would most likely prevent the behavior from recurring, I don’t agree with it because it isn’t a practice that typically occurs in the “real world”; and essentially the purpose of the behavior plans are to teach a youth to behave appropriately within such scenarios. If an office employee does something that is deemed inappropriate by his boss, he wouldn’t be docked money from his check, unless the behavior cost the company money, in which case, it would be appropriate. It just seems like if the youth has earned the points by meeting the goal behavior, they shouldn’t then lose their points; but instead should simply not receive the points that they were potentially going to gain.

    Reply

    • Ashley
      Jun 10, 2014 @ 11:03:54

      Becca, I thought your point about being “real life” was very insightful. I never looked at it that way and it would make sense to implement procedures children are more likely to see in adulthood. However, not all the great things we do in life are rewarded or even acknowledged which also leaves room for disappointment or failure to comply with regulations when one knows that nothing good or bad would come of it. If you had a child that was ADHD or ODD you would want to use the system to help in that moment, how do you continue to teach your children as they get older that sometimes life is not fair or life does not reward you for good things?

      Reply

  2. Sarah Chelio
    Jun 09, 2014 @ 09:14:11

    1) I was interested to read this week’s chapters because working with parents is something that I am most concerned about. I know that this is something that many of the clinicians at my internship site struggle with when working with the students. Although it can be difficult, I know that is a necessary aspect of effectively treating any child. One can do all the work they want with children in their office, but if their living environment is unhealthy, it will maintain their problem behaviors. According to Chapter 14 of Friedberg & McClure in order to do this parents and therapists must be on the same page. Psychoeducation is the first step in making that happen. This helps parents have realistic expectations, understand and reinforce positive behaviors, give directions, effectively remove privileges, and properly deal with unwanted behaviors. I think that how much focus is given to each aspect, and how long this takes, depends on the parent. Those that are higher functioning, open to therapy, or more knowledgeable about these areas already are likely to learn quicker. Those who are less knowledgeable, or more reluctant to the process, might require more education.

    2) Overall, I found Barkley’s advice for educating parents to be clear and helpful. One thing that I agree with Barkley about is his views on the importance of giving directions and commands. He says that this basic task is often overlooked by parents, but it is important. When parents are able to do this effectively, it will increase compliance while decreasing the amount of commands they must give. In order to do this, Barley says that parents should not give any demands unless they are willing to enforce them. He further goes on to note that giving a direction is different from making a request, in which there is a choice implied. I think that this is useful advice for parents dealing with undesired behaviors. In order for the child to take them seriously when they tell them to start or stop doing something, there must be consequences for failing to comply. Otherwise, they will not listen and the parent will grow frustrated with having to tell them numerous times.

    Reply

    • Taylor Tagg
      Jun 09, 2014 @ 21:59:06

      Sarah, I appreciate your honesty in regards to being concerned about working with parents. Although it can be an intimidating experience initially, I think it is important for us to remember that, more often than not, parents are bringing their children into therapy due to a concern and a desire for help. Yes, they may seem so frustrated that they just can’t take it anymore, however, even at that they are still interested in what they can do to foster the changes that are being made in session outside of session. I can recall some uncomfortable, yet important conversations I have had with parents in regards to their parenting styles and what could be done differently within the household to better the child. It is a tough thing to do because we most certainly do not want to imply to parents that they are not doing a good job, but sometimes they just need a little bit of insight, from a professional standpoint, about what could be maintaining the child’s presenting problems.

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    • Jane Jenkins
      Jun 11, 2014 @ 20:39:19

      Sarah, I like your attention to the parents’ reluctance or willingness to be involved in the therapy and its affect on the therapeutic process for the child. The child is embedded in the environment that the parents create for him or her, so it only makes sense that they have to be a part of the solution. An open parent has got to be a therapist’s dream, whereas a guarded parent leaves questions unanswered and a difficult time making any progress on the child’s behalf.

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    • nafi
      Jun 13, 2014 @ 14:24:15

      Sarah I completely agree with everything that you stated. Working with parents maybe difficult as not all with be the same. We may come into connect with parents that are willing to engage and implement treatment interventions while others may not be so willing. It will be difficult when working with children that are not receiving the adequate support and stimulation at home. As for parents that are engaging in their child’s treatment you mentioned in a nut shell consistency and that is very important. Parents that say one thing but do the other are not promoting the best example of rewards and consequences for their children. Being consistent is also important for starting to develop new patterns and routines. Being directive will only help the parent in the long run to maintain their role with the parent-child relationship.

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    • Larrisa Palmer
      Jun 14, 2014 @ 03:06:45

      Sarah, I do agree with you that if a child’s environment remains the same his or her presenting problem is likely to continue and that is why it is important for the therapist to incorporate parents and teachers in treatment. It is by no means easy and it seems to be a long and weary process that may cause us to become overwhelmed. I like that there are resources (Barkley and Patterson step-by-step programs) that we can adapt when working with parents

      Reply

  3. Taylor Tagg
    Jun 09, 2014 @ 13:38:52

    1) Working with parents and teachers is central to working with youth. Therapists need to establish a positive therapeutic relationship with the parents of their clients since they will be working with parents collaboratively in helping their child. A good relationship and understanding of what is in the best interests of the child will further aid in parents becoming more involved with certain homework/take home activities. I am currently working with a 4 ½ year old boy who is presenting anger issues. I created an “Anger Chart” for him, which included the situation and trigger (if any), the behavior (i.e. verbal, emotional, physical), and the consequence that followed. I have incorporated this for a couple weeks now and my client’s parents have been very compliant with this chart- filling out each column whenever an episode occurs. This intervention proved to be effective for both myself and the parents, as we have now declared themes in his behaviors (i.e. morning routines and transitions leading to a morning chart and rewards that follow task completion per day), and the parents have become more aware of their consequences with my client.
    Aside from parents, teachers are also important collaborators in working with youth, as they provide observations and information in perhaps one of the most important settings outside of the child’s home. How a child interacts and behaves in school can present a great deal of insight into the presenting problems. For example, if the child is disruptive at home but not at school, we can hypothesize that the home environment may be the problem. However, if the child is attentive and hyperactive at both home and school, we can hypothesize that ADHD may be prominent in the child. Teachers provide a great deal of information that can guide therapists in formulating a more comprehensive conceptualization of the child’s case.

    2) Barkley’s rationale is geared towards children diagnosed with ADHD. I believe a strength of Barkley’s approach is the emphasis of a neurophysiological deficiency as the underlying problem in children with ADHD. I believe that this perception of a biological basis to the disorder may be helpful in educating parents about the disorder and alleviating some thoughts or feelings of being responsible for how the child has come to present. Coinciding with this, I found that another strength of Barkley’s approach was the close tie between ADHD and ODD. From my clinical work, I can see how children with ADHD can display ODD-like tendencies due to consistent negative reinforcement and feedback from parents. Being a parent of a child with ADHD can also lead to a great deal of frustration and therefore, it may be hard for parents to reinforce good behavior, and for children to therefore identify good behavior. I believe it is so important in working with children with ADHD and parents to reinforce the idea that a lot of what the child is doing may be unintentional due to a neurological deficit and how important it is for parents to keep this idea in mind when disciplining the child. I also believe in the importance of consistently calling attention to anything positive a child does, as they need to be assured of such strengths, much like Barkley rationalized. A weakness of Barkley’s approach, in my opinion, may be in regards to the time-out rule, which is implemented very shortly after the child’s noncompliance. In the BPT program, parents would issue a command, wait five seconds, issue a warning, wait another five seconds, and then send the child to time-out. Depending on the age of the child, I feel that such a short time span from a command, to a warning, to a time-out may be a little bit unfair. It may be possible that the child (as is the case with ADHD) may find it hard to control focusing and paying attention. Such a short time lapse leading to a time-out may send them negative messages about themselves, essentially influencing self-esteem.
    In regards to Patterson’s approach of OSLC Parent Training, I had similar impressions of strengths and weaknesses as I did with Barkley’s approach. I really liked the extent of education that is incorporated in Patterson’s approach and all of the strategies needed to incorporate a successful positive reinforcement system. However, the five minute time-out procedure still stood out to me in regards to how age-appropriate it may be for preadolescents. Based on both program approaches, I have thought more about at what ages and under what circumstances should children receive time-outs. If I had to choose one approach over the other, I would probably choose Barkley’s approach, as I see there being more of an issue with parent compliance and motivation to complete tasks with Patterson’s.

    Reply

    • Ashley
      Jun 10, 2014 @ 11:10:00

      Taylor, we had the same idea about the time out rule! Although you were smarter and knew it was a BPT approach. I just remember it from childhood! Clearly, I agree that a warning seems fair enough since most children (adults as well) do not enjoy chores or completing unpleasant tasks (such as homework :p)

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    • Anthony Rofino
      Jun 14, 2014 @ 14:05:28

      Taylor, I agree that the five minute time out thing seems a little inefficient for anyone above the age of 7-8. I have found working in the field that this isn’t the best way to handle working with children. Consequences have to be sufficient enough where they are a learned experience, but not harsh enough to be unreasonable.

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  4. Becca Boisvert
    Jun 09, 2014 @ 20:41:11

    Taylor, It’s really great that you have been able to implement the anger chart, that the parents were receptive to the idea, and that it has worked in showing that there are patterns in his behavior. I think one of the important points that the readings emphasized this week is that an overwhelmed parent may overgeneralize a child’s behavior and just say that they are difficult or challenging all the time; but when the behaviors are documented, the parents are able to see that there is a pattern in the child’s day that is causing the issue, which may be malleable, thus resulting in a change of behavior. I really think that part of working with kids is interesting! Its like detective work.

    Reply

    • Taylor Tagg
      Jun 09, 2014 @ 21:50:17

      Thank you for your comment, Becca. The Anger Chart has worked so well! By implementing it, my client and I can actually talk about what exactly happened, how it made him feel, and alternatively what can be done in the future. More so, just this past week when asking my client about a particular behavior (i.e. stealing sister’s toy), I was able to uncover that he is modeling behaviors from a boy at school whom gets into some trouble. This was a small breakthrough for me and my work with him in that we could talk about “copying” others and the consequences that follow. However, none of this would have been brought to knowledge if it weren’t for the parents compliance in filling out the Anger Chart step by step! I recommend such an activity to anyone working with young children with anger issues, as it opens a gateway to conversation and active problem-solving.

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  5. Ashley
    Jun 10, 2014 @ 11:00:21

    1. Mash and Barkley made a statement in our readings that really stood out to me. They stated that child behavioral issues are due to parent practices. Although I have known this for some reason the statement really hit me because I am not working in the field with adolescents. Working with parents and teachers is absolutely imperative when working with children. Changing child-adult interactions changes not only behavior but future cognitive structures. I think, however, as a young clinician it is going to be extremely hard to look at a parent and tell them they are doing things wrong and this is a large factor in their child acting out. Getting parents on board for a new plan might be harder than it seems.

    2. In both the Barkley and Patterson approach I thought education of ADHD was most important for parents. In today society we get caught up on just giving people medication to alleviate the problem or change the behavior and we do not take enough responsibly for how our actions affect the child’s behavior as well. Through ADHD education, parents can understand all aspects that maintain the negative behaviors and additional ways to change it other than medication. One aspect that I really thought was important was reinforcements. Encouraging good behavior is more easily accomplished when a child knows that a reward is following the behavior. In Barkley’s model a negative reinforcement is time out which he implements immediately after a task is not complete by a child. In Patterson’s model the child gets a warning. I think in this regard, Patterson’s model would be more effective because most children with or without ADHD do not always like complying with rules or chores. Giving children a warning at least gives them an opportunity to make the right decision. Overall, (im going to cheat) I would mash the two models together. Some aspects of Barkley’s is very strong while some aspects of Patterson’s could be useful as well.

    Reply

    • Taylor Tagg
      Jun 10, 2014 @ 11:23:47

      Ashley, I liked your comment in regards to medication and ADHD. Although medication can have positive implications for children suffering from the disorder, it is not sufficient enough without looking into parent-child interactions and what parents are doing (or not doing) that could be further exacerbating symptoms of the disorder. I firmly believe that educating parents about ADHD and what can be done to make the child’s life a little bit easier is imperative, in addition to informing parents about certain strategies or skills that could be employed that could benefit not only the child, but how the parent views their child, which will essentially influence their interactions with them (i.e. difficult child, less interactions and frustration; well-behaved child, more interactions, nurturance, and support).

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    • Larrisa Palmer
      Jun 14, 2014 @ 03:43:32

      Ashley, like you I stopped and thought about the statements that were made by Mash and Barkley that children behavioral issues are as a result of parental practices and quite frankly I agree with them 100 percent. Parents are the very first teachers to their children, the behaviors that they exhibit can give us ideas of what is going on in their homes. Therefore, it’s only logical to incorporate parents into therapy. You are definitely right that as young clinicians it will be challenging, I think the most we can do is to prepare ourselves by becoming knowledgeable about of the ins and outs, and be confident.

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  6. Sara Grzejszczak
    Jun 11, 2014 @ 19:18:45

    Working with parents and teachers while providing therapy to children will be challenging. Doing in-home therapy currently and working with teachers and parents is challenging because much time is spent in the home doing ABA therapy with their children who have been diagnosed with ASD and once we leave for the day programs and behavior plans that we have worked on are not practiced and so the next day it is like starting from scratch. Many times this is even true after being in the child’s home each day. I think that it at times would even be worse doing therapy with children and their families and teachers when therapy does not happen every day and the therapist is working on things like behavior plans for children who have ADHD or CP and their parents and teachers are not completely on board with the idea of the intervention. In contrast I think it also could be really rewarding working with parents and teachers because you would be able to give them tools to help with the other children in the home or classroom inadvertently while working with the child. It is times like this and the potential of this happening that make me excited to continue to work with children and their families and teachers.

    Strengths of the Barkley approach is the fact that the parent is educated on ADHD and his form of behavior modification can be used across different settings so that way the parent can always be prepared for any type of behaviors that the child may have. After the parents have the behavior plan solidified at their home they then can go out to the store they will be know how to give directions and implement effective timeouts either at the store or have a contingency set up so that way the timeout will happen when they get home. Patterson has some of these strengths as well, Patterson and Barkley also have a type of token economy set up so that way younger children can be immediately reinforced by the small token and older children can have a point system that is kept in a small notebook which is more discrete and age appropriate. Weaknesses of these two approaches have to be the fact that if the parents are not on board with the program or if they do not see the expected results right away they may not keep up with the behavior plan at home and results may not be able to be seen. This would also be true if the program is being followed and implemented at home and not at school because the teacher will not follow through for some reason, this too would impede the expected results across settings. Both approaches seem to be effective but I personally would start parents off with the Barkley approach because the timeout is shorter and the way that the program is set up is more interactive and really teaches parents how to implement everything before having the parents do the behavior programs on their own.

    Reply

    • Jane Jenkins
      Jun 11, 2014 @ 20:32:32

      Sara, I like your comments about the benefits of working with parents on behalf of their children. I have begun doing that in my practicum. What I did not foresee (which I should have) is all the “stuff” the parents are carrying around that has influenced the child. Though it sounds negative, I feel that getting to these issues and addressing them within the family context will positively impact the long-term well-being of the child in the situation if we can get through.

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    • Sarah Chelio
      Jun 13, 2014 @ 08:49:04

      Sara, I liked how you mentioned both frustrations and rewards of working with families. Although I have not yet begun working with the parents, I can imagine how difficult it can be to provide psycheducation and interventions to those who are low functioning or reluctant to change. I think that it is important to remember how rewarding it feels when success if finally achieved when one is experiencing that frustration. It is also good to keep in mind how necessary working with the family is in order to help the child.

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    • Robin Horsefield
      Jun 14, 2014 @ 15:41:14

      Sarah, I think your comment about therapy with children is correct. I can see how in-home therapy would be very different from interventions used in the schools. A working alliance between the therapist, parents and teachers is essential to making any kind of extended behavior change. If you can create a team approach with all the major figures in the child’s life you are more likely to make a lasting change. I also liked your comment about the potential for reaching other children during the course of therapeutic interventions. I hadn’t thought of that as a potential outcome before.

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  7. Jane Jenkins
    Jun 11, 2014 @ 20:26:52

    1) Working with parents and teachers can be a tall order. Balancing the idea that you want to be an advocate for the child, with accepting the fact that the parents and/or teachers are not providing what the child needs is, no doubt, the toughest part about working within this part of the child’s environment. It is difficult not to take sides when it is tempting to want to lecture a parent or teacher about their role in the child’s difficulty. This is not only counterintuitive, but goes against the grain of the therapeutic process. I have been advised to see the parent, teacher, or other adult in the child’s life through a lens that promotes empathy. Obviously, if everything were great they would not be seeking help. If we can view the adults in the situation as parents or teachers as individuals who mean well by the child but are overwhelmed by their situation, we can focus on providing them with skills and tools that will help them function more adaptively. This indirectly helps the child and strengthens the family structure at the same time.

    2) The Barkley approach to therapy with youth has a strong focus on parental perception and understanding of the sources of behavioral problems in kids, which I really support. They also focus on enhancing the value of attention, which seems very important in getting the child to buy in to some of the changes made. I’m a little cautious about removing points at any time during the contingency process, so in my opinion this presents a weakness in this approach. As Barkley stated, problem behaviors are generally not due to sheer deviance. Introducing negative consequences instead of simply saying, “you don’t earn points this time because….” might produce a cascade where the child has no more points to lose. Nothing to lose means a risk of the method losing effectiveness and regression to learned methods of behaving.
    The piece of the Patterson approach I especially appreciate is the reading assignment for the parents. Not only does it help them understand the dynamics of behavior on a very deep level, but it measures their level of commitment early on. If they don’t read the book you already know what you are up against. I also like the emphasis on positive reinforcement and social reinforcement, which helps the family gain closeness and respect for each other. A weakness of this therapy might be the learning curve during the problem-solving and negotiation strategies, but once mastered, might be the tipping point to a better functioning child who feels heard and respected. Of the two I lean toward the Patterson approach.

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    • Julianna Aguilar
      Jun 12, 2014 @ 11:04:34

      Jane, I like how you pointed out being a bit cautious about creating a system where points are removed from the child for certain behaviors. I was a bit surprised to find that removing points was part of the model after the Friedberg and McClure (2002) reading pointed out that it is likely not to be effective. One example the authors provided was that if too many points are removed from the child, the child ends up owing his or her parents points. If this is the case, the child can end up needing to have several days to a week of nearly perfect behavior just to get back to zero. Then, as you pointed out, the intervention could lose effectiveness or even cause the child’s progress to regress if he or she does not feel that it possible to earn points.

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    • Rebekah Kiely
      Jun 13, 2014 @ 22:48:21

      Jane,
      I like your comment about employing empathy with parents and the difficulties of working with them. This is something I am also concerned about myself. Over the course of my time in this graduate program I have often been reminded that when working with children, it is the parents that some interventions may have to focus on. I find that parents of young children are hesitant to accept that something they are doing is not what is best for their child. If it is something about the parent that needs to change (such as certain parenting styles) in order for the child to more adaptively behave/think, keeping the parents engaged in therapy may become increasingly difficult. As such, I think it is important to learn about and observe the parents as well as the child so we can individualize the interventions not only to the child, but also to the parents when necessary.

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    • Robert Jarrard
      Jun 14, 2014 @ 11:11:29

      I agree with you, Jane, on the importance of the Patterson model in its use of positive reinforcers and social reinforcers that draws upon family strengths and develops better communication. I can see why the Patterson model is more appropriate for adolescents due to its more flexible approach than Berkley’s model as well as less emphasis on behavioral interventions and use of punishments. The
      problem-solving and negotiation strategies Patterson advises may be particularly challenging for families that tend to be more authoritarian towards their children with conduct problems. But adopting these strategies may be very effective in reversing negative patterns of interactions where once the child feels respected, they are more likely to respect their parents.

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    • Robin Horsefield
      Jun 14, 2014 @ 15:55:08

      Jane, I agree with your point of view regarding the reading assignment inherent in Patterson’s approach. When you mentioned this appreciation in class it made a great deal of sense as a screening method to see which parents are serious and committed. The reading will provide a foundation of understanding that the parents can use to negotiate with the therapist. They may recognize the error of their previous methods, develop ideas about what might work for their child; having the reading as a context may serve to pave the way for the therapist-parent relationship.

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  8. Melissa Symolon
    Jun 11, 2014 @ 23:52:03

    1. Personally, I have always wanted to work with children and adolescents since I knew I wanted to pursue a counseling career. I did not realize until the end of my undergraduate studies that, generally, much of the time spent treating children is actually done by working with parents and parent training. There are obvious pros and cons to this point. Because parents are so influential to children, it is most helpful when parents are willing and participate in treatment. On the other hand, it is extremely difficult when parents are not invested in their child’s treatment. A parent’s level of involvement can make or break the degree of progress a child can make in therapy.
    Working with teachers is important, too, because children’s problems often generalize into the school setting. As with parents, there are also pros and cons to working with teachers. Teachers are sometimes great at recognizing and identifying a problem and working with the child and the family to improve/fix the problem. Other times, teachers can be so overwhelmed that they overlook behavior or emotional problems. During fellowship with Drs Doerfler and Volungis, I learned that teacher’s perceptions of students’ behavior problems are, unfortunately, often inaccurate. That is why it is important to work with teachers to train them on how to identify and work with children with behavior and emotional problems.

    2. I think that Barkely’s behavior parent training has more strengths than Patterson’s program. I have read about Barkley’s program before and I find it to be very specific, detailed, it takes into account many aspects and possibilities of behavior problems, and the work involved is reasonable for parents to complete. Barkley’s program includes psychoed about ADHD and ODD so that parents can understand why their child acts they way he/she does. His steps are graduated so that parents do not move on until they have mastered the former step. I like how he emphasizes special time between parents and the child so that a strong and healthy bond is created. I found Patterson’s program to use basic reinforcement and problem solving techniques, whereas Barkely also focuses on the importance of building a strong parent-child relationship.

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    • Sara Grzejszczak
      Jun 13, 2014 @ 18:01:57

      Melissa, I was definitely shocked too to find out that most of the time was spent working with the parents! After the initial shock settled I realized that when I thought about all of my jobs as a nanny and daycare worker when there were problems with the child my co-workers and I would automatically think about the things the parents were doing that were not working for the child. This then made a lot of sense because the parent and how willing they are to work with you and with their child does make or break the progress. I also felt that Barkley’s approach had more pro’s than con’s as well. The special time between parents and children really can help build a relationship between them so that way parents can point out the positive things that children are doing and also to help increase the number of times that children comply with the demands that their parents are giving them.

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    • Juliana Eells
      Jun 14, 2014 @ 10:33:29

      I also liked how Barkley emphasized strengthening the relationship between parents and children. I feel like having a strong, positive relationship with the child in general will help in treating the problem behaviors as well as any emotional problems, improving their overall well-being. Like we discussed in class, there are some parents who cannot find anything positive to say about their child or say they have no strengths, and some may be just very overwhelmed and frustrated with their child’s behavior. In these types of cases I think building the relationship between parent and child would be an especially important part of treatment.

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  9. Paige Hartmann
    Jun 12, 2014 @ 00:19:56

    When providing treatment to youth, both parents and teachers play an integral role in the process. Since the child spends the majority of his/her time between home and school, parents and teachers can provide useful information about the child’s presenting problem (since the problem may present differently within these domains than within therapy). It is crucial for parents, teachers, and the therapist to have a shared understanding of the child’s presenting problem, treatment goals, and treatment plan. This may require the therapist to provide some psychoeducation to the parents. Ensuring that the parents and teachers work collaboratively to help implement the child’s plan helps prevent inconsistencies for the child. One of the biggest barriers to effective treatment for a child includes reluctance, noncompliance, or no involvement from the parents.

    The reading describes Barkey’s 10-step behavioral parenting training program for working with children who have ADHD. The first step in Barkley’s approach involves educating the parent about ADHD, which I believe is an essential aspect for the parent. In order for a parent to help their child effectively manage their behavior and improve their ability to follow rules, the parent must first have a clear understanding of the child’s diagnosis. I believe that it is particularly important for the parent to learn how to use parental attention effectively with their child. It is essential to educate the parent the importance of increasing the child’s positive behavior through the use of reinforcement.

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    • Julianna Aguilar
      Jun 12, 2014 @ 10:46:01

      Paige, I like how you pointed out the importance of the therapist, parents, and teachers being on the same page about the child’s presenting problems, treatment goals, and treatment plan. This communication is especially essential for determining if the child exhibits different behaviors between home and school. Making that determination could shed light on the factors that could have caused or maintain the child’s problems. One issue I have found is the reluctance on the part of some families to allow that communication. We think of gathering all of this information as nothing but a positive in order to provide the most beneficial treatment possible. However, parents sometimes do not feel the same way, which often raises alarm about possible additional issues that the parents do not want the school or the therapist to know about. In the school where I work, we cannot speak to the outside therapist without a waiver. If the child’s parents do not sign the waiver, we have no way of knowing what the child and family is working on in therapy unless they self-report that information, and therefore we cannot help support or modify the outside therapist’s interventions to best suit the child at school.

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  10. Rebekah Kiely
    Jun 12, 2014 @ 08:04:04

    Working with parents and teachers when providing therapy to youth can be very challenging. Engaging parents in Barkley’s BPT program offer a great way to structure and guide the course of therapy for the parents. I especially enjoy Barkley’s acknowledgement of prospective future challenges regarding any new problematic behaviors which may develop. Step 10 of the BPT program is devoted to managing future misconduct in which parents are provided with the skills needed to manage future problems with their children. I believe that by bringing attention to the fact that one does have a plan to use in the future if need be can be very reassuring to parents and may enhance a mother or father’s self-efficacy when it comes to being able to adaptively manage their child’s difficult behaviors. I also find it very interesting that in Patterson’s OSLC parent training, a modification to allow this training to be applied to delinquent adolescents was developed. Although the feasibility of this approach on a larger scale is questionable, I like the possibility that future developments of such a program are possible and we may help adolescents with such problems. I understand the importance of prevention methods, but I also wish to acknowledge that it remains important to have interventions for adolescents who we are unable to prevent from developing their problems.

    The fact that both of these approaches to working with parents employ a step-by-step program that supports autonomy of the parents and allows them to gradually develop their own skills when it comes to managing their child’s behavior is a significant strength. These programs offer parents a guidance, but do now give them the false belief that we, as therapists, will always remain with them to explain to them exactly how to handle a certain behavior. By allowing the parent to develop their own skills over the course of therapy I believe these programs are capable of decreasing the likelihood of problematic behaviors returning. However, I also can’t help but question the use of punishment within these approaches. Despite the great emphasis placed on reinforcement, I feel it should be acknowledged that punishment is not the optimal way in which to change a child’s behavior. I see it being entirely possible that some parents will use punishment more than reinforcement simply because they are used to doing such a thing; and the use of punishment can be problematic. The punishment would need to be applied every time the child exhibited the undesirable behavior, which considering the vast number of environments a child may be in (i.e. home, school, friends houses) is nearly impossible. This also brings to mind the challenge of employing CBT with children who have divorced parents: If both parents do not engage in therapy with their child and employ the advised interventions I feel it is possible the change in behavior will not generalize to all environments and the problem would remain.

    Reply

    • Melissa Symolon
      Jun 14, 2014 @ 21:45:47

      Rebekah, I really like how you pin-pointed the importance of the parent’s self-efficacy to be able to effectively parent children with ADHD. So much attention is placed on the child’s behavior and self-effiacy that the well-being of the parents is often thought of last. I think that you being able to pick that detail out of the reading shows that you will do well at working with parents 🙂

      Reply

  11. Julianna Aguilar
    Jun 12, 2014 @ 10:29:40

    Working with parents and teachers is an essential part of providing effective therapy to children. I felt that two points in Friedberg and McClure’s (2002) chapter particularly resonated with me: the difference between desirable behaviors and expected behaviors, as well as reinforcing and punishing certain behaviors. First, the authors discuss the potential difficulty of helping parents understand that their view of expected behavior actually may be desirable behavior that is not attainable by any child. I see this issue quite a bit working in a high school where parents often complain, for example, that “Johnny should be getting A’s like his brother. I do not understand why he is not.” When this is the case, the parents will remain determined that there is a problem until Johnny has achieved all A’s, despite the counselor’s reports of significant progress in multiple other domains. Second, I imagine one of the more difficult interventions to engage parents in is praising the child for positive behavior instead of always focusing on the negative. By the time that parents bring their child in for therapy, they are likely so focused on the negative that it is difficult for them to break that habit, as well as to accept that their behavior needs to change as much as the child’s in order for treatment to be successful. With teachers, one aspect that I find most difficult that Mash and Barkley (2006) acknowledge is how time-consuming some interventions can be. For example, the authors describe one intervention in which the teacher is expected to record the child’s school performance one or more times throughout the school day and then report it to the parents by sending the ratings home with the child. It does not sound like much on the surface, but when the teacher has 100 other students whose parents may also need to be contacted for various reasons, it is unlikely that the teacher will be willing to adhere to this intervention due to lack of time. When this is the case, the therapist may not be able to gain important information about school functioning.

    Both the Barkley and Patterson models have strengths and weaknesses. First, Barkley’s model addresses symptoms namely related to ADHD by increasing attention to compliant behavior and using time-outs for non-compliant behavior. There are two aspects of Barkley’s approach that makes it unique, though. First, the author suggests that children with ADHD have deficits in self regulation and executive functioning as opposed to solely being the result of poor parenting. If this hypothesis is correct, parents must provide more explicit and systematic rules and consequences for non-compliant behavior to these children than to children without ADHD. Second, Barkley incorporates training for managing symptoms associated with ODD as these symptoms are often associated with ADHD. Together, these foundations inform a 10-step model for treating these children which generally involves educating parents about ADHD and ODD, managing the child’s non-compliance, and increasing positive behaviors at school and home. To me, Barkley’s incorporation of ODD into his model is one of the greatest strengths being that comorbid issues are often overlooked. Barkley makes an effort to address the complexity of ADHD and associated issues in order to provide the most comprehensive treatment possible.

    Likewise, Patterson’s model follows a similar structure of educating parents, identifying the child’s problem behaviors, implementing reinforcements and punishments, and learning about problem solving and negotiation. The beginning of this model is more therapist driven, then gradually shifts responsibility to the parents to manage their child’s behavior more independently. One aspect of the model that seems to be a strength is that 30% of the treatment time focuses on marital issues, parents’ personal adjustment problems, and family crises (Mash & Barkley, 2006). It is understandable that parents may overlook the role that they play in their child’s problems. By using nearly one-third of the therapy to explicitly address parental issues that may be affecting the child, both the parent and the child learn about all sources of the problem. For both models, however, I see a potential drawback being parental non-compliance being that it is a potential issue with all therapy for children. Parents may be looking for a quick fix and have difficulty understanding the importance of education, reward, punishment, and self-monitoring, or simply feel that they do not have the time. Overall, I am not sure I could pick one model over the other. However, being that Barkley’s model is largely geared toward children with ADHD and ODD symptoms, I would assess the child and their symptoms first in order to determine if they would be an appropriate fit for that model.

    Reply

    • Paige Hartmann
      Jun 12, 2014 @ 17:33:27

      Julianna, I like how you discussed the difference between expected behavior and desired behavior in how it related to a youth and family that you work with. It is very common for parents to hold their children up to the same standards as their siblings, especially when it comes to academics. It is important for the parents to recognize that these expectations are not always realistic.

      Reply

    • Juliana Eells
      Jun 14, 2014 @ 10:48:43

      Julianna, I agree that there may obstacles when working with teachers in terms of time available to focus on the child and willingness to implement interventions. Not only do that have to report on the child’s behavior but the teacher may also have to start changing the way they do things with the child, which may be a lot to ask for an already busy teacher who has so many other students as well. Some teachers have great classroom management skills in general which would be helpful, but others lack some of the important skills that we discussed in class such as consistency, follow through, proportional punishments, avoiding power struggles, etc. If a teacher is struggling with some of these things it may be more difficult for them to make changes than it would be for a parent because they have so many other children to attend to at the same time.

      Reply

  12. Angela Vizzo
    Jun 12, 2014 @ 10:50:20

    When working with children, working with the parents and teachers of the children is just as important as working with the child, themselves. Many of the problems children exhibit come from inconsistencies or deficits in their environment or system. Therefore, in order to improve the behavior changes have to be made to the environment as well as teaching the child to manage his or her behavior. I am apprehensive to work with parents, specifically regarding having to teach them new parenting techniques and therefore implying that their current parenting is inadequate. I am also nervous that parents will use the fact that I do not have children of my own as a way to invalidate my advice and not carry out suggested techniques.

    The approaches by Barkley and Patterson emphasize direct commands, consistent commands, negative reinforcement in the form of time-out, and positive reinforcement in the form of tokens or points. In addition, Patterson emphasizes constant monitoring of the children by parents. There are strengths and weaknesses within each of these approaches. Both approaches emphasize educating the parents about the child’s behaviors which is a huge strength. However, a weakness would have to be that in order for either of these systems to work both parents, all caregivers, and teachers would have to be fully on board which can be very hard. Especially in the case of teachers who have 20 or 30 students to take care of and cannot possibly use a different discipline system with each child in the classroom. Also, the time-out technique can only work until the child is a certain age and then becomes inappropriate.

    Reply

    • Paige Hartmann
      Jun 12, 2014 @ 17:37:06

      Angela, I am worried about similar concerns when beginning to work with parents within their child’s treatment. As a young therapist, it will definitely be difficult to teach parents more adaptive parenting skills, as parents may be skeptical. This is why it is imperative to build a strong rapport with both the child and the parents, since they both play equally important roles within the therapeutic process.

      Reply

    • Rebekah Kiely
      Jun 13, 2014 @ 22:48:54

      Angela,
      I like your comment about feeling apprehensive when working with parents, but I also believe it is important to be aware that parents are likely just as apprehensive about working with a therapist. It is easily understood that parents will be apprehensive about therapy regarding their child and I think it is extremely important for us to make a significant effort to become aware of the parents feelings regarding bringing their child to therapy. When it comes to children, preventive measures regarding mental health are often not taken by parents and as such when beginning therapy, it is because parents are now at a loss of what to do. Considering that parents may be feeling guilt as a result of not being able to help their child is important to be aware of. I think that as therapists, we need to think from the parents perspective as well as our own to support a strong therapeutic alliance with the parents.

      Reply

  13. Robert Jarrard
    Jun 12, 2014 @ 11:39:43

    1) Although working with parents is probably the most difficult aspect in providing therapy to youth, it’s necessary in ensuring the child’s progress beyond the therapy session. If the parents are noncompliant with the treatment methods and goals, how can the child be expected to be compliant? Building a relationship with the parents may be as important as or even more so than with the child, especially the younger the child is like Dr. V mentioned. Rather than focusing on the “problem” child, it is more effective to address dysfunction in the family unit that maintains the child’s problematic behaviors. Psychoeducation is central to this process as many parents may not realize how their behaviors, no matter how well-intentioned, are inadvertently reinforcing their child’s negative behaviors. Like Friedberg & McClure mentioned, parents are often reluctant to initiate treatment methods, thinking that it is just more work. But through Socratic questioning, parents tend to realize their current methods are not working the way they thought so they are more willing to give the therapist’s new methods a try.

    2) I like the emphasis both Barkley and Patterson place on the pscyhoeducation of parents since without some background on their child’s disorders, how can parents identify symptoms and possible causes? I agree that enhancing parental attention is important as parents tend to pay too much attention to inappropriate behaviors and not enough to appropriate ones to not only reduce negative behaviors, but increase positive ones. I find Barkley’s home token economy to be overbearing for parents, and for their children, as it seems rather impractical to expect parents to be highly consistent in rewarding or taking away tokens in the manner that Barkley advocates. I think Patterson’s point system is more realistic and flexible, though it is probably better suited to older children. I think both approaches to time-out are useful including Barkley’s methods of managing noncompliance in public places.

    Reply

    • Sara Grzejszczak
      Jun 13, 2014 @ 17:52:23

      Robert, you mentioned many good points about working with parents and while doing in home therapy at my current job I have to utilize many of those skills in order to help parents understand how to best help them and their child. It definitely gets easier as time goes by and a relationship is forged between you and the parent and now much of the time parents are okay with many of my suggestions. The token system in Barkley’s approach might be tedious but young children will definitely not understand points and will want something tangible every time they do what they are supposed to do. I feel that after a while, especially if parents buy into the system and start to see results, parents will get so used to paying attention to the appropriate behaviors and rewarding them that they won’t even think about it and it’ll be second nature. At least that is what the hope is!

      Reply

  14. Juliana Eells
    Jun 12, 2014 @ 12:50:10

    While I have not yet had a chance to work with children, one of my biggest concerns about working with children is dealing with parents. Although it is essential in the treatment of children, I imagine it can often be difficult to get parents on board and properly involved in treatment. Parents may be sensitive to feeling like we are telling them they are doing something wrong in their parenting, or may not agree with the approach that we present. But in order to properly help the children, we have to know how to effectively work with their parents. I liked the readings this week because I felt like they provided a lot of good information and plans for working with parents and I found that very helpful. Working with teachers may also be difficult as they often have so many children they are responsible for and may feel that they are too busy to give a lot of extra attention to one child in their class.

    I thought that Barkley’s program was very thorough and detailed addressing many important issues in parenting training. In the Mash & Barkley reading they detailed each step in Barkley’s program which even included steps to work on school behavior specifically and how to manage future problems, which I thought was great. However, this program has only been proven effective with children ages 2-11, and not with adolescents so that some aspects of this program must be combined with another approach to be effective in adolescents. I also thought it was unfortunate that implementing this program as a preventative measure in preschoolers was not effective and many parents were not willing to attend consistently or at all, in order to prevent aggressive/hyperactive/impulsive behaviors from becoming a more serious problem.
    While many aspects of Patterson’s approach (parent education, positive reinforcement, time-out, etc.) were similar to Barkley’s interventions, this program just seemed like it was not as thorough as Barkley’s program especially in terms of parent education, targeting school behavior, and dealing with future problems. I also thought Barkley’s suggestion for time-out duration (1 minute for each year of age) was more appropriate than Patterson’s 5-minute time-out across the board, as I think there should be some adjustment based on age. However, I liked that Patterson’s approach has also been modified to work with adolescents.
    I might prefer Barkley’s approach because it seems to be more thorough, but both appear to be effective intervention strategies when you look at the research.

    Reply

  15. Robin Horsefield
    Jun 12, 2014 @ 12:50:36

    My current job requires that I communicate with parents about their children and their progress at karate on a regular basis. This is easy to do when parents understand where you are coming from and have realistic expectations about their children. On the flip-side, my job is difficult when there are parents who constantly compare their children to other children or push their children too hard. I have found that showing the parents that you genuinely care about their children and have a vested interest in their progress is a good way to keep them on your side. Similarly to the reinforcement examples, being consistent with parents is important too. They need to be made to understand rules, boundaries and realistic expectations not unlike children. I can imagine that teachers have their own inherent obstacles because they are equally responsible for usually 15-25 students on any given day.

    I enjoyed the Friedburg chapter; the information and examples translated well when reading the Mash excerpts. As I have mentioned before, I do not have children of my own nor have I worked with children in a clinical setting, but I have done my fair share of babysitting and caring for children. The part mentioning how the emotional salience of a situation influencing the use of punishment or reinforcement was particularly interesting. I have heard a number of parents lose their tempers and threatening or taking away big life events. I prefer the Barkley approach, which works “when used correctly,” and I see this point as both a strength and a weakness. When reinforcement and punishment are used immediately and appropriately the results are usually lasting, but the trouble is maintaining the endurance to see the approach through. By the time parents seek help, they are usually burnt out or losing patience rapidly. While the payoff may be great, some parents may not have the strength to follow through. The Barkley approach not only teaches parents and teachers how to change behavior through reinforcement, but also shows them that by changing how you approach a child with commands and requests, you can influence how the child responds. More than a few light bulbs went on for me while reading these suggestions.

    Reply

    • Melysa Faria
      Jun 12, 2014 @ 14:49:53

      Robin,
      I like that you pointed out many parents don’t decide to get services for their children until they are burnt out and losing their patience. Parents tend to seek services when they feel there are no other options because they don’t want to face the possibility that there may be “something wrong” with their child or with their parenting. I think a good addition to both Barkley and Patterson’s interventions could be the identification of the child’s strengths along with the identification of the child’s problems in order to use these strengths to improve behaviors and keep from completely focusing on the negative. This could really help to validate parents and give them hope for improvement and help them to get some motivation to keep from giving up, even if they are burnt out and running out of patience.

      Reply

    • Robert Jarrard
      Jun 13, 2014 @ 21:44:13

      I like how you incorporated your experience, Robin, in your answer. With parents coming into therapy already tired from so many past attempts, they may be searching for a quick fix, like medications. I know a young couple who have a young daughter that has brought them to wit’s end before they sought therapy. They wanted medication for her suspected ADHD, but the therapist wanted to try behavioral interventions first. This couple was very lax on discipline and inconsistent, so the therapist suggested the proper use of time-out and other rewards and punishments. This couple is still struggling trying to correct their past mistakes and find it difficult to be consistent, though they’ve made some progress. At least they are no longer convinced she has ADHD and needs medication, and they realize how their interactions with her influence her behavior. If only they sought therapy early… It goes to show how difficult for both the parents and the child to change past bad habits.

      Reply

    • Melissa Symolon
      Jun 14, 2014 @ 21:35:22

      Robin, I like that you mentioned that parents have to be consistent with their parenting techniques. It is easy for children to not understand the message or to even get the wrong message when parents are inconsistent of their expectations. I think that can be the biggest obstacle for some parents because some days they may do really well at enforcing rules and setting boundaries, and other days they may have a bad day at work or be feeling run down and that effects how they parent their children. I know that it is also important for parents to be on the same page as one another. Your point on consistency reminds me of a story a professor from undergrad told the class once. She worked with a mother and her eight-year-old daughter for a couple of weeks. Her daughter was having long and intense temper tantrums that are abnormal for eight-year-olds to have. My professor taught the mom to ignore her, as well as other techniques and the temper tantrums significantly decreased to not lasting longer than five minutes. But the father/husband traveled a lot, so when he finally came home the daughter got worst and had an extinction burst because the father had not been learning how to properly handle the temper tantrums that whole time. It is so unfortunate to accomplish so much with a client just to have something so simple, like giving a child attention, ruin all that progress.

      Reply

  16. Anthony Rofino
    Jun 12, 2014 @ 13:39:26

    1) In my personal experience, working with parents is the most important aspect of therapy with children. No matter how much work you do with a child, that work is almost completely invalidated if it is not followed through at home. Also, on a similar note, much of the time, children’s issues will be exacerbated by the home presence. It is through work with the parents that children have the greatest chance of improving. Teachers are just as important. Keeping the communication between parents, teachers, and students allows for the best way for continuity of care and to make sure the work done in therapy is followed through

    2) Overall, I really enjoy the information provided by Barkley. Barkley gives a good amount of information on giving directions and commands.He says that this is overlooked by parents, but it is very important. When parents make it very clear what is to be expected, there is less need for commands as the expectation are clear. Some parents can have a problem with this though. It can be difficult for parents to stick to limits that they have set. I think one of the problems with this theory is that it is mostly targeted for younger children and has not been proven well for adolescents, although I do believe it to be affective.

    Reply

  17. Nafi
    Jun 12, 2014 @ 14:28:41

    Working with parents and teachers can sometimes be difficult. Depending on the age of the child, much gathered information will be obtained from these two sources. In some instances, both parties will report great observations will be informative for assessing the presenting problem. Yet, in some instances, parents and teachers may not be provide the most accurate observations or information. When obtaining information from parents and teachers, clinicians want to be careful not to just “take their word for it.” Reports from more than one source is a good way to look for consistency and to filter information. Moreover, parents and teachers may not always be cooperative during treatment. Parents may not agree with the course of treatment that has been laid out for their child while teachers may not want to fill out their part of an assessment instrument. The supports which the child is receiving outside of the therapeutic environment are important for maintaining positive outcomes. All systems linked to the child, should be on the same page in how to manage the presenting symptoms. Pyschoeducation may need to be provided to both parents and teachers but more especially parents. Treatment will be focused on the child but the parents may also need some professional support. Therefore, consider offering counseling services or even support groups for parents.
    Strength of both approaches is that education is stressed for parents. As previously mentioned this is a part of therapy can will have a long term effect and help maintain positive outcomes. Providing education to parents will also consist of helping parents many different tools and strategies for managing their child’s symptoms. Parents need education on the nature of the illness but also on the course of treatment that will promote the highest level of adaptive functioning for their child. Medication does not always have to be the course of treatment for a child. Barkely’s approach implements behavior modification techniques that can be used in varying settings. This is beneficial for parents as they can develop a consistent plan for handling behaviors at home, at the store, or anywhere else. As with any treatment intervention, parents may not want to continue treatment efforts at home. This is one problem that as mentioned, can affect the course of treatment and the longevity of positive outcomes. In choosing one of these approaches, I would choose the Barkley as it appeared more specific and directive in describing techniques and interventions

    Reply

    • Angela Vizzo
      Jun 14, 2014 @ 17:49:44

      Nafi, I like your comment about how important teacher and parent observations are. They can be great insight into the child’s behavior and can alert the therapist to whether the behavior is occurring all of the time or only in certain situations or with certain caregivers which plays a key role in treating the behavior or symptom.

      Reply

  18. Melysa Faria
    Jun 12, 2014 @ 14:43:46

    1. When reading the textbook chapters for today, I kept thinking to myself, “Wow, these books make it seem so simple to work with parents and teachers using these interventions”, however that is not always the case. There are some families who are open with sharing information about the structure in the home and are able to be realistic about shared responsibility for their children’s difficult behaviors, but there are some families who are not able to do this. It is always unfortunate when a parent brings their child into therapy and asks for the child’s behaviors to be “fixed”. There are far too many parents out there who feel that their child is the problem and refuse to try any new parenting skills. When presenting interventions, I have heard many parents say things like “I’ve tried that, it doesn’t work and it’s a waste of my time” or “the therapy is for my kid, I’m not the problem”. There are also teachers that I have worked with who state they simply don’t have time to give extra attention to one student in particular or send home report cards every day. Even if a child has an Individualized Education Plan or a 504, schools sometimes try their hardest to avoid having to provide accommodations that cost money or take extra time. Many of the interventions discussed in the textbooks are methods that I have utilized or seen other clinicians utilize with families, and when the whole family participates and the school is on board, things generally go well and behaviors improve. It is when families and schools feel they don’t have the time to intervene and feel that it’s the child’s responsibility to change that the behaviors tend to either stay the same or get worse.

    2. I found Barkley’s 10 steps to Behavioral Parent Training (BPT) to be very clear and concrete. I think some of the strengths of this interventions include the psychoeducation on both ADHD and ODD, the establishments of consistent and clear rules and expectations, the collaboration with the child’s school, the practice of managing potential future misconduct, and the follow-up session that is used to review with the parents the skills which were learned and provide any final clarifications. One thing I was unsure about was the implementation of time-out in public places. While I understand the importance of immediate consequences for problem behaviors, I feel that public time-outs can be very distracting for children and very difficult for a parent to enforce. I felt that going to the car temporarily to complete a time-out or going home immediately after the problem behavior may be more effective. I also felt that in the token economy system that taking away points or tokens that have been earned for good behavior after a negative behavior can be a bit unfair and other forms of punishment (e.g. taking away a toy) may be more appropriate. If children are losing their points or tokens that they have earned, they may develop a “why bother” attitude if they feel they might lose their points anyway.
    Patterson’s parent training model also has a lot of notable strengths such as psychoeducation provided to parents at the start of therapy, the identification of problem behaviors specific to the identified client, the emphasis on parents learning to have consistent supervision over their children, and the focus on any parental problems that require intervention. This approach addresses both behaviors of the child and environmental factors at home which may be influencing the child’s behaviors during the intervention. One of the things I would question about this intervention is the gradual removal of tangible reinforcers. This could create some difficulties in the parent-child relationship and defiance may return. If non-tangible reinforcers are implemented from the beginning and used continuously (ex: extra time with mom, movie night, etc.) then there may be less of a risk of falling back on problem behaviors.
    Both Barkley and Patterson’s interventions require full parental (and some school) collaboration and involvement. Parents begin the process with full support in implementing structural changes at home and gradually learn to use these strategies on their own. If the parents do not have full commitment to these interventions, then they will not be effective and problem behaviors could stay the same or get worse. With full parental participation, I feel that either intervention could be effective in decreasing problem behaviors. However, I prefer Barkley’s model because of the concrete steps provided for each session and clear instruction on the implementation of structural changes in the home, including intervening in behavioral problems at school.

    Reply

    • Anthony Rofino
      Jun 14, 2014 @ 14:09:34

      Melysa, it was interesting to read your experience working with parents and children. I have also encountered many parents who believe that their child is the only source of the problem, but I have also encountered quite a few parents who realize that they may be making mistakes and that they want to change for the better. I find that these parents are the ones that truly change.

      Reply

    • Angela Vizzo
      Jun 14, 2014 @ 17:42:37

      Melysa, I like your comments about parenting and teachers. I think we all wish it could be as simple to implement interventions as the books make it seem, but like you mentioned this is usually not the case in practice. Like you mentioned one of the hardest parts about treating children is getting the parents and teachers on board in order to change the environment to support what the child is learning in therapy.

      Reply

  19. Larrisa Palmer
    Jun 12, 2014 @ 14:49:44

    Personally, I am open-minded in regards to working with parents and teachers. I believe even the most difficult and annoying parents possess certain key strengths that can be utilized to help their children resolve difficulties. I think a lot time parents respond in a negative or even hostile way because they lack the skills necessary to effect change and they are extremely frustrated, they have experienced treatment failures before and are pessimistic about the possibility of positive outcomes. Every situation will be different, many parents will come to therapy at the contemplation stage of change because they were court-ordered as well as there will be parents who are at the action stage who are willing to do whatever it takes to make treatment effective for their children. It is not an easy task working with parents and teachers but in order for treatment to be effective we have to incorporate the different systems in the child’s life.

    As it relates to the Barkley and Patterson’s approaches, the strengths of these programs include: improving parental knowledge, managing and improving the child’s compliance through the evaluation of the child’s non-compliance and causes of misbehavior, and focusing on appropriate interactions as well as reinforcers of compliance. One possible weakness could be linked to the behavior modification system, particularly the home token economy. If parents are not flexible and creative enough to modify this system frequently it can become habitual for both parents (who may become exhausted and quit) and the child (who may become unmotivated) which may result in undesirable outcome.

    Reply

    • Sarah Chelio
      Jun 13, 2014 @ 08:57:32

      Larrisa, I liked your point about keeping an open mind. I think that is important because all parents are different. Like some said in class, most of the time parents are open to therapy and want to do what is best for their child. Going in with judgments before getting to know them will effect therapy, so this is never a good idea. This will also make it harder to empathize, which is a key aspect to therapy.

      Reply

    • nafi
      Jun 13, 2014 @ 14:28:03

      Larrisa, I really appreciated reading your more positive aspect on working with parents. I did not really think about therapy from a parents point of view. You are right that some parents may be frustrated or even scared to have entered their child in treatment. For some parents this may signify an inadequacy to help their child and initially this parent may be resistant to clinicians. I guess we have to keep in mind that therapy will not only reshape the life of the child alone but rather all connecting systems will be affected.

      Reply

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Adam M. Volungis, PhD, LMHC

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