Early Intervention

Running Head: EARLY INTERVENTION

Early Intervention is the Best Treatment for Students with Conduct Problems John Laing University of Calgary

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This paper attempts to identify the most effective practices in treating students with conduct problems. A macro-perspective of intervention is taken in the writing of this paper because supporting children with conduct problems is more difficult than simply applying modifications in the classroom. Targeting one risk domain seems inadequate in extinguishing problematic behaviours. There is much research supporting the need for early intervention strategies for children with conduct problems. The most effective early intervention practices are those that incorporate home-school collaboration. School settings provide universal access to children and families allowing for the delivery of universal prevention programs. Because early intervention has the greatest effect on improving classroom behaviour for children with conduct problems it is imperative the school boards adopt family-school based early intervention strategies as common practice. This paper will also briefly discuss supports needed to make teachers more effective in managing children with conduct problems. Early intervention is thought to be preventive as intervening with children with conduct problems later in their schooling has little long-term effect. The best intervention for children with conduct problems is prevention/early intervention and should be facilitated by schools. Characteristics of Conduct Problems

According to the U.S Department of Education, 2002a, .72% of all students meet the criteria for emotional disturbances and/or behavioural disorders (as cited in Mastropieri & Scruggs, 2007, p. 64). Jordan (2007), defines behaviour exceptionality as a learning disorder where the student struggles with: the ability to build or maintain interpersonal relationships; excessive anxieties or fears; a tendency to compulsive reaction; and the ability to learn that is not traced to

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intellectual, sensory, or health factors. These symptoms have a negative impact on the students ability to learn and are displayed over a period of time (Jordan, 2007). For the purpose of this paper behavioural exceptionality and emotional disturbance will be defined as conduct problems. The most relevant subtypes of conduct problems are opposition defiant disorder and conduct disorder (McMahon, Wells & Kotler, 2006). According to the DSM-IV-TR, ODD is a recurrent pattern of negativistic, defiant, disobedient, and hostile behaviour toward authority figures (as cited in McMahon et al., 2006). Specifically, the child must display at least four of the following behaviours: losing temper; arguing with grownups; defying or not complying with grownups rules; deliberately annoying others; blaming others; being touchy or becoming easily annoyed; displaying anger and resentment; and being spiteful or vindictive (McMahon et al., 2006). These behaviours must be displayed more often than their same aged peers, disturb social and academic achievement and are displayed for at least six months (McMahon et al., 2006). The DSM IV TR defines CD as repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated (as cited in McMahon et al., 2006, p. 139). These behaviours are placed into four groups: aggressiveness toward people and animals; property destruction; deceptiveness or theft; and serious rule violations (McMahon, Wells & Kotler, p. 139 Mash). Students with behavioural deficits are often seen as the most challenging students for teachers to manage (Jordan, 2007). Students displaying such behaviours have struggles in and out of the classroom. Although classroom intervention may prove useful, support from outside the classroom must be considered as well. For students with such deficits to be successful in the classroom intervention must be across settings and involve multiple people. Without support from

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outside the classroom teachers will continue to struggle managing children with conduct problems. A definition of conduct problems is being utilized for this paper because a basic school definition of behaviour exceptionality or emotional disturbance implies that intervention is a classroom issue only. Focusing on classroom intervention only provides a narrow view of the students needs and does not take into account other areas of the students life effecting classroom success. Students described with conduct problems struggle with appropriate social behaviour in the classroom. Such students may be overly aggressive with their classmates or teachers and can cause harm when playing with others. Students may seem immature, oblivious to classroom rules and do not respond to discipline appropriately when compared to their average functioning classmates (Mastropieri & Scruggs, 2007). Students with conduct problems exhibit external behaviours and often blame others for their behaviour or mistakes (McMahon et al., 2006). These students avoid accepting or processing their own role in their inappropriate behaviours and attribute the cause of their behaviour to others (Mastropieri & Scruggs, 2007). Many student with conduct problems struggle with internal disturbances such as anxiety, depression, phobias and psychosomatic disorders; however, internalizing issues are beyond the scope of this paper. Students with conduct problems and/or related internalizing characteristic often struggle with academic achievement. According to Lane, Reid, Gonzalez, Trout, & Epstein, children with such issues may function two or more grade levels below their same aged peers (as cited in Mastropieri & Scruggs, 2007, p. 66). Childrens behaviour problems were found to negatively effect their learning behaviours as well as their language and literacy and mathematics achievement (Escalon, Shearer, Greenfield & Manrique, 2009). It is unlikely conduct problems begin with the childs first day of school; therefore, intervention prior to the school years should be considered. Importance of Early Intervention

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Many students with conduct problems enter the school system ill prepared for school. Children that are socially maladjusted struggle with social relationships and academic achievement. Preschool children who exhibit conduct problems are at risk for peer and teacher rejection, being removed from inclusive classrooms, health concerns, drug and alcohol abuse, school failure and dropout and dependency on social services (Mclaren & Nelson, 2009). Children who are exposed to poverty-related risk issues, prior to entering the school system, are more likely to exhibit conduct problems. Intervention programs targeted at children from low SES homes aim to improve a childs School Readiness. School Readiness involves emotional self-regulation, social competence and family/school involvement (Webster-Stratton, Reid & Stoolmiller, 2008). Webster-Stratton et al. (2008) evaluated the effectiveness of the Incredible Years Teacher and Child Training Programs in high risk schools. These programs were part of a universal prevention program for children in Head Start Programs. The program provided a social and emotional school curriculum, trained teachers in effective classroom management skills and promoted parent-school involvement. Along with improving school readiness such programs aim to prevent conduct problems. The absence of conduct problems plays a vital role in social adjustment and academic success (Webster-Stratton., 2008). According to Webster-Stratton et al. (2008), the programs appeared effective in improving the childs school readiness, preventing conduct problems and lead to future academic success. Children who display conduct problems at an early age are more likely to have continued conduct problems later in life (McMahon et al., 2006). Patterson, Capaldi & Bank refer to children with early onset conduct problems as early-starters (as cited in McMahon, Wells & Kotler, p. 147). Early-starters tend to display conduct problems during the preschool years and their problems get progressively worse as they reach grade school. Because early starters have a poor prognosis it is

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important for early intervention. Without early intervention behavioural problems may become crystallized by age 8, leading to social and academic deficits; therefore, Intervention prior to age 8 seems to have the best result for social and academic achievement (Webster-Stratton, Reid & Hammond, 2004). Gill, Hyde, Shaw, Dishion & Wilson (2008), evaluated the effectiveness of early intervention for a child displaying early-starter characteristics. Gill et al. (2008) found the Family Check-Up, a family-based and ecological prevention intervention for children at risk for problem behaviours, lead to clinically meaningful improvements in the childs conduct problems. The Family Check-Up was an intervention utilized prior to the school years and had positive longterm effects on the childs conduct problems. Family-Centered Intervention Parent-child interaction is the most important risk factor associated with early onset conduct problems (Webster-Stratton et al., 2004). Inconsistent and harsh punishment and low nurturing of children by parents increase the likelihood of a child developing early onset conduct problems. As a result, the best treatment for conduct problems has been to teach parents more effective parenting techniques (Webster-Stratton et al., 2004). Behavioural Parent Training is another family-based intervention strategy used as an early preventive intervention for children with ODD (Mackenzie, 2007). BPT program teach parents skills to effectively manage their childs behaviour including: positive reinforcement of desired behaviour such as verbal praise and tangible rewards; providing consequences for misbehaviour without coercive punishment; and monitoring skills to distinguish between positive and negative behaviours (Mackenzie, 2007).

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Furthermore, Coping Power is an empirically supported cognitivebehavioural program for children at risk for serious conduct problems and their parents. The Coping Power program has been found to reduce childrens substance use, delinquent behaviour and aggression in school settings indicating that the intervention can produce sustained changes in child and family functioning (Lochman, Boxmeyer, Powell, Vojnaroski & Yaros, 2007). Although the Coping Power program is a family centered intervention it is facilitated by school based clinicians. Mackenzie (n/d) suggests incorporating another treatment domain will improve BPT outcomes. Home-School Collaboration Involving teachers in the treatment process appears to have greater effects on treatment outcomes because it targets more than one risk domain and improves generalization of treatment across settings (Mackenzie, 2007). Treating only one risk domain (parenting interaction) decreases generalization of treatment outcomes across settings. Along with negative parenting interactions, negative academic and social school experiences contribute to conduct problems (Webster-Stratton et al., 2004). Working collaboratively, parents and teachers can support childrens learning at home and develop congruent home-school behaviour plans that can have positive effects on childrens academic, social and emotional development (Webster-Stratton et al., 2008). Known as Fast Track, Slough & McMahon (2008) investigated the effectiveness of a longterm, multi-component intervention designed to prevent the development of conduct problems in at-risk children. According to Slough & McMahon (2008), intervention targeting a single risk dimension has not proven effective for youth with conduct problems. Identifying conduct problems early, targeting multiple risk domains and using a long-term perspective gives children with conduct problems the best chance for social and academic success (Slough & McMahon, 2008).

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School settings are the key to early intervention strategies for children with conduct problems. Schools can target at risk students based on neighbourhood or school risk factors (Brotman, Kingston, Bat-Chava, Caldwell & Calzada, 2008). Recent research has focused on making programs more appealing, relevant, and accessible to families who are less likely to have access to quality services and are less likely to use traditional programs (Mackenzie, 2007). Because schools provide universal access to children and families, families may feel less stigmatized by early intervention facilitated by the school. Instructing teachers on effective strategies to use in family intervention is paramount in school-based prevention interventions. Furthermore, involvement of school personnel may promote positive relationships between the parent and the school (Brotman et al., 2008). The U.S Department of Health and Human Services (1996) outlines the requirement of Head Start programs as part of Head Start Performance Standards (as cited in Escalon et al., 2009). These performance standards outline Head Starts crucial role in providing early intervention for children with conduct problems (Escalon et al., 2009). Teachers in Head Start programs are often the first people to observe a childs behavioural deficits. It is important for teachers to be trained in identification of such deficits using measures that are easy to use and ongoing professional development is important for teachers dealing with children with conduct problems and their families (Escalon et al., 2009). It is also important to train teachers how to prevent social rejection and manage aggression in the classroom. Low rates of praise and inadequate classroom management contribute to classrooms with increased levels of aggression and rejection (Webster-Stratton et al., 2004). Treatment for conduct problems should include training teachers in effective classroom management techniques and methods to increase teacher-parent collaboration. Mclaren & Nelson

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(2009) found, Functional Assessments of children with conduct problems led to decreases in undesirable behaviours. Individualized intervention plans derived from Functional Assessments lead to decreased levels of inappropriate behaviour in children with conduct problems (Mclaren & Nelson, 2009). These results indicate teachers should understand the components of a Functional Assessment and should be able to carry-out informant methods, direct observation and analysis of a students behaviour (Mclaren & Nelson, 2009). Having teachers ready to carry out Functional Assessments and understand effective classroom management is vital to the success of early intervention programs. Children with conduct problems will benefit from parent-teacher collaboration because of a consistent socialization process from school to home (Webster-Stratton et al., 2004). Combining parent training with teacher training promotes school-home collaboration and is more effective than treating one risk domain. Webster-Stratton et al. (2004), found greater improvements in the childs behaviour when treatment targeted more than one risk domain. Combining teacher training with parent training showed the best treatment results for kids with conduct problems. Although teacher-parent collaboration can be an effective intervention strategy for children with conduct problems, few teachers poses the necessary skills for fostering such a relationship. Instructing teachers on how to effectively engage parents is vital to school-home intervention strategies. ParentCorps is an intervention model aimed to promote positive parenting practices, parent-school involvement and child social competence as a means of preventing conduct problems (Brotman et al., 2008). Teachers were trained to facilitate ParentCorps, an after school conduct problems prevention program for preschoolers and their families. Using this model teachers, mental health care professionals and pre-K teachers work together holding groups for children and parents. Teachers provide insight into how strategies taught in the parenting group are

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used in the classroom. According to Brotman et al. (2008), teaching teachers how to deliver ParentCorps improved the teachers understanding of conduct problems and facilitated improved parent-teacher interaction. Also, because ParentCorps targeted several risk domains a reduction in conduct problems was likely. Although early intervention is the key to treating children with conduct problems, the severity of the childs behaviours is likely to play a role in intervention outcomes. Bernat, August, Hecktner & Bloomquist (2007) found no significant program effects for reducing symptoms for children diagnosed with conduct disorder. Bernat et al. (2007) studied the Early Risers preventive intervention program that targeted children with ODD and CD. They found a significant reduction is ODD symptoms; however, CD symptoms remained consistent. Children with CD symptoms at the age of twelve showed the littlest reduction in problem behaviours. This suggests the severity of conduct problems plays an important role in symptom reduction along with the childs age. Perhaps children aged twelve showed fewer improvements because their problem behaviours have been reinforced for longer. Another important factor is children and families who were more exposed to intervention treatment did not show greater reduction in problem behaviours. Hawes & Dadds (2007) reported children with limited empathy, guilt and constricted emotionality were less likely to have significant reductions in conduct problems. Children showing the highest levels of these traits were the most likely to be re-diagnosed with ODD following parent training intervention. This seems to suggest children with more severe ODD and CD traits may not respond to tradition early intervention strategies. Conclusion

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Many factors contribute to the success of intervention strategies for students with conduct problems. Early intervention practices seem to have the greatest positive long-term effects in reducing conduct problems in classrooms. Parent involvement in treatment appears to be the most important factor contributing to decreasing conduct problems in children. However, teachers trained in family and class intervention techniques along with being involved in treatment increases the likelihood that positive treatment effects are long-term and consistent across settings. The severity of the childs conduct problems along with their age can influence the effects of intervention techniques. Older children with more severe conduct problems are less likely to show increased desirable behaviour after treatment. Evidence suggests family-centered early intervention preventive strategies, facilitated by schools, is the best intervention to improve classroom behaviour of children with conduct problems. Although micro-interventions within the classroom are important, a wider view of how to best support students with conduct problems is critical if the most effective intervention is to be understood.

References Bernat, D. H., August, G. J., Hektner, J. M., & Bloomquis, M. L. (2007). The Early Risers Preventive Intervention: Testing for Six-year Outcomes and Mediational Processes. Journal of Abnormal Child Psychology, 35, 605617.

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Brotman, L. M., Kingston, S., Bat-Chava, Y., Caldwell, M. B., & Calzada, E. J. (2008). Training School Personnel to Facilitate a Family Intervention to Prevent Conduct Problems. Early Education & Development, 19(4), 622-642. Escaln, X. D., Shearer, R. B., Greenfield, D., & Manrique, S. (2009). Promoting Classroom Learning for Head Start Children: The Importance of Identifying Early Behavior Problems and Fostering Adaptive Learning. Behaviors' NHSA Dialog, (12)1, 45-50. Gill, A. M., Hyde, L.W., Shaw, D. S., Dishion, T. J., & Wilson, M. N. (2008). The Family CheckUp in Early Childhood: A Case Study of Intervention Process and Change. Journal of Clinical Child & Adolescent Psychology, 37(4), 893-904. Hawes, D. J., & Dadds, M. R. (2007). Stability and Malleability of Callous-Unemotional Traits During Treatment for Childhood Conduct Problems. Journal of Clinical Child and Adolescent Psychology, 36(3), 347355. Jordan, A. (2007). Introduction to inclusive education. Mississauga, ON, Canada: John Wiley & Sons Canada. Lochman, J. E., Boxmeyer, C., Powell, N., Wojnaroski, M., & Yaros, A. (2007). The Use of the Coping Power Program to Treat a 10-Year-Old Girl with Disruptive Behaviors. Journal of Clinical Child and Adolescent Psychology, 36(4), 677687. Mackenzie, E. P. (2007). Improving Treatment Outcomes for Oppositional Defiant Disorder in Young Children. Journal of Early and Intensive Behaviour Intervention, 4(2), 500-510. McMahon, R. J., Wells, K. C., & Kotler, J. S. (2006). Conduct Problems. In Mash, E. J., & Barkley, R. A. (3rd ed.), Treatment of Childhood Disorders (pp. 137-268). New York: The Guilford Press.

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Mastropieri, M. A., & Scruggs, T. E. (2007). The Inclusive Classroom: Strategies for Effective Instruction (3rd ed). New Jersey: Pearson. McLaren, E. M., & Nelson, M. C. (2008). Using Functional Behavior Assessment to Develop Behavior Interventions for Students in Head Start. Journal of Positive Behavior Interventions, 11(1), 3-21. Slough, N. M., & McMahon, R. J. (2008). Preventing Serious Conduct Problems in School-Age Youth: The Fast Track Program. Cognitive and Behavioral Practice, 15 317. Webster-Stratton, C., Reid, J. M., & Stollmiller, M. (2008). Preventing conduct problems and improving school readiness: evaluation of the Incredible Years Teacher and Child Training Programs in high-risk schools. Journal of Child Psychology and Psychiatry, 49(5), 471 488. Webster-Stratton, C., Reid, J. M., & Hammond, M. (2004). Treating Children With Early-Onset Conduct Problems: Intervention Outcomes for Parent, Child, and Teacher Training. Journal of Clinical Child and Adolescent Psychology, 33(1), 105-124.

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