Medical News: Family Therapy Can Combat Conduct Disorders (if done right)

Medical News: Family Therapy Can Combat Conduct Disorders - in Pediatrics, Parenting from MedPage Today

Conduct problems? Drug abuse? What to do, who can help? Many people aren't sure who to turn to, A psychologist, counsellor, therapist, psychiatrist? Which profession? Research has shown that family therapy can help quell substance abuse and conduct disorders in children and adolescents, but is not as effective when the diagnosis is attention deficit hyperactivity disorder (ADHD), researchers said here today. Simply put, yes, a family therapist can be effective, but when there is underlying Attention Deficit Hyperactivity disorder, family therapy might not be the way to go. (although parent training, education and support are necessary).

This study (click above) is a 10-year review of published research and it found that two types of family therapy, parent management training and behavioral family therapy, are especially effective for conduct disorders. Many parents want to have family meetings, or have their child seen alone for therapy. That may simply not be the effective way to deal with these particular problems. Dr. Josephson, one of the co-authors of the review, which will be published in the September issue of the Journal of Child and Adolescent Psychiatry, presented these findings at a back-to-school health briefing sponsored by the American Medical Association and the National PTA.

Parent-management training teaches parents techniques such as positive reinforcement and working with children to develop problem-solving skills. Studies suggests that parent-management training can be an effective for conduct disorders for up to 14 years -- long enough for a child to complete elementary and high school. (In my office I often suggest some specific books by Dr. Russell Barkley on both ADHD and conduct disorder). Behavioural family therapy, practiced in my office, is a similar technique but it also incorporates "into treatment a variety of family, parent, and child factors that have been implicated as leading to disruptive disorders (e.g. parental stress, cognitions about the child, child temperament)." What the literature presented review suggested is that "ADHD core symptoms are better controlled by a combination of pharmacotherapy and board based intervention"s that include psychosocial interventions and may include family therapy.

Finally, Dr. Josephson said that family-based therapy may help in some of the current concerns about the side effects of pharmacotherapy, such as suicidal ideation. "When physicians and parents are partners in monitoring patients' safety, the family serves as a safety net that can facilitate several treatment goals." To sum up: Conduct Disorder (a specific diagnosis only your medical doctor of psychologist can determine) which is associated with ADHD is best treated first medically, then behaviourally, and last by family therapy. Parenting skills, education and coaching are critical components to success.

For more information on ADHD (Attention Deficit Hyperactivity Disorder, parenting, child behaviour, academic problems and relationship issues, please feel free to visit my website at www.relatedminds.com I also have specific information on ADHD available at www.adhdhelp.ca and information on my counselling and assessment services can be found at either the British Columbia Psychological Association (click here), Psychology Today (click here) or my AAMFT Family Therapist website (Click here). I am a registered Psychologist here in British Columbia, along with being a Registered Marriage and Family Therapist and teacher of special education. There is also some specific information on treatment for aggression and anger in children on my webpage called "The Angry Child," (Click here)

I look forward to hearing from you.

Dr. Jim Roche
Registered Psychologist
778.998-7975
Offices in Burnaby and Vancouver, British Columbia

Child Behaviour Problems? Parenting books, Where to Start?

Problems with child behaviour? And wondering where to start? Often parents come to my office with very specific problems: toileting, talking back, non-compliance (NO!) and difficulty with home work. I usually have specific behavioural interventions that we talk about and work on, but beyound the specifics there is always the more general question in parent's minds, "What's a parent suppose to do to avoid these issues and problems?" Generally, "What's a great parent look like?" Well, that's a good question, and I have a good answer too. One that doesn't overwhelm and can set you on a path to feeling good about yourself as a parent. The first recommended reading I make is usually: Raising an Emotionally Intelligent Child, by John Gottman (Simon and Schuster, 1997 ISBN: 0684838656). You can find a link to this book on my web page at www.relatedminds.com. Just go to the suggested readings page and you can order this book from Amazon.ca, the cheapest way to obtain it. And yes, for those who find reading just can't fit into your schedule, there is also a CD or the book, and a DVD. You can also download a copy from Audible.com if you use an iPhone or other device, and it loads directly to your music player. There are no excuses!

I find this is one of the most useful, research-based, and insightful books on parenting around, and it is research based. This is important, as there are many, many parenting books for behaviour issues out there that are simply made up theories from what the author thinks would work, but doesn't know will work. John Gottman is a professor of psychology at the University of Washington, and author of Why Marriages Succeed or Fail. His extensive work with parents and children based on his deep understanding of the emotions offers a guide throughout the years of parenting. He suggests that "emotion coaching" is they key to raising emotionally intelligent children, and helps parents to understand their parenting style and how to make the most of it.

Here are Gottman's five key steps to what he calls "emotion coaching" (1) becoming aware of the child's emotion, (2) recognizing the emotion as an opportunity for intimacy and teaching; (3) listening empathetically, validating the child's feelings; (4) helping the child find words to label the emotion he is having; and (5) setting limits while exploring strategies to solve the problem at hand.

Dr. Gottman's book is filled with practical examples of how to deal with different kinds of challenges in healthy ways. In addition to discussing the role of mothers, it also includes discussion of the critical role that fathers play and the importance of a healthy marriage in creating the environment that can help children to develop their potential as fully as possible. what we know from Dr. Gottman's research is that a child who learns to be happy in relationships, who is social, understands and can cope with his or her emotions, is more likely to graduate from high school, live longer, live healthier and be generally more successful in life. In many ways emotional knowledge is more important than academic knowledge (but, yes, we need both).

I suggest Dr. Gottman's book as a starting point for any parent. It shows you in a non-threatening way, how things ought to be going. Once we know that we can start to work on particular difficulties that you and your child may be having. In my clinical setting we will quickly get involved in behaviour therapy, cognitive therapy, behaviour management techniques and so on, but it's always good to have a firm grounding and some idea of where we are going. Dr. Gottman's book is a quick read (listen or view) and from there we can get into the nitty gritty details of improving your child's behaviour and academic outcomes.

Below you will find a link to an introductory talk by Dr. Gottman:


For more information on parenting, child behaviour, academic problems and relationship issues, please feel free to visit my website at www.relatedminds.com I also have specific information on ADHD available at www.adhdhelp.ca and information on my counselling and assessment services can be found at either the British Columbia Psychological Association (click here), Psychology Today (click here) or my AAMFT Family Therapist website (Click here). I am a registered Psychologist here in British Columbia, along with being a Registered Marriage and Family Therapist and teacher of special education. There is also some specific information on treatment for aggression and anger in children on my webpage called "The Angry Child," (Click here)

I look forward to hearing from you.

Dr. Jim Roche
Registered Psychologist
Offices in Burnaby and Vancouver, British Columbia