Therapeutic Relationships: Children and adolescents with disruptive behaviors
Assignment: Therapeutic RelationshipsA child’s or adolescent’s disruptive behaviors can be challenging for a clinician. Disruptive behaviors can interrupt the counseling process, and they often signify the existence of emotions a child or adolescent is unable to express verbally. Some prospective child and adolescent clinicians may be ill-equipped to manage disruptive behaviors or recognize that the behaviors are symptomatic of an issue or disorder. This lack of knowledge may elicit a nontherapeutic response from a clinician, which can damage the development of a therapeutic relationship. A therapeutic relationship is vital in order to counsel children and adolescents effectively.To prepare for this Assignment, review the Disruptive Behaviors Part Two media and select a particular child or adolescent with a disruptive behavior. Consider one strength and one weakness of the therapeutic relationship with the child or adolescent during the counseling sessions.The Assignment (3–5 pages) is in two parts:Part One: Ineffective InterventionsIdentify the less effective counseling session you selected, and explain why it was less effective.Identify and explain the intent of the target goal in the counseling session.Explain one ineffective aspect of the counseling approach and why.Explain one misstep the counselor made that inhibited the development of a therapeutic relationship and why.Part Two: Effective InterventionsIdentify the more effective counseling session you selected, and explain why it was more effective.Explain one intended goal the counselor was attempting to accomplish in the counseling approach and why.Explain one ineffective aspect of the counseling approach and why.Explain two critical skills the counselor demonstrated that promoted the development of a therapeutic relationship and how those critical skills were used.Support your Assignment with specific references to all resources used in its preparation. You are asked to provide a reference list for all resources, including those in the week’s resources for this course.Disruptive Behaviors
In the DSM-IV, attention deficit and disruptive behaviors were grouped as a category
within the classifications of disorders usually first diagnosed in infancy, childhood, and
adolescence.
Though it is true that these disorders are generally first diagnosed during these stages,
the classifications of these disorders has been reconceptualized to reflect their
similarities in manifestation, as well as considerations for the impact on social
functioning. ADHD, for example, is grouped in the DSM-5 with neurodevelopmental
disorders; research has supported a strong biological basis for this disorder as well as
for others found in this classification (see “Exceptionalities” in Week 11 of this course).
However, because the expression of ADHD often includes behaviors that can be
disruptive to the child’s social environment, it will be included with the topics for this
week.
Other disorders addressed this week are those now included in a new chapter of the
DSM-5: disruptive, impulse-control, and conduct disorders. This new grouping of
diagnoses reflects a recognition of the similarities of these diagnoses—all of these are
associated with an intrusion upon the rights, property, or physical safety of others. In
addition, individuals with these disorders generally act against societal expectations
and norms and show a significant inability to control behavioral or emotional impulses.
Disruptive, Impulse-Control, and Conduct Disorders
This new DSM-5 chapter includes oppositional defiant disorder, intermittent explosive
disorder, conduct disorder, antisocial personality disorder (also listed in the personality
disorders chapter), pyromania, kleptomania, other specified disruptive, impulse-control,
and conduct disorders, and unspecified disruptive, impulse-control, and conduct
disorders.
Two of these diagnoses are new to the DSM-5: other specified disruptive, impulsecontrol, and conduct disorders, and unspecified disruptive, impulse-control, and conduct
disorders. These take the place of disruptive behavior disorder NOS in the DSM-IV,
which has been removed. Both of these diagnoses represent significant clinical
distress or impairment based on criteria for disruptive, impulse-control, and conduct
disorders, but do not meet full criteria for a specific diagnosis in this class. Clinicians
should use other specified disruptive, impulse-control, and conduct disorders and add
the specific reason for the more general diagnosis (e.g., falling short of duration or
frequency criteria). The latter diagnosis—unspecified disruptive, impulse-control, and
conduct disorders—is used when clinicians cannot (or choose not to) identify reasons
for the inability to make a more specific diagnosis, yet clearly observe multiple criteria
from the disruptive, impulse-control, and conduct disorder classification.
The following is a summary of key changes to diagnostic criteria for this group of
disorders.
Oppositional Defiant Disorder
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Criterion A has been revised in several ways. First, the symptoms have been grouped
into categories relating to mood, behavior, and malicious intent. Second, the duration,
persistence, and frequency requirements have been more clearly described, with
considerations made for differences related to age, developmental level, gender, and
culture. Lastly, a severity rating associated with pervasiveness has been included in
the specifiers for this disorder.
Intermittent Explosive Disorder
The criteria for this diagnosis have been considerably revised in the DSM-5. Criterion A
has been expanded with more specific detail added, including the inclusion of verbal
aggression and nondestructive aggressive behavior. Language has also been added
regarding intensity and frequency of the outbursts that are key components of this
diagnosis. In addition, the minimum age for this diagnosis is now 6 years old; this
change helps to distinguish the diagnostic criteria from normal temper and behavioral
variations in very young children.
Conduct Disorder
The DSM-5 criteria for a conduct disorder diagnosis is similar to that found in the DSMIV. However, an important addition has been made: The DSM-5 includes a specifier for
observed limitations in socially appropriate emotional response. This may be
exemplified by deficits in empathy, remorse, or guilt. This may also be reflected in a
general lack of concern over impact of behaviors and decreased expressive affect.
Neurodevelopmental Disorders
This group of disorders is covered more thoroughly in Week 11 of this course.
However, one of the disorders from this group frequently has a disruptive component
to it and is, therefore, included in this week.
Attention-Deficit/Hyperactivity Disorder(ADHD)
Though the basic diagnostic criteria for ADHD is very similar in the DSM-5, there are a
number of key differences from the DSM-IV, including stage-related examples to aid in
diagnosis in childhood, adolescence, and adulthood. One of the key changes has been
to raise the identification of symptomology from before age 7 to before age 12 and to
use a single diagnosis with specifiers rather than several related diagnoses in a group.
Specifiers replace prior subtypes, identifying the predominant presenting
symptomology. Specifiers are also now used to reflect severity of impairment of
functioning.
Reference:
• American Psychiatric Association. (2013). Highlights of changes from DSM-IVTR to DSM-5. Retrieved from
http://www.dsm5.org/Documents/changes%20from%20dsm...
