Applying Cognitive Behavioral Interventions and Behavioral Contracting to Address Conduct Disorder in Children - On Second Thought: from Iffy to Witty Thoughts
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Applying Cognitive Behavioral Interventions and Behavioral Contracting to Address Conduct Disorder in Children

Applying Cognitive Behavioral Interventions and Behavioral Contracting to Address Conduct Disorder in Children

Conduct Disorder is a distinctive challenge that warrants attention in the treatment of childhood mental health disorders. Typically diagnosed in childhood or adolescence, Conduct Disorder is characterized by a persistent pattern of behaviors that infringe upon the rights of others and disregard societal norms and rules. These behaviors can range from mild aggression and deceit in young children, such as lying and pushing, to more severe acts of aggression, such as vandalism and theft, in adolescence.

If left untreated, the dangers of Conduct Disorder can result in lifelong consequences. Beyond the immediate disruptions in personal relationships, academic pursuits, and daily functioning, unaddressed Conduct Disorder can negatively impact success in adulthood. From a potential progression towards more severe antisocial behaviors and criminal activities to an increased risk of developing comorbid mental health disorders, the implications underscore the necessity for effective intervention. A 2007 study in the Archives of General Psychiatry reported findings that boys who had a conduct disorder in childhood were three times more likely to develop a mood disorder, eight times more likely to be homeless, three times more likely to have a dependency on alcohol, and twenty-five times more likely to have attempted suicide by age 32 years compared to boys without this diagnosis.

Conduct Disorder can be challenging to treat. While some psychotropic medications may be helpful in slightly reducing symptom severity, medications are not the first line of treatment. Research reported in the 2019 edition of Psychiatry, Psychology, and Law identified that when it comes to young children, it’s best to prioritize parent training as the first-line approach. For older youths, cognitive-behavioral approaches tend to be more effective. Family interventions have been found to be more successful with older youths, while multi-component and multimodal treatment approaches have had moderate effects during both childhood and adolescence. Traditional talk therapy is also problematic, as youth with these symptoms can be challenging to engage.

Cognitive Behavior Therapy (CBT) offers effective treatment interventions for Conduct Disorder in children, specifically behavioral interventions. Research in the Clinical Psychology Review in 2021 identified that treating externalizing symptoms, such as those consistent with Conduct Disorder, with a wide range of CBT-oriented treatments offered positive treatment outcomes. Researchers concluded that benefits included CBT in routine care yielded large effect sizes, there was evidence that patient gains in symptom improvement were maintained at follow-up, and 86% of the patients completed treatment.

Behavioral interventions in Cognitive Behavioral Therapy (CBT) are strategies and techniques that focus on identifying and modifying specific behaviors that contribute to psychological distress and negative thought patterns. Behavioral interventions are rooted in established learning theory, positing that behavior patterns are acquired through exposure to rewards and consequences. As a result, inappropriate behaviors can be effectively “unlearned” and substituted with more socially appropriate actions. Given that many of the symptom expression in Conduct Disorder is manifested in a behavioral manner, such interventions are applicable in treating the disorder.

Key Behavioral Strategies in Treating Conduct Disorder: Addressing Conduct Disorder through behavioral therapy involves several pivotal strategies aimed at fostering positive behavioral change. These strategies include:
1. Behavioral Contracting: A fundamental component, behavioral contracting establishes a clear and collaborative agreement between caregivers and children. Each contract outlines the specific behavioral changes sought, leaving no room for ambiguity. For example, addressing disrespectful behavior involves detailing various manifestations of disrespect, such as muttering or backtalk, along with consequences and rewards.
2. Contingency Management: A form of behavioral contracting, the core premise of contingency management is to establish a clear link between actions and outcomes, offering individuals tangible incentives for adopting prosocial behaviors while simultaneously highlighting the repercussions of engaging in problematic conduct. This proactive framework seeks to empower individuals to make informed choices by visualizing the potential outcomes of their actions.
There has been considerable research into the efficacy of contingency management and behavioral contracting for substance use disorders; however, additional research is warranted in examining the outcome of these interventions with youth experiencing externalizing symptoms. A study reported by the American Psychological Association in 2021 found mixed results on the effectiveness of behavior contracting in youth with a Conduct Disorder diagnosis, with only about half of the participants showing improvement. The researchers conclude that additional studies into these treatment interventions will help to assess better outcomes in treating youth with these behavioral interventions. Investigations into parent training in contingency management and behavioral contracting may offer promising outcomes.

Treating Conduct Disorders offers mental health professionals a challenge. However, the consequences of ineffective interventions can be dire for young people as they grow into adulthood. Behavioral interventions in CBT offer some tangible resources for parents and youth to break the cycle of negative thinking and maladaptive behaviors. Additional research is warranted to further the efficacy of treating Conduct Disorder.

A boy stealing money while his mother is on the phone.