Embedded Files
Purpose
Purpose
The purpose of the module is to provide you with a learning opportunity to review at-risk externalizing behaviors and psychiatric conditions associated with patterns of consistent externalizing behaviors.
Retrieved from : TOT 2: Externalizing Behaviors (2019)
Externalizing behavior consists of a child acting out with aggression, violence, harassment, impulsivity, disruptiveness, conduct problems, and defiance. Externalizing behaviors, unlike internalizing behaviors, typically result in harming or hurting (external) others. Childhood aggression (physical or verbal) can also be described as conduct problems and is more than likely the leading cause of adult crime and violence. Disruptive Behavior Disorders is a clinical/diagnostic umbrella term for prolonged and severe conditions of externalizing behaviors, most commonly broken down into either Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) (Powell, 2014). Substance Use Disorder is also commonly associated with externalizing behaviors. Up until this point it is easy to remember that the behaviors that children use always have a purpose. When children are using externalizing behavior it is easy to feel like they are attacking you personally or that they are just “bad” kids. Often the response is to become “objective” and to crack down on behavior through punishment. As mental health therapists we need to step back, take care of ourselves and then remain engaged in the process of caring for and accepting the child for who they are and working to understand the reason behind behavior so that we can address the reason.
ODD: 1% to 11% of all children and youth; age of onset around 4 and increasing in late adolescence (APA, 2013).
CD: 4% of all children and youth; mostly boys; 4 key symptoms include: aggression towards others, destruction of property, covert behaviors like lying and stealing, and serious violations of rules like using drugs, running away from school, school truancy (APA, 2015).
Consequences
ODD and CD and other disorders associated with externalizing behaviors are often associated with a wide range of negative outcomes in adolescence and adulthood and elevated risk of developing mood disorders, anxiety disorders, PTSD, impulse control disorders, and psychotic disorders (Lochman & Boxmeyer, 2012). If the problem behaviors go untreated for a child their future may result in an undesirable outcome. The consequences the child may face is ending up dead, in jail, or engaging in substance abuse resulting in making it nowhere in life (Jennifer, 2010). This behavior impacts family, school, and other social interactions with the environment. Parents, teachers, and other adults will often punish or isolate a child who is displaying externalizing behaviors instead of finding the help and support they need to correct the negative patterns of behavior (Jennifer, 2010).
Retrieved from : TOT 2: Externalizing Behaviors (2019)
At this point it is worth revisiting the difference between signs and symptoms. Signs are the outwardly visible aspects of a psychiatric disability. There are a number of signs that can indicate that a child is experiencing the impact of a psychiatric disorder. Excessive sleeping is often an early indicator of depression. Symptoms are feelings or the complaints expressed by the person. A child may express feeling tired all the time, even when they have gotten a lot of sleep. This is an example of an early symptom. Prodromal signs and symptoms are indicators that the child is moving toward an exacerbation of or a first time experience of psychiatric disorder. Davidson (2003), in a qualitative study designed to explore early intervention for psychiatric disability indicated that because there is so little education or discussion of psychiatric disorders these early signs and symptoms are overlooked or explained away as other things, especially when the child has not had an experience of their disorder before. This is not unlike other medical diseases or disorders. It isn’t unusual for people to find alternative explanations for early signs or symptoms of diabetes or cancer. I must have drunk too much coffee, or I must have a sinus infection …. Often when children show externalizing behaviors due to psychiatric disorders, those observing simply assume they are bad behavior or associated with poor choices on the part of the child.
Lisa Lambert is a mom of a teen son with bipolar disorder. She writes a blog about their experience as he has grown up. She touches on a controversial blog post written by Liza Long called “I am Adam Lanza’s Mother” which you can search for if you want. (It is interesting but I have some fundamental issues with her point. If you are interested we can talk). This post specifically addresses why sometimes parents don’t ask for help when their kids are engaging in these sorts of behaviors. I also included a copy in the Readings and Resources folder.
https://childmind.org/article/why-parents-are-silent-about-mental-illness/
Warning/At-Risk Signs – Externalizing Behaviors
The DSM 5 outlines the following early warning signs or prodromal signs (externalizing behaviors) associated with Disruptive Behavior Disorders:
Irritable temperament
Inattentiveness
Impulsivity
Defiance of adults
Poor social skills
Lack of school readiness
Coercive interactive style
Aggression towards peers/Bullying
Lack of problem-solving skills
Children and youth exhibiting externalizing behaviors, according to Gathright and Tyler (2014), are also at risk for developing the following co-morbid conditions:
ADHD
Mood Disorders
SUD
Learning Disorders
Speech Language Disorders
Anxiety Disorders
Retrieved from : TOT 2: Externalizing Behaviors (2019)
Children who are at risk for disruptive behavior disorders and present with externalizing behaviors can be identified at early ages in school settings. There is a strong association between externalizing behaviors and poor academic functioning and lower levels of school connectedness (Buckley, 2008). Poor and failing grades in late elementary and middle school are considered to be one of the strongest indicators for disruptive behavior disorder risk. Children with conduct and behavioral issues typically begin having trouble with their behavior in grade school and have increased conflict with family and peers; additionally, they tend to have considerable lower academic achievement outcomes (Jennifer, 2010). According to Long, Kuo, and McCormick (2010), it is critical to implement school-based prevention and intervention programs for youth at-risk for developing DBD, as certain prevention programs have demonstrated reductions in ODD and CD diagnoses in late adolescence and early adulthood.
As you know or have learned, children with emotional and behavioral problems are eligible for special education services. A report from the US Department of Education (2007) estimated that nearly 500,000 students were receiving special education and related services due to emotional disturbance and behavior-related issues.
There are many risks and categories of risks that can increase the probability that a child may develop conduct and/or antisocial behaviors. Risk factors for youth aggression can include biology, temperament, community and neighborhood features, family issues, peer relations, and social cognitive functioning (Powell et al., 2014). As you think about these risk factors think back to Harper High School. If these things can cause children to use externalizing behaviors, imagine how it is for entire communities of people who share some of these experiences. It is important to know that many kids exposed to these things go on to do fine. Unfortunately most are negatively affected in some way.
Some of the most common and highest risk factors include:
Maternal exposure to drugs and alcohol
Home violence
Low SES
High neighborhood crime
Gang violence
Negative peer influence
Family history of criminality
Substance use
Social rejection
(Powell et al., 2014)
There are several self-report tools and questionnaires for warning signs for externalizing behaviors and conduct related disorders. The Student Risk Screening Scale-Externalizing 7 (SRSS-E7) is a free, 7-question, teacher (school professional)-completed rating scale. According to Copeland et al. (2014) and Witte (2012), the SIBSS has been found to have excellent accuracy and sensitivity for predicting externalizing behavior problems at school and the increased likelihood of developing ODD and CD. A pdf of the SRSS-E7 can be found in the module folder.
Additionally, more information about the assessment can be found at http://miblsi.cenmi.org/MiBLSiModel/Evaluation/Measures/StudentRiskScreeningScale.aspx (or cut and paste link into your browser)
Retrieved from : TOT 2: Externalizing Behaviors (2019)
Evidence-Based Intervention and Prevention Curricula/Programs
Powell and colleagues (2014) reviewed some effective intervention options that can be applied within the school context for students who display externalizing behaviors. Some of these programs have been mentioned in previous modules. Take some time to do a quick web search of some of the recommended programs.
If the links are not active, please cut and paste into your browser:
Botvin LifeSkills Training
Website: http://www.lifeskillstraining.com/
You Tube Video on Lifeskills: https://www.youtube.com/watch?v=filhrGEQozU
Incredible Years (Incredible Years Parent program, child program, and teacher program)
Website: http://incredibleyears.com/You Tube Video: https://www.youtube.com/watch?v=liRCsK7YmY8
Coping Power
Website: http://copingpower.com/
Retrieved from : TOT 2: Externalizing Behaviors (2019)
Assignment
Brainstorming:
What are your thoughts? How might an occupation-centered theoretical lens strengthen or complement these efforts to support mental health efforts? How might you use an occupation-based small group intervention to support/complement lessons learned by participating in these evidence-based interventions? How might your “revisit” these skills in an occupation-based small group with middle school students or high school students?
Page updated
Google Sites
Report abuse