Behavioral Approaches for Children and Adolescents: Challenges for the Next Century

177 Pages·1995·11.58 MB·English

by  Philip C. Kendall (auth.)

Behavioral Approaches
for Children and
Adolescents
Challenges for the Next Century
Behavioral Approaches for
Children and Adolescents
Challenges for the Next Century
Edited by
Henck P. J. G. van Bilsen
PedologischInstitut
Rotterdam,TheNetherlands
Philip C. Kendall
Temple University
Philadelphia,Pennsylvania
and
Jan H. Slavenburg
PedologischInstitut
Rotterdam,TheNetherlands
Springer Science+Business Media, LLC
LibraryofCongressCataloging-in-PublicationData
Onfile
Proceedingsofan InternationalConferenceonCognitiveBehaviorTherapiesandApplied Behavior
AnalysiswithChildrenandAdults:Challengesforthe Next Century,
held July3-5, 1995,inRotterdam, TheNetherlands
IIISSSBBBNNN 999777888---111---444777555777---999444000888---333 IIISSSBBBNNN 999777888---111---444777555777---999444000666---999 (((eeeBBBooooookkk)))
DDDOOOIlI 111000...111000000777///999777888---111---444777555777---999444000666---999
© 1995 SpringerScience+BusinessMediaNewYork
OriginallypublishedbyPlenum Press,NewYorkin1995.
Soficoverreprintofthehardcover Istedition1995
Allrightsreserved
10987654321
Nopartofthisbookmaybereproduced,storedinaretrievalsystem,ortransmittedinanyformorbyany
means.electronic, mechanical, photocopying,microfilming,recording,orotherwise,withoutwritten
permissionfrom thePublisher
PREFACE
Challenges for the nextdecade as the subtitle ofa book isa statementofambition.
In the present time we have to be ambitious as scientists, clinicians, and teachers.
Without ambition we would not be able to confront the problems ofyoung people in an
effective way.
In this decade, we can see an abundance of problems of young people: football
hooliganism,school drop out,vandalism,delinquency,lack ofsocialskills,aggression,and
depression.
The problem seems to grow. Governments, parents,and concerned citizens call for
action now. Unfortunately, the action that is taken is often impulsive and not based on
scientificallyproven methods: longerjailsentencesfor youngfirst offenders,puttingyoung
offenders in military look-aliketrainingcamps,etc.
For some reason, the usage ofeffective interventions is limited. In this, book the
reader will find an extensive overview of what we know to be effective as a "cure" or
prevention for the above-mentioned problems.The first four chapters will give the reader a
clear insight ofwhat the"stateofthe art" is today.
An integrative overview ofcognitive behavioural therapies with children and ado
lescentsisgivenbyKendall,Panichelli-Mindel,andGerow.Russoand Navaltaprovidesome
new dimensionsofbehavioranalysisand therapy.What behavioral approachescan offerto
education is described by Slavenburgand van Bilsen in two chapters.
In Part II authors from Australia, the United States, and the Netherlands describe
programs for specific clinical populations: attention deficit disorder, anti-social youth,
learning problems,socialskills problems,depression,and aggression.
In Part III theproblemofunwillingandunmotivatedclients isdiscussed.What todo
when theydon't want?
Henck P.J. G.van Bilsen
Philip C. Kendall
Jan H.Slavenburg
v
CONTENTS
I. Cognitive-Behavioral TherapieswithChildrenand Adolescents:An Integrative
Overview .
Philip C. Kendall, Susan M. Panichelli-Mindel,and Michael A.Gerow
2. Some New DimensionsofBehaviourAnalysisand Therapy. ................. 19
Dennis C. Russo and Carryl P.Navalta
3. BehaviourTherapy and Educational Reform:AReview ofStudy Findings 41
Jan H.Slavenburg
4. Unused Opportunities for BehaviourTherapy in Education " 53
Hcnck P.J.G.van Bilsen
5. Cognitive BehaviorModificationofADHD:AFamilySystem Approach 65
Harry van der Vlugt, Huub M.Pijnenburg, Paul M.A.Wels,and Aly Koning
6. Competency-BasedTreatmentfor Antisocial Youth ......................... 77
N.W.Slot
7. BehaviourTherapy with Learning Problems. .............................. 87
Chris Struiksma
8. TreatingChildren Who Lack Social Skills ina Pedological Institute School .... . 95
Ria Swager
9. StopThink Do: Improving Social and Learning Skills for Children in Clinicsand
Schools 103
Lindy Petersen
10. Cognitive and Behavioral TreatmentofChildhood Depression 113
Kevin D.Starkand Anne Smith
II. Cognitive Behavioral TherapyofAggressiveChildren: EffectsofSchemas 145
John E. Lochman and L. Lenhart
vii
viii Contents
12. Motivationas a Preconditionand Bridgebetween Unmotivated Clientand
OvermotivatedTherapist 167
Henck PJ.G.van Bilsen
Index 175
1
COGNITIVE-BEHAVIORAL THERAPIES
WITH CHILDREN AND ADOLESCENTS
An Integrative Overview
Philip C. Kendall, Susan M.Panichelli-Mindel, and Michael A. Gerow
TempleUniversity
Dept. ofPsychology
Weiss Hall Room 478 (265-67)
Philadelphia, Pennsylvania 19122
In general, psychological theory and underlying world views guide psychological
therapy.One beginswith ontological and epistemological assumptionsabout the worldand
how humans operate within it (stated either explicitly or implicitly), and from these
assumptions, one constructs either a theory ofhuman behavior or a research paradigm to
study human behavior or both. In the field ofclinical child psychology there has been an
increasing interest in the formulation ofcognitive-behavioral theories, especially as they
relate to psychopathology and psychotherapy. These theories, tied to empirical data (i.e.,
observationsofphenomena),attempttoidentifyconceptsthat generalizetobroadercircum
stances.This chapter providesan overview ofthe emergingand evolvingcognitive-behav
ioral position, especially as it relates to psychosocial therapy with children. We will begin
by brieflydiscussingthe theoretical framework on which the cognitive-behavioral position
is based. Next, we will illustrate how this theory guides the therapeutic posture of the
cognitive-behavioraltherapist. Inabriefreviewofthe extantliterature, weconsidercogni
tive-behavioralapplicationswith avarietyofclinical problemsinyouth.Finally,wesuggest
future directions for theory and practice.
BRIEF HISTORY AND THEORETICAL OVERVIEW
Cognitive-behavioral theory is a mediational theory and represents a hybrid of
behavioral andcognitiveresearchand theory.Inintegratingthesetwoapproaches,theorists
have removed the doctrinaire attitude ofstrictly behavioral theorists by incorporating the
cognitiveactivitiesofthechildintotheequation.Strictbehavioraltheory(e.g.Skinner,1987)
recommends the shunning of"internal" (i.e., not visible to direct observation) variables.
Observable behavior represents, according to behaviorists, the only possible domain for
scientific psychological research. In clinical realms, this translated into therapies, for
example systematic desensitization and flooding (e.g. Wolpe, 1958), where the focus of
BehavioralApproachesfot ChildrenandAdolescents, Editedby
H.1.'J.G.vanBilsenctal..PlenumPress.NewYork.1995
2 P.C.Kendall et al.
attentionwasprimarilyonchangingobservablebehavior.This directionradicallyconflicted
with the historically-dominantpsychodynamic view ofpsychology,which held that intrap
sychic forces were responsible for behaviorand therefore the crux oftherapeutic effort lay
in"working through" internal conflict.
The theoretical revolution which brought behaviorism into a dominant position of
several recent decades lead to a counter-revolution. Cognitive theorists re-introduced "in
ternal" variables into research and clinical practiceand built a body ofresearch suggesting
that cognition (i.e. thought) influenced behavior. The so-called cognitive revolution pro
ceeded in several directions (e.g. information-processing, connectionist theory, etc.), the
details of which we omit here (see Ingram, 1986; Kendall and Hollon, 1979; Varela,
Thompson,and Rosch, 1991, and others for details), and created aspace for an integration
ofthe two approaches. Cognitive-behavioral theory, as described here, represents an inte
gration ofcognitive and behavioral positions in the realm ofinformation-processing and
social learningtheories(Kendall and Bacon, 1988).
The cognitive-behavioral position, when applied to psychopathology and its treat
ment, consists of several components. First, it posits that psychological problems (e.g.,
disorders, difficulties) result from behavioral and cognitive antecedents. For example, the
distress of an anxious youth is associated with both behavioral avoidance and/or the
contingencies surrounding the feared event(s) as well as cognitive appraisal,attitudes, and
beliefs surrounding the behavioral events. In other words, a child who worries about
interactingwithpeersdoessobecauseofpast learninghistory(e.g.,distresswhen withpeers)
and cognitiveappraisalofthepast events and anticipatoryappraisal offutureevents(e.g.,a
self-statementsuch as"Theywillcriticize/rejectme," reflectingabeliefsuch as"peopleare
to be feared becausepeerfailure isunavoidable").
Given this framework, a therapeutic pathway becomesclear.Remedy occurs within
both behavioraland cognitiverealms.Itdoes notsuffice,cognitive-behavioraltheorystates,
to have a socially anxious child to face numerous social situations; nor does it suffice to
simply teach coping skills. Rather, the combination represents the preferred route where
behavioral and cognitive dysfunctions are addressed. Cognitive-behavioral therapy is a
skill-buildingapproachthatusesknowledgeofdevelopmentaltrajectoriestoaffectnecessary
change, adjusting the dysfunctional path ofa troubled youth. Acognitive-behavioral inter
vention involves both the teachingofcoping skills and the practiceofthese skills inactual
situations, with opportunity for feedback from the therapist.
While thetheory hasgarneredmuchsupportfrom practitionersand researchersalike,
cognitive-behavioral theory continuestohave itscritics(e.g.Lee, 1990).Forexample,strict
behavioristscriticize cognitive-behavioral theory because itrelieson"undefinedandunob
servable variables in order to explain behavior" (Lee, 1990, p. 143). This position arises
from thebeliefthat while"humanbehavioriscomplex...itisdeterminedbymaterial events"
(Lee, 1990, pp. 144). Wemaintain that human behavior is complex and multi-determined.
We are sceptical that behavior will find simple, linear explanations in material causes.
Although so-called "internal" causes are not observable, we believe that cognition and
emotioninfluencebehaviorinwaysthatsimple stimulus-responserelationshipsoften cannot
explain.
Because of its stress on cognitive and behavioral factors, one could argue that
cognitive-behavioral theory and practice fails totake emotion into account. Kendall (1991)
described how cognitive-behavioral theory includes emotion.Cognitiveappraisal ofaffect,
for example, iscritical intheetiology ofmany childhoodand adolescent disorders.Never
theless,cognitionand affect are interrelated:thevarianceinetiologyofsome disorders may
be best accounted for by cognitive assessments and analyses (Kendall, 1991) while other
disorders may find best explanation from within otherperspectives(e.g.emotional, behav-
Cognitive-BehavioralTherapieswith Children and Adolescents 3
ioral). This position underscores the cognitive-behaviorist's beliefin the multi-determined
natureofhuman behavior.
Cognitive-behavioraltheoryconsiderscontextsuch asthesocial/interpersonal world
of the child. These contexts provide the behavioral settings in which events impact the
functioning ofchildren and youth.Unfortunately, the precise role ofthese contexts has yet
tobewell researched.Forexample,althoughparentsareconsideredimportantintheetiology
ofseveral childhood problems, we remain uncertain ofthe specific role(s) they play. The
cognitive-behavioral theorist and therapist seeks to determine the effect of the familial
(school, peer) contexts on the development (both "normal" and maladaptive) ofyouth.
Considerationofdevelopmental pathwaysrepresentsan under-investigated but criti
cal arena that cognitive-behavioral theorists and therapists have begun to explore. Cogni
tive-behavioral theory allows for abroaderframework within which tostudypsychological
problems.Cognitive-behavioral interventionsare designed with at least two developmental
considerations in mind. First, the current developmental level ofthe child (i.e. cognitive
ability, current developmental challenges) is assessed to affect the thrust and inform the
interventiontobeused.Forexample,ayoung,cognitivelyimmaturechildmightbenefitless
from long,didactic sessionsand would bebetterservedby brief, activesessions,oftenwith
the cognitivecontentofthe sessionoccurringinvivo.Second, the intervention isbest when
it occurs in the context of the developmental challenges facing the child. Therefore, a
cognitive-behavioral therapist seeing a child dealing with separation anxiety at age nine
intervenes within the appropriate developmental challenge (i.e. issues ofautonomy).
Cognitive-behavioral theory represents an amalgam of behavioral and cognitive
positionswith an integrationofemotionaland contextual factors:the theoryremainsflexible
toreformulationinaccordwithdata. However,theflexiblenatureofthecognitive-behavioral
position leaves the theory vulnerable to the criticism that it fails to take a true position.
Because we do not maintain that the theory can explainall ofhuman behavior,the theory's
weaknesses are acknowledged from the start. In this sense, cognitive-behavioral theory is
not so much a theory as its isan approach to theory formulation and, more importantly to
this paper,an approach to therapy.It isadata-driven, hypothesis-testingapproach,combin
ing cognitiveand behavioral interventions into anew -and hopefully more useful -hybrid.
THERAPISTS' ROLES AND COGNITION
Posture ofthe Therapist
The cognitive-behavioral therapist plays a number ofroles when treating children
and adolescents.Theseroles can bedescribedasconsultant,diagnostician,and educator.As
aconsultant,the therapisthelps thechildtodevelopskillstothink independentlyratherthan
providing specific solutions to the child's problems.Both therapistand child collaborate in
this problem-solving effort, together generating ideas to try and to evaluate in an effort to
helpthechildhandledifficultiesheorsheisexperiencing.Thetherapistprovidessuggestions
for the child to think about and describes experiments to use to determine whether these
ideas have value for the individual child. The child is given the opportunity to "test-out"
these ideas, implementand practicethosethat seem most helpful,and intheprocessexamine
and correctdysfunctionalbeliefs.The therapistandchildshareexperiences,and the therapist
helps the childto makesenseoftheexperiences-all without telling thechild what to do.In
this way the therapist facilitates the processofproblem-solving, without providing specific
solutionstoproblems.The therapist fosters the child's independenceand affordsopportuni
ties for the child to think and problem-solveon his or her own.