Evidence-Based Practice with Emotionally Troubled Children and Adolescents (Practical Resources for the Mental Health Professional)

436 Pages·2009·2.06 MB·English

by  Morley D. Glicken

Preface
Over the years I’ve thought about the many children I’ve worked with during
my time as a school social worker. Fresh from my MSW degree and not knowing
much about the helping process, I used common sense helping approaches that
I’d learned from watching my father deal with union members who came to our
house on weekends with serious problems brought about by alcoholism that I
would later realize were very much like what we did in social work. The men
who came to our house were men whose burned out lives was a reminder to me
that boredom and lack of recognition in the workplace destroy the will to live
meaningful lives. My father was always kind, generous, and supportive. My
mother did the same thing in her daily coffee and tea sessions with our neighbor
ladies. You might say that I grew up in a social work home where the helping
process was simple yet effective.
Although the children I saw in the school system had some troubled behavior,
it never crossed my mind that they had serious emotional diffi culties. Instead,
I saw them as children coping with over-worked parents who were doing the
best they could. I felt that forming a partnership with parents, children, and
the schools would make kids better, and it did. I never used play therapy in the
orthodox sense but strove to help children see what was good about them. I
used cognitive therapy, which I was just learning in the 1960s with success, and
brought to our suburban Chicago community an Adlarian group from Chicago
to do a wonderful form of parent effectiveness training that worked so well that
each week we would have hundreds of parents attending.
Over the years I’ve met a few of my clients. They are doing well. I can’t say
that for certain about everyone I worked with, but I have a sense that many have
done well, and that the little help I provided got a number of children over emo-
tional bumps at important moments in their lives. I never thought of my kids
as having a diagnosis. They were having problems, to be sure, but they were all
open to change. And they loved coming to sessions, many of which were done in
groups and consisted of joke telling and anything to loosen the emotional cons-
traints that parents had sometimes placed on them. It was a glorious experience
and certainly the best time in my life.
Imagine then my concern to see so much in the literature about early child-
hood schizophrenia, bi-polar disorder, and the heavy reliance on medications
for children who are, it seems to me, no different than the children I worked
with in the 1960s. Having written a number of books before this one, I was
surprised to see so little in the literature about childhood problems, particularly
effective treatment for abused and neglected children. Rather than developing a
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xviii Evidence-Based Practice with Socially and Emotionally Troubled Children and Adolescents
concise framework to assess and treat children, we were, it seemed to me, using
an adult model of assessment and treatment that seemed unlikely to help and
fairly likely to hurt children if, for no other reason than by misdiagnosing them
and using medications with troublesome side effects.
Furthermore, it seemed to me that rather than giving children room to grow
and develop in their own unique ways we were restricting normal development
by making the word “normal” increasingly limited and narrow. The growing li-
terature, on the interference with normal male development in youth by creating
diagnostic categories for boys who we all know needs a bit of space and support
to develop well, is just one of many examples. The over-attentive parents who
shelter children from obstacles that might be necessary for healthy development,
or what has been called the millennium children who grow up lacking prepara-
tion for life challenges or independence, is yet another trend that troubles me.
Consequently, my second book on evidence-based practice is written in hopes
of bringing some common sense back to the treatment of children by fi nding
and evaluating best evidence. It’s the type of book I would have wanted to read
and use when I worked with children. Hopefully, you the reader, will fi nd it
helpful in your work with the children of America who deserve the best help
we can offer. And I hope, as I do in all my books, that in reading this book you
will remember the many children among us who suffer because of the abuse
and neglect of their bodies and their spirit. Their anguish should motivate us
to open our hearts and minds to new ideas, to new treatment approaches and,
in Bertrand Russell’s words, to have “unbearable sympathy for the suffering of
others.”
Morley D. Glicken, DSW
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Acknowledgement
I want to thank the staff at Elsevier, particularly my editors, Mica Haley and
Renske van Dijk for their support, encouragement, and help with this book.
Writing about children is a gift for an older writer and working with Elsevier
has been a joy.
Two of my wonderful MSW students, Joan Bourke and Meghan Anaya helped
with chapters in this book on ADHD and cyber bullying, respectively. Teaching
is a privilege and having such great students to work with is more than any
educator can ask for.
Thanks to my colleague at Arizona State University West Department of Social
Work for her insightful comments about evidence-based practice in Chapter 1
of the book.
Thanks also to the wonderful people at Sage, Allyn and Bacon/Longman, and
Rowman and Littlefi eld for their permission to use material from several of my
prior books. The addition of that material enriches this book and I appreciate
their kind help.
Finally, I want to thank the children I’ve worked with over the years who pro-
vided the motivation to write this book. Their desire to change and their hard
work to cope with diffi cult life problems are, as always, an inspiration to me.
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About the Author
Dr. Morley D. Glicken is the former Dean of the Worden School of Social Service
in San Antonio; the founding director of the Master of Social Work Department
at California State University, San Bernardino; the past Director of the Master
of Social Work Program at the University of Alabama; and the former Executive
Director of Jewish Family Service of Greater Tucson. He has also held faculty
positions in social work at the University of Kansas and Arizona State University.
He currently teaches in the Department of Social Work at Arizona State Univer-
sity West in Phoenix, Arizona.
Dr. Glicken received his BA degree in social work with a minor in psychology
from the University of North Dakota and holds an MSW degree from the
University of Washington and the MPA and DSW degrees from the University
of Utah. He is a member of Phi Kappa Phi Honorary Fraternity.
Dr. Glicken published two books for Allyn and Bacon/Longman Publishers in
2002: The Role of the Helping Professions in the Treatment of Victims and
Perpetrators of Crime (with Dale Sechrest), and A Simple Guide to Social Re-
search; and two additional books for Allyn and Bacon/Longman in 2003: Vio-
lent Young Children, and Understanding and Using the Strengths Perspective.
He published Improving the Effectiveness of the Helping Professions: An Evi-
dence-Based Approach to Practice in 2004 for Sage Publications and Working
with Troubled Men: A Practitioner’s Guide for Lawrence Erlbaum Publishers
in Spring 2005. In 2006 he published Life Lessons from Resilient People, and
Social Work in the 21st Century: An Introduction to Social Problems, Social
Welfare Organizations, and the Profession of Social Work, both published by
Sage Publications. In 2008 he published A Guide to Writing for Human Ser-
vice Professionals for Rowman and Littlefi eld Publishers. In 2009 Rowman and
Littlefi eld will publish his book Evidence Based Practice with Older Adults: A
Psychosocial Perspective. His intro to social work book, Social Work in the 21st
Century: An Introduction to Social Problems, Social Welfare Organizations,
and the Profession of Social Work, will be published as a second edition in 2009
by Sage Publications.
Dr. Glicken has published over 50 articles in professional journals and has writ-
ten extensively on personnel issues for Dow Jones, the publisher of the Wall
Street Journal. He has held clinical social work licenses in Alabama and Kansas
and is a member of the Academy of Certifi ed Social Workers. He is currently
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xxii Evidence-Based Practice with Socially and Emotionally Troubled Children and Adolescents
Professor Emeritus in Social Work at California State University, San Bernar-
dino, and Director of the Institute for Personal Growth: A Research, Treatment,
and Training Institute in Prescott, Arizona offering management consulting
and research services to public and private agencies. More information about
Dr. Glicken may be obtained on his website: www.morleyglicken.com, and he
may be contacted by e-mail at: [email protected].
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Part One
The Current State of Practice with
Children and Adolescents

1
The Current State of Assessment,
Diagnosis, and Treatment of
Children and Adolescents with
Social and Emotional Problems
Atatimewhenincreasingnumbersofchildrenarebeingdiagnosedandtreated
for emotional problems, the unsettling thought of misdiagnosing children who
need help but are not being served because of racial and gender issues, and
treatmentoflargenumbersofchildrenwhoare,inreality,respondinginnormal
ways to maturational and social changes has begun to capture a great deal of
attentioninthepopularandprofessionalliterature.
Unlike most adults, young children are often unable or unwilling to talk
abouttheirsymptoms,leavingmentalhealthprofessionalstorelyonobservation
and information from parents and teachers, which may be incorrect or biased.
Because children develop so quickly, what may look like attention deficit dis-
order in January may seem like something else or perhaps nothing at all in the
summer.Sosubjectiveistheprocessofevaluatingtheproblemsencounteredby
childrenthatthetrialanderrorsearchforadiagnosisandtreatmentoftenends
with serious errors. Also, adult diagnoses are often used in lieu of diagnostic
categoriesforchildren(USDepartmentofHealthandHumanServices,2000).
The Surgeon General’s Report (US Department of Health and Human Ser-
vices, 2000) suggests that many human service professionals prefer not to use
a diagnosis with children because “[m]any of the symptoms, such as outbursts
ofaggression,difficultyinpayingattention,fearfulnessorshyness,difficultiesin
understandinglanguage,foodfads,ordistressofachildwhenhabitualbehaviors
are interfered with, are normal in young children and may occur sporadically
throughoutchildhood”(Chapter3).
Contrary to the current practice of assigning a diagnosis indicating serious
emotional problems using adult diagnostic categories, the Surgeon General’s
Report (US Department of Health and Human Services, 2000) wisely cautions
cliniciansabouttheuseofadultdiagnosticcategoriesbynotingthat:
Well-trainedcliniciansovercomethisproblembydeterminingwhetheragiven
symptomisoccurringwithanunexpectedfrequency,lastingforanunexpected
length of time, or is occurring at an unexpected point in development.
Clinicians with less experience may either over-diagnose normal behavior as
a disorder or miss a diagnosis by failing to recognize abnormal behavior.
Inaccuratediagnosesaremorelikelyinchildrenwithmildformsofadisorder
(Chapter3).
Copyright©2009ElsevierInc.Allrightsreserved.
4 TheCurrentStateofPracticewithChildrenandAdolescents
Yet the problem of misdiagnosing children seems more serious than ever, with
new and increasingly arcane diagnostic categories developing that suggest the
existenceofverylargenumbersofAmericanchildrenwithemotionalproblems.
Somecommonlydiagnosedmentaldisordersinyoungerchildrenincludeatten-
tion deficit hyperactivity disorder (ADHD), depression, anxiety, and opposi-
tionaldefiantdisorder(ODD).TheDSM-IV(AmericanPsychiatricAssociation,
1994)saysthatODDexistsifachilddemonstratesfourofeightofthefollowing
behavior patterns: “(a) often loses temper; (b) often argues with adults; (c) is
oftentouchyoreasilyannoyedbyothers;(d)andisoftenspitefulorvindictive.”
(p.93).Thesebehaviorsarecharacteristicofmanychildrenandadolescentsand
would not, in and of themselves, give most children an accurate diagnosis of
oppositionaldefiantdisorder.
Attention deficit disorder is perhaps the most common diagnosis used with
children.QuestionsusedtodetermineADHD,suchas“Doesthechildhavedif-
ficultyinsustainingattention,followinginstructions,listening,organizingtasks?
Does he or she fidget, squirm, impulsively interrupt, leave the classroom?” are
suchcommonbehaviors,particularlyinboys,thatonemightaskwhyattention
disorderisadiagnosisgiventoboysataratetwicethatofgirlswhentherates,
medicallyspeaking,arethesame.
Moretroublingisthefindingregardingseriousmentaldisorders.Carey(2007)
reports that the number of American children and adolescents treated for bi-
polar disorder increased 40-fold from 1994 to 2003, and has certainly risen
furthersince2003.AccordingtoCarey,instudiesofdoctorsinprivateorgroup
practice in New York, Maryland and Madrid, the numbers of visits in which
doctorsrecordeddiagnosesofbi-polardisorderincreasedfrom20000in1994
to 800000 in 2003, about one percent of the population under age 20. Carey
(2007,p.1)alsonotesthat:
AccordingtogovernmentsurveysatleastsixmillionAmericanchildrenhave
difficultiesthatarediagnosedasseriousmentaldisorders,anumberthathas
tripledsincetheearly1990seventhoughoneofthelargestcontinuingsurveys
of mental illness in children, tracking 4500 children ages 9 to 13, found no
cases of full-blown bi-polar disorder and only a few children with the mild
flightsofexcessiveenergythatcouldbeconsiderednascentbi-polardisorder.
Moreover,thesymptomsdiagnosedasseriousemotionalproblemsinchildren
oftenbarelittleresemblancetothoseinadults.Instead,children’smoodsoften
flip on and off throughout the day, and their upswings often look more like
extremeagitationthanbi-polardisorder.
InaninterviewwithJudithRapoport,chiefofchildpsychiatryattheNational
InstituteofMentalHealth,Dess(2000)askedifchildhoodonsetschizophrenia
is on the increase. Rapoport responded that in 8 years, NIMH had identified
only55casesofearlychildhoodschizophreniaandnotesthattheyarelooking
hardtofindothercasestoprovideadditionalinformationontheearlyphysical