Therapeutic Interventions

1. Arrange for a complete medical and psychosocial evaluation of the child with a conduct disorder. (1, 2)

1. Meet with the parents to gather a developmental history and review their concerns about maladaptive behavior, academic, and social-emotional problems presented by the child.

2. Assist the parents in arranging for their child to receive a comprehensive psychosocial, medical, and educational evaluation completed by a mental health clinic, hospital, or agency and the child's school.

2. Eliminate abusive and neglectful parent/child interactions. (3, 4)

3. Adopt a parenting approach that is compassionate yet very firm and highly structured and takes the emotionality out of the discipline. (5, 6, 7, 8)

3. Explore for incidents of abuse, neglect, volatile, or overly punitive parenting that may have contributed to the formation of the child's aggressive and antisocial behavior.

4. Initiate either a verbal or written commitment from the parents to substitute positive forms of consequential discipline for punitive, volatile, or abusive discipline.

5. Assign the parents to use the technique of broken record when the child questions an instruction or challenges parental authority (e.g., "You need to do your homework now"; "Probably so, but you need to do your homework now.").

6. Emphasize to the parents the crucial difference between firmness (holding to a disciplinary intervention and focusing on the child's inappropriate behavior) and harshness (attacking the child's personality and demeaning the self-esteem).

7. Advise the parents to use tightly controlled choices when allowing the child to make some decisions and have some control in his/her life (e.g., "Would you prefer to feed the dog now or in 15 minutes?"); inform the parents that if the child refuses to make a choice or manipulates the options then the parent must make the decision.

4. Create a behavior management plan that targets the problem behaviors, and provides structured and straightforward parental actions and consequences. (9, 10, 11, 12)

5. Participate in ongoing counseling sessions focusing on the multifaceted problems of parenting a child with a conduct disorder. (13, 14)

8. Assign the parents to create a plan for time out in their home when the child's behavior becomes negative or intolerable and to utilize this process as an opportunity for the child to calm down, regroup and regain appropriate behavior.

9. Assist the parents in prioritizing a few critical behaviors for modification and defining an alternate expected, appropriate behavior for the child.

10. Assign the parents to complete the "Replacing Noncompliance with Compliance and Cooperation" activity from the Parenting Skills Homework Planner (Knapp) to encourage the child to recognize and substitute appropriate actions for inappropriate behavior.

11. Advise the parents to be realistic in their expectations expressed in the behavior plan to increase the success level and avoid defeat.

12. Instruct the parents to plan ahead and prepare their responses to the chronic negative, oppositional, and defiant behavior exhibited by their child and to remain calm and extremely firm when implementing a predetermined intervention.

13. Discuss with the parents the emotionally draining nature of parenting a child with a conduct disorder and encourage them to participate in regularly scheduled counseling sessions to help them deal with the critical issues the child may present.

14. Advise the parents to arrange for ongoing counseling for the child at school or with a private therapist to deal with antisocial feelings and behaviors and to learn alternate behaviors and strategies for successful coping.


16. Instruct the parents to access information about conduct disorder from organizations that can provide help information and support (e.g., American Academy of Child and Adolescent Psychiatry (202) 966-7300 or, Family Self-Help Group for Parents of Children and Adolescents (800) 950-6264 or, TOUGHLOVE® International (215) 348-7090 or

6. Seek information from

15. Assign the parents to read literature that describes conduct disorder in youth (e.g., Your Defiant Child by Barkley, Parenting the Strong-Willed Child by Forehand and Long, or It s Nobody's Fault by professionals, mental health organizations, and by professionals, mental health organizations, and by

17. Assign the parents to explore available respite care from access a list of respite facilities from ARCH National Respite Network and Resource Center community agencies or to

(800) 773-5433 or

Cooperate with the school to ensure that the child's conduct is not threatening to others. (19, 20)

9. Cooperate with the juvenile justice system to thwart continued criminal behavior from the child with a conduct disorder. (21, 22)

18. Instruct the parents to place the child in a psychiatric hospital or a residential treatment center or wilderness school when the behavior becomes uncontrollable or the child becomes a threat to self or others.

19. Assist the parents and the school in establishing a time-out area or Student Responsibility Center where the child can go when disruptive or uncooperative to cool off and plan for more appropriate behavior before participating in routine classroom activities.

20. Recommend that the parents and the school consider special education or Section 504 accommodations to help the child participate successfully in the academic environment (e.g., smaller classroom, special classes, reduced school day).

21. Advise the parents to enlist the help of local law enforcement immediately when the child attempts to break the law; stress that early intervention with criminal or pre-criminal behavior is essential to reduce the occurrence of future attempts.

22. Instruct the parents to become familiar with programs offered by the juvenile justice system in their area and to enroll the child in any programs that could help control the antisocial behavior.

10. Agree to discuss feelings, issues, and personal concerns relating to the child with a conduct disorder regularly in face-to-face conversations. (23, 24)

11. Meet with school personnel, other caregivers, and involved professionals regularly to review strategies for working with the child with a conduct disorder. (25, 26)

12. Participate in parent training classes. (27, 28)

13. Use privileges to shape the child's cooperation,

23. Assign the parents to arrange private discussions so they can share feelings, anxieties, concerns, successes, and problems related to parenting a child with a conduct disorder.

24. Advise the parents to be aware of attempts at triangulation and manipulation by the child and support one another with all of their parenting strategies.

25. Assign the parents to meet with the child's teachers to access the child's academic potential and determine a mutually agreed upon level of academic performance that must be maintained to earn privileges at home or school.

26. Advise the parents to meet regularly with all caregivers of the child to coordinate behavior plans, address problem situations, and clarify the current level of adjustment.

27. Refer the parents to a parenting class (e.g., Systematic Training for Effective Parenting (STEP) by Dinkmeyer and McKay)

to acquire techniques of positive discipline to use with the child.

28. Meet with the parents to help them initiate parenting strategies of positive discipline learned in parenting classes or from recommended parenting books or tapes (e.g., Your Defiant Child by Barkley or Children: The Challenge by Dreikurs and Stoltz).

29. Assist the parents in creating a list of privileges that can be used compliance, and positive behavior. (29, SC)

14. Limit the child's exposure to television and violent computer or video games. (31)

15. Investigate the possibility of comorbid conditions that may be affecting the child with a conduct disorder. (32, 33)

16. Enroll the child with a conduct disorder in anger management and social skills classes provided by the school or a community mental health agency. (34)

as rewards when the child behaves appropriately or withheld when the child does not adhere to the behavior plan.

30. Assign the parents to complete the "Using Privileges as Contingencies and Consequences" activity from the Parenting Skills Homework Planner (Knapp) to encourage the child to engage in more appropriate behavior.

31. Inform the parents that television, video, and computer games are filled with violence, drug and alcohol use, sexuality, and youth given unreasonable entitlements and advise them to limit all media use to no more than 1 to 2 hours per day.

32. Advise the parents that conduct disorder often exists with other neuropsychiatric disorders and review the child's psychiatric and psychological evaluations with the parents to identify any other coexisting conditions.

33. Assign the parents to consult with the child's medical doctor to explore the possibility of medication to treat the symptoms of conduct disorder and other existing comorbid conditions.

34. Assist the parents in locating an anger management and a social skills program for the child with a conduct disorder offered by school, the juvenile justice system, or local community health agencies.

Adopt programs to eliminate alcohol and substance abuse from the lifestyle and enhance physical and mental fitness. (35, 36)

Implement strategies to reduce the stress level within the family and between themselves. (37, 38)

35. Assign the parents to adopt daily habits that will prepare them for the immensely challenging job of parenting a child with a conduct disorder (e.g., get enough sleep, exercise regularly, eat healthy foods, eliminate abuse of alcohol and illegal or restricted substances).

36. Encourage the parents to participate in strategies and programs designed to reduce stress and enhance emotional balance (e.g., reduce workload, keep a journal, build a support network).

37. Instruct the parents to implement a getaway evening every week to escape from the pressures of parenting and the demands of their children.

38. Advise the parents to enroll the siblings in counseling sessions at school or with a private therapist or agency to deal with the emotional stresses of living with a brother or sister with a conduct disorder.

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