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Author: Bayly, Nolla-Jean, P

Title: Conduct Disorder and Oppositional Defiant Disorder: Intervention and

Prevention

The accompanying research report is submitted to the University of Wisconsin-Stout, Graduate School in partial

completion of the requirements for the

Graduate Degree/ Major: MS School Psychology

Research Adviser: Christine Peterson, Ph.D.

Submission Term/Year: Fall, 2012

Number of Pages: 46

Style Manual Used: American Psychological Association, 6th edition

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I attest that the research report is my original work (that any copyrightable materials have been used with the permission of the original authors), and as such, it is automatically protected by the laws, rules, and regulations of the U.S. Copyright Office.

My research adviser has approved the content and quality of this paper. STUDENT:

NAME: Nolla-Jean Bayly DATE: 12/21/2012

ADVISER: (Committee Chair if MS Plan A or EdS Thesis or Field Project/Problem):

NAME: Dr. Christine Peterson DATE: 12/21/2012

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Bayly, Nolla-Jean, P. Conduct Disorder and Oppositional Defiant Disorder: Intervention and

Prevention

Abstract

Conduct Disorder and Oppositional Defiant Disorder are prevalent concerns in the area of

Emotional Disturbance, as defined by IDEA. School-based services are often the first supports

students with social-emotional/behavioral disorders encounter. Thus, the efficacy of school-

based interventions is crucial to the social, emotional, academic success of students at risk and

diagnosed with ODD or CD. A comprehensive review of the research literature on school-based

prevention and intervention methods was conducted, and results are summarized.

Key Terms: Oppositional Defiant Disorder, Conduct Disorder, social-emotional disorders of

children, school-based interventions.

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Table of Contents

.................................................................................................................................................... Page

Abstract ............................................................................................................................................2

Chapter I: Introduction ....................................................................................................................4

Statement of the Problem .....................................................................................................5

Purpose of the Study ............................................................................................................6

Research Objectives .............................................................................................................6

Research Questions ..............................................................................................................6

Assumptions and Limitations of the Study ..........................................................................7

Definition of Terms..............................................................................................................8

Chapter II: Literature Review ........................................................................................................10

ODD and CD in the School Setting ...................................................................................10

Best Practices in Assessment of ODD and CD ..................................................................13

Assessment Instruments .....................................................................................................17

Evidence Based Interventions in the School Setting .........................................................21

School Based Intervention and Prevention Programs ........................................................25

Chapter III: Summary, Critical Analysis, and Recommendations .................................................34

Summary ............................................................................................................................34

Critical Analysis.................................................................................................................38

Recommendations ..............................................................................................................40

References ......................................................................................................................................42

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Chapter I: Introduction

Adolescents exhibiting emotional behavior disorders (EBD), such as oppositional defiant

disorder and conduct disorder, present particular needs within the school-setting. Oppositional

defiant disorder (ODD) manifests in children through argumentative, hostile and defiant

behavior, uncontrollable temper, deliberately agitating others, and being easily provoked by

others (APA, 2000). Conduct disorder (CD) manifests as children and adolescents who exhibit

ODD behaviors transition into more aggressive responses (McMahon & Wells, 1998). CD is

characterized by aggression towards animals and people, destruction of property, deceitfulness or

manipulation, theft, truancy, and serious violations of rules (APA, 2000). Extrinsic behaviors

associated with ODD and CD (aggressive, oppositional, self-serving, and rejecting behaviors)

tend to function as a reinforcing mechanism that strengthens intrinsic motivators inherent in the

disorders. These extrinsic behaviors contribute to low expectations from others and rejection

from peers and adults.

Children and adolescents identified with ODD and CD present unique educational,

social-emotional, and behavior challenges resulting from disruptive behavior. In the school

setting, the distributive noncompliant behavior associated with EBD is troublesome for several

reasons as it threatens safety in the school and creates classroom interruptions which impedes

other students’ learning Additionally, as a result of their behavior students identified with ODD

and CD are more likely to miss valuable class time, which among other variables, increases their

risk of academic failure resulting from underdeveloped skills, low homework completion, and

inconsistent attendance. These students are also expelled at a higher rate than their peers (Shinn

& Walker, 2002).

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The Individuals with Disabilities Education Improvement Act of 2004 (IDEiA) identifies

Emotional Disturbance (ED) as an area of disability. The manifestation of ED as defined in the

school setting as follows:

Emotional disturbance—This refers to a condition exhibiting one or more of the

following characteristics over a long period of time and to a marked degree, which

adversely affects a child’s educational performance: (1) an inability to learn, which

cannot be explained by intellectual, sensory or health factors; (2) an inability to build or

maintain satisfactory interpersonal relationships with peers and teachers; (3)

inappropriate behavior or feelings under normal circumstances; (4) a general pervasive

mood of unhappiness or depression; or (5) a tendency to develop physical symptoms or

fears associated with personal or school problems. This term includes schizophrenia. The

term does not apply to children who are socially maladjusted, unless it is determined they

have an emotional disturbance (U.S. Department of Education, 2012, p. 15).

ODD and CD disorders are represented within the category of ED. Students labeled with these

disorders encounter social, emotional, and behavioral challenges often misunderstood by their

peers, adults, and even internally within themselves (Wilmshurst, 2005).

The role of school professionals must address the specific and challenging needs

regarding ODD and CD as a means of creating a healthier and safer school, as well as promoting

the safety and long-term success of the student(s).

Statement of the Problem

Although students identified with ODD and CD often have average to high intellectual

function, their academic performance is typically low. Research has shown that students

identified with ODD and CD are more likely to: fail minimum competency exams, be retained,

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drop-out, become truant, receive instruction in restrictive classroom settings, to engage in

criminal behavior and encounter the juvenile justice system, when compared to their same-aged

peers (Lahey, Moffitt, & Caspi, 2003). Furthermore, the likeliness students with CD will drop

out of high-school is heightened when persistent and extreme problematic behavior is combined

with learning deficits or low academic skills (Shinn & Walker, 2002). Research suggests that

after high-school, students labeled as Emotionally Disturbed are at heightened risk of

unemployment and homelessness, incarceration, becoming parents at younger age, and losing

custody of their children, when compared with students identified in any other area of disability

(Morris, Baker, Valentine, & Pennisi, 1998).

Purpose of the Study

The purpose of this investigation is to evaluate the efficacy of emotional-behavioral

assessment and intervention methods for students exhibiting oppositional defiant disorder and

conduct disorder. A comprehensive review of the research literature will be conducted to review

and better convey the unique factors contributing to these disorders and implementation of

prevention and intervention measures to support students.

Research Objectives

The primary objective of this literature review is to conceptualize the contributing factors

relating to ODD and CD, as well as the variables that support the disorders. Additionally, this

research seeks to address the behavioral, academic, and social development of students at risk

and diagnosed with ODD or CD and applicable approaches to intervention.

Research Questions

The purpose of this research is to address the following questions:

1. What effective methods are available to school professionals to asses ODD and/or CD?

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2. What are best practices in developing individualized intervention plans for students with

ODD and CD?

3. How do evidence-based behavioral interventions meet the academic and behavioral needs of

students with ODD and CD, as well as contribute to the efficacy of the school climate?

Assumptions and Limitations of this Study

It is the assumption of this researcher that school professionals and parents of students

with ODD or CD share a common objective to intervene in the child’s maladaptive behaviors

and to facilitate adaptive behavior. It is also assumed behavior modification is contingent upon

valid and reliable assessment and interventions. Additionally, intervention and prevention

efforts must focus on short-term, incremental growth, while attaining long-term goals addressing

the educational, social, and adaptive success of students with ODD and CD.

Limitations include, but are not limited to: availability of resources and existing research

(despite significant studies within the fields of child psychology and educational psychology that

addresses ODD and CD, there remains several unanswered questions regarding the efficacy and

maturation of the disorders). School professionals may be limited to observing and adapting

variables supporting maladaptive behavior within the school setting, despite the

acknowledgement that students acquire behavioral, academic, and social skills across various

environments. A further limitation regarding this literature review is the types of treatment

available to school professionals. For instance, although medication is proven beneficial in

treating impulse control and executive function deficits (Schroeder, & Gordon, 2002), school

professionals may provide information to parents and families, but cannot initiate medication

into interventions. Lastly, while the etiology and manifestation of ODD and CD is widely

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researched, this literature review focus on several the types of tools and methods used in

evaluation and treatment, though will not provide an exhaustive list.

Definition of Terms

For purposes of this literature review the following terms are defined as follows:

Behavioral Factors. This term is defined as temperament and developmental maturity.

This may include problem-solving and critical thinking skills, social skills, and interpersonal

skills.

Biological Factors. This term is defined as neuropsychological and genetic composition.

This may include learning difficulties or intelligence.

Family/home Factors. This term is defined as factors in the child/adolescences home

that affect social, emotional, and behavioral development. This may include care-taker support,

care-taker parenting skills, care-taker violence and/or aggression, care-taker health, socio-

economic status, and stability/instability of home environment.

Conduct Disorder (CD). This term is characterized by persistent problematic behavior

displayed through hostile, violent, destructive, and manipulative actions (APA, 2000).

Additionally, a high-frequency of the problematic behaviors in the following areas are displayed

over 12 consecutive months (as defined by the Diagnostic and Statistical Manual of Mental

Disorders, Fourth edition): Aggression to people and/or animals; Destruction of property;

Deceitfulness or theft; Serious violations of rules (APA, 2000). CD is occurs children and

adolescents under 18 years old and cannot be explained by another disorder (APA, 2000).

Conduct Problem (CP). This term is used to describe CD and ODD behavior

(McMahon, & Wells, 1998).

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Emotional Behavioral Disorder (EBD). This term is defined by federal legislation as a

category of special education for students identified as emotionally disturbed (U.S. Department

of Education, 2012, p. 15).

Emotionally Disturbed (ED). This term is defined by federal legislation and describes

an inability to learn that is directly associated with emotional, behavioral conflict. Youth

identified as ED meet criteria for special education services and supports (U.S. Department of

Education, 2012, p. 15).

Oppositional Defiant Disorder (ODD). This term is characterized by persistent

problematic behavior displayed through aggressive, argumentative, and defiant actions (APA,

2000). Additionally, a high-frequency of the problematic behaviors is observed for a minimum

of six consecutive months and occurs children and adolescents under 18 years old and cannot be

explained by another disorder (APA, 2000).

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Chapter II: Literature Review

This chapter will begin with an overview of ODD and CD and its impact on learners in

the school setting. It will continue with a discussion on best practices for assessment of ODD and

CD in a school-based psychoeducational evaluation. Additionally, this chapter will focus on the

instruments and methodology used in emotional-behavioral assessments. Finally, the chapter

concludes with detailed description of evidenced-based interventions used in the school-setting

to support positive student outcomes in the prevention and intervention of ODD and CD.

ODD and CD in the School Setting

Despite significant research on the topic, the etiology of ODD and CD remains

undetermined (Sattler & Hoge, 2006). Experts agree that behaviors associated with emotional

disturbance manifest in accordance to the child or adolescent’s social, emotional, and behavioral

development, which is a product of biological, behavioral, and home variables. The first three

years of a child’s life have an enormous impact on their social-emotional development. During

this time, children exposed to caregiver depression, caregiver detachment, stressful home

environment, low social-economic status (SES), poor quality of care, and inadequate attention,

are at a heightened risk of developing ODD and later on CD. (Aguilar, Sroufe, Egeland, &

Carlson, 2000; Wilmshurst, 2005). By age 2, children exposed to prolonged neglect exhibit

overt signs of maladjustment displayed through intense non-compliance, withdrawal, and

inattentiveness. By kindergarden, these children may display overt behaviors related to ODD

and precursors to CD (Farmer & Bierman, 2002).

ODD, a precursor to CD, is challenging to treat, yet ODD presents less complexities than

CD treatment and intervention (Lahey et al., 2003). ODD and CD behavior manifests through a

continuum of overt and covert behavior. Both overt and covert behaviors may exhibit as

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destructive and non-destructive behaviors (Frick, Lahey, Loeber, & Tannenbaum, 1993;

Wilmshurst, 2005). Overt non-destructive displays in arguments, defiance, and easily agitated,

whereas overt destructive presents as hostile behavior towards others and harassing peers (Frick

et al., 1993). Similarly covert non-destructive behaviors encompass truancy, swearing, and

defying authority, and covert destructive behaviors exhibit acts of violence such are arson,

stealing, violating the law, and brutality (Frick et al., 1993).

It is estimated that for 75% students, school is their sole provider of mental health

services and interventions (Hoagwood & Erwin, 1997). Often, social-emotional maladjustment

in children is identified by the student’s classroom teacher (Flanagan & Caltabiano, 2004). The

classroom setting provides multiple and frequent opportunities for teachers to observe their

students in relation to their peers. This provides teachers a unique perspective to contrast

students’ social-emotional development and interpret displays of concerning behaviors.

Teachers and parents are often the first to identify academic difficulties in students and to refer

students for psychoeducational assessment (Flanagan & Caltabiano, 2004).

Behavioral and academic concerns may result from a skill deficit or a performance

deficit. Skills deficits occur when the child or adolescent lacks knowledge, experience, or ability

to perform in the expected way, whereas a performance deficit indicates the student has the

knowledge and ability to perform the skill surrounding the expectation, but is unmotivated or

resistant to comply (NASP, 2002). For students identified with ED, skill and performance

deficits may be entwined, due to distractions caused by intense social-emotional demands

(NASP, 2002). Students whom display problematic behavior and academic difficulties,

particularly difficulties in reading, are the most likely group of students to drop out of school

(Shinn & Walker, 2002).

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A longitudinal study conducted by Farmer and Bierman (2002) examined the

correlation of aggressive and withdrawn behavior displayed by students in early elementary

school, in relation to the potential for social and academic difficulties in later grades. The results

of their research revealed that first graders whom displayed aggressive-withdrawn behaviors

were also highly correlated to poor academic performance in third grade. Students identified

with aggressive-withdrawn behavioral concerns in first grade also demonstrated high-inattention,

aggression, and social skills deficits in kindergarden. Farmer and Bierman contend that

aggressive-withdrawn behavior in kindergarden and first-grade places the student at an increased

risk of developing significant social-emotional and academic difficulties in later grades. Farmer

& Bierman also determined that students in the study whom displayed aggressive-withdrawn

behavior in first-grade also tended to score lower on IQ tests when compared to their peers.

Researchers hypothesized that these students experienced limited responses that enabled their

ability to recall and demonstrate a socially acceptable response, and/or relied on poor emotional-

regulatory skills when responding to new or challenging academic and social demands in the

school-setting (Farmer &Bierman, 2002).

The transition from kindergarden to first grade is challenging for many students (Farmer

& Bierman, 2002). Students entering first grade encounter increased academic and behavioral

expectations that are exceedingly difficult for students with maladaptive social-emotional skills

and limited attention. New demands in first grade that increase in each subsequent grade level

include literacy skills, unsupervised and unstructured social interactions, sustained attention, and

emotional regulation (Farmer & Bierman, 2002). Farmer & Bierman (2002) contend that

attention and peer relations in kindergarden are precursors for future problematic behavior and

require proactive intervention to address the heightened risk of developing anti-social,

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aggressive, withdrawn behavior. Furthermore, their research endorsed early intervention and

prevention methods to support positive school entry that promotes social skills and positive

behavior, that begins in kindergarden and is reinforced during transitions into higher-grade

levels, and social-emotional curriculum that targets social skills, emotional regulation, problem

solving skills (Farmer & Bierman, 2002).

Best Practices in Assessment of ODD and CD

ODD and CD assessment methods are designed to evaluate students needs, identify the

problem behavior in concrete and measurable terms, identify the need(s) being served by the

problem behavior and contributing variables, in order to implement proactive interventions that

support adaptive behavior and academic achievement. Early interventions significantly increases

the likeliness that ODD will not progress into CD. Wilmsurst (2005) noted that when ODD

behavior is intervened, 75% of children diagnosed with ODD will not go on to develop CD.

Review, Interview, Observe, Test (RIOT) describes empirically-derived data-based steps

in a school-based evaluation (Howell & Nolet, 2000). RIOT, is used to gather data to determine

if problematic behavior is supported by a skill-based or performance-based deficit.

Review. Fact finding begins by Reviewing the student’s records (medical, academic,

behavioral), previous assessments (academic, cognitive, or behavior), samples of the students

work, benchmarking data, instructional match, and the instructor’s concerns (Howell & Nolet,

2000).

Interview. Conducting interviews with parents and teachers can provide information

about the student’s behavior patterns and behavior strategies, triggers, and maintainers (Howell

& Nolet, 2000). Teacher interviews provide details regarding their perception of the student’s

behavior, instructional match, response to intervention, goals, and instructors’ discipline and

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reinforcement responses to student behavior. Interview with the student will require significant

rapport and may provide insight into the function of the behavior(s), thoughts/feeling towards

school and people, likes/dislikes, receptive and expressive skills, ability to discuss emotions, and

the student’s problem solving and critical thinking skills (Howell & Nolet, 2000). Student and

parent interviews are also employed to gain information about home to school collaboration,

communication style, as well as the views, expectations, supports, and motivation garnered

towards the students behavior and performance (Howell & Nolet, 2000). (Rating-scales,

questionnaires, and status sheets may also be sought for additional information within the scope

of Interview and Test.)

Observation. This contributes to data collection and evaluation as the observer

systematically tracks several variables that influence learning and behavior. Observation

provides the assessment with direct examples of instruction, student behavior (attention,

participation, social skills, and antecedents and consequences to overt behavior), how the student

interacts with others, and the overt and covert rules governed within the classroom and peer

relations (Howell & Nolet, 2000). Best practice in ODD and CD observations involves

conducting multiple observations across several settings, consider different times of the day and

different days of the week (Howell & Nolet, 2000). The student should be observed in settings

identified as “low risk” and “high risk” for behavior problems, also across structured and

unstructured settings, as this may provide insight into the function of the behavior. Additionally,

input from multiple raters using various observational techniques will likely enhance the

assessments accuracy in determining the antecedents and consequences surrounding problem

behavior (Howell & Nolet, 2000). Observations are valuable resources to support other sources

of information.

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Test. This addresses specific data collection components regarding the student’s

awareness about behavioral expectations, instructional match, instructional effectiveness and

opportunity to learn, employs progress monitoring procedures to determine students present level

of performance, and finally, assesses the learner’s performance level in relation to grade level

expectations and provides opportunities to observe the student work, attack difficult problems,

and handle frustration (Howell & Nolet, 2000). Data collected may identify variables that

support and hinder the student’s ability to succeed (Howell & Nolet, 2000).

A functional behavior assessment (FBA) is an empirically-based approach commonly

used in the school-setting to determine the rationale/reason a student behaves a particular way.

FBA serves as a basis for developing effective interventions. FBA approaches (problematic)

behavior as contingent upon the context (environment) it occurs and assumes that behavior

occurs as a functional (rational) response to the environment (Crone & Horner, 2003). FBA data

is collected through direct observations, systematically measuring the behavior. Next, the data is

analyzed to identify patterns in the students behavior and in the environment, and why the

behavior occurs. Patterns indicate antecedents (environmental context that triggers the behavior)

and consequences (responses that reinforce and maintain the behavior). Identifying antecedents

and consequences helps the student’s support team to predict when the problem behavior will

occur (Crone & Horner, 2003). The team will select an intervention that alters the student’s

interaction with the environment, causing the student to respond differently. Designating an

effective intervention requires identifying the function (need) the student is fulfilling through the

problematic behavior. The Wisconsin Department of Public Instruction (2007) identified the

following categories as six primary functions of behavior:

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Escape or avoidance – avoiding a particular activity, such as a class, an interaction with a

particular person or group, or an unpleasant situation; Justice or revenge – getting back at

an individual or group for a real or an imagined slight, sometimes on behalf of a friend or

family member; Acceptance and affiliation – belonging or gaining acceptance to a group;

seeking to impress members of a peer group a student hopes to join; Power or control –

wanting to dominate, be in charge, control environments; refusing to follow rules or

directions; refusing to participate in certain activities; Expression of self – seeking to

announce independence and/or individuality to express the individual’s vision of self;

Access to tangible rewards or personal gratification – behaving in a manner to get

tangible reinforcement (such as items, money, privileges); seeking to feel good or get

immediate feedback or reward. (p. 3).

To accurately determine the function of the behavior requires direct observations (to

determine the antecedents and consequences surrounding the behavior), a review of records and

interviews with teachers, parents, or the student, to collect context information pertaining to the

emergence of the behavior and outside setting events that contribute to the likeliness the

problematic behavior will occur (for example a lack of sleep, parents divorcing, etc.) (Crone &

Horner, 2003). Interventions focus on making the problem behavior an irrelevant or inefficient

response in the new environment and provide or facilitate an adaptive replacement behavior that

is incompatible with the problem behavior, yet meets the same function as the problem behavior

(Crone & Horner, 2003). For example, imagine a student becomes agitated as s/he works on an

assignment and responds by yelling, crumpling and throwing the assignment. A typical response

may be remove the student from the class and another adult authority will debrief with the

student (perhaps a principal, school liaison, or social worker). If the function of behavior is

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escape/avoidance, to release/get away from the frustration associated with the difficult task, in

which case removing the student from class and debriefing with the student is fulfilling his/her

need to escape the classroom and avoid the frustrating assignment. The student’s team may

decide a more useful strategy (intervention) is to encourage the student to take a break and when

the frustration has subsided assist the student with the difficult academic problem. The function

of the original behavior is still being served by the break as his/her frustration released, by

adding immediate feedback and assistance with the difficult portion of the assignment the

teacher is facilitating positive feedback and reinforcing that a successful strategy to use when

approaching an item that is too challenging is to seek clarification from the teacher. Continuing

to document the students response to this new response/intervention will provide meaningful

data that can be compared to the baseline data regarding the frequency the problematic behavior

occurs (Crone & Horner, 2003). The rate of academic progression and number of disciplinary

referrals is also a meaningful comparison with baseline and intervention data (Crone & Horner,

2003).

Assessment Instruments

One technique to gather context data is through standardized instruments such as

behavior rating scales, self-report questionnaires, and checklists. When completed by a variety

of respondents, rating scales, questionnaires, and checklists provide quantified non-direct

observations that describe possible risk factors and the frequency the child or adolescent displays

concerning behavior(s). Collecting information from multiple raters is critical to accountability

and transparency when analyzing results. Comparing ratings from multiple respondents (parents,

teachers, and the target student) increases validity and indicates the intensity that the student

displays problematic behavior in various settings (Frick & McMahon, 2008). Results from these

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measures are also used in the selection of interventions and to monitor the effectiveness of a

chosen intervention (Conners, 2008). Standardized, normative-referenced rating scales and

questionnaires indicate if a child’s behavior is typical for their age or if the intensity of the

behavior(s) is cause for concern (Frick & McMahon, 2008). Many rating scales and self-report

questionnaires provide several subtests and items to distinguish problem behavior from expected

behavior, risk potential, variables within the child (e.g., attitude, self-concept, learning deficits,

study skills), and variables outside of the student (e.g., observer bias, antecedents, consequences)

(Frick & McMahon, 2008). Self-report questionnaires may clarify internalized struggles and

motivations experienced by the youth. An additional component of rating scales is described by

Frick and McMahon (2008):

These [in addition to assessing CP] typically include scales assessing anxiety, depression,

social problems, and family relationships. Thus, these rating scales can be very helpful in

providing a broad screening of many of the most common co-occurring problems that are

often found in children with CP and many of the risk factors that can play a role in the

development and maintenance of CP (p. 47).

Effective rating scales for assessing, screening, and progress monitoring ODD and CD

related behaviors include (but is not limited to) the Behavior Assessment System for Children-

Second Edition, Conners Comprehensive Behavior Rating Scale, and the Social Skills

Improvement Scales.

Behavior Assessment System for Children- Second Edition (BASC-2). This is a

comprehensive tool that assesses school adjustment, adaptive behavior, and learning problems in

children and adolescents ages 2- through 21-years-old (Reynolds & Kamphaus, 2004). This tool

employs a multi-rater approach that provides scales for parents/care-giver, teachers, pre-school

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teachers, and self-report scales for children and adolescences ages 6- through 21-years old

(Reynolds & Kamphaus, 2004). The BASC-2 measures externalized behaviors and internalized

emotional difficulties that interfere with positive relationships and learning, such as (parent and

teacher forms) aggression, anxiety, attention problems, conduct problems, depression, functional

communication deficits, learning problems, social skills deficits, somatization, study skills,

withdrawn behavior, and (self-report forms) alcohol abuse, anxiety, attention problems, attitude

to school, attitude to teachers, atypicality, depression, hyperactivity, interpersonal relations, locus

of control, relations with parents, school maladjustment, self-esteem, self-reliance, sensation

seeking behavior, sense of inadequacy, social stress, and somatization (Reynolds & Kamphaus,

2004). The BASC-2 provides norm-referenced groups to aid scoring and interpretation.

Examiners may compare results to the target student’s same-aged peers, in addition to, ADHD

and learning disabilities population (Reynolds & Kamphaus, 2004).

Conners Comprehensive Behavior Rating Scale (Conners CBRS). This is a

comprehensive tool used to assess social, emotional, and behavioral maladjustment in school

aged children and adolescents ages 6 - 18 years-old (Conners, 2008). The Conners CBRS offers

a multi-rater approach with parent and teacher reports that target youth ages 6 - 18 years-old, and

self-report questionnaire option for students ages 8-18 years old (Conners, 2008). The Conners

CBRS self-report provides a unique vantage point to assess internalized emotional issues such as

depression, irritability, anxiety, obsessive-compulsive tendencies (Conners, 2008). Results

comply with eligibility criteria outlined in IDEA and diagnostic criteria endorsed by the

Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition- Text Revision (DSM-IV-

TR), making the Conners CBRS a valuable tool in school-based assessments (Conners, 2008).

The Conners CBRS includes scales that specifically measure CD, ODD, and a variety of the

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most common co-morbid disorders (including Attention Deficit Hyperactivity Disorder-ADHD,

depression, mood disorders, anxiety disorders, autistic disorder, Asperger’s disorder, phobias,

learning impairments, and trauma-specific disorders) (Conners, 2008). Specific childhood

behavioral difficulties listed in the CRBS manual includes emotional distress, defiant/aggressive

behaviors, academic difficulties, hyperactivity, social problems, perfectionistic and compulsive

behaviors, violence potential, and physical symptoms (Conners, 2008). Self-harm and Severe

Conduct critical items are placed throughout the protocol, selection of any critical item is

addressed on the Conners CBRS computerized print-out to alert practitioners to the student’s

heightened emotional and behavior needs (Conners, 2008). The Conners CBRS may also

function as a progress monitoring tool, to evaluate intervention/treatment effectiveness or

possible progression of the disorder (Conners, 2008).

Social Skills Improvement Scales (SSiS). This is a standardized, normative-referenced

rating scale used to assess social-emotional behavior functioning, social skills and engagement,

and academic competence in children and adolescents ages 3 - 18 years-old (Elliot & Gresham,

2008). The SSiS rating scale is composed of a multi-informant structure and provides parent,

teacher, and student forms. Responses generate descriptions regarding the following areas:

externalizing behavior, bullying behavior, hyperactivity/inattention, internalizing behavior,

behavior associated with Autism Spectrum Disorder, social skills communication, cooperation,

responsibility, empathy, engagement, self-control, reading achievement, math achievement, and

motivation to learn (Elliot & Gresham, 2008). The SSiS provides norm-referenced comparative

data, based on the child or adolescent’s same aged peers based on gender or combined gender.

The SSiS can be administered and interpreted by teachers or other school professionals whom

hold a bachelors degree with course work in psychological test measurement and interpretation

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(Elliot & Gresham, 2008). The SSiS is used for individual and universal, screening and

assessment. The SSiS Classwide Intervention Program Teacher’s Guide (2007) provides

detailed curriculum and interventions, assessment and progress monitoring instructions for

individual, class-wide, or school-wide interventions, and interventions designed to build home-

school collaboration. According to the SSiS examiners manual, ratings take 15-20 minutes to

complete and are valid for assessment and intervention monitoring (Elliot & Gresham, 2008).

The SSiS intervention program includes teacher guides, video clips of social skills for each unit,

resource disc with printable hand-outs, student booklet, SSiS performance screening guides for

accurate administration and interpretation (Elliot & Gresham, 2007). Specific intervention

curriculum is provided for school aged children, preschool through high school (Elliot &

Gresham, 2007).

It is important to note that rating scales must be interpreted with caution, due to the

subjectivity inherit in the design (Frick & McMahon, 2008). Data between subject responses

will likely differ when comparing each parent’s responses, teacher responses, and student

reports. Differences between raters does not necessarily indicate the results are invalid.

Inconsistencies may result when the child/adolescent behavior is dependent upon the

environment, in which case this information may be very useful for intervention planning, as it

indicates positive behavioral supports for the child. Differences between raters may also indicate

bias or response-style. Because the nature of behavior rating scales and questionnaires has a

large margin for subjectivity, best practice dictates these tools should never be used alone for

diagnosis or disability identification.

Evidenced Based Interventions in the School Setting

Research suggests early intervention has the highest success rate for eliminating defiant,

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hostile, and aggressive behavior, because early intervention will potentially address risk factors

before the begin (Shinn & Walker, 2002). Best practice in assessment and interventions,

endorsed by the National Association of School Psychologists (2009), suggests that multi-tiered

problem-solving models effectively facilitate systematic safe-guards that promote early

identification and prevention. Multi-tiered models also provide a school-wide approach to

building student’s adaptive social skills and emotional regulation techniques and enhance anti-

bullying and violence prevention efforts.

Within a three-tiered model, tier I embodies the school-wide universal supports that teach

behavior expectations to all students (NASP, 2009). The majority of students are successful with

universal tier I support. A fraction of students will required additional support. (Tier I behavioral

interventions frequently employed by teachers include simple acts of cueing, seating

arrangements, and verbal reminders.) Tier I also provides explicit instruction regarding

academic and behavior expectations to all students. This instruction is provided at the beginning

of the school year. Explicit instruction and consistency creates concrete, predictable

expectations and consequences that increases students ability to manage their behavior

(McKevitt & Braaksma, 2008). Tier II is more individualized, targeting at-risk students

identified through built-in screening and provides support to address academic and behavioral

needs (NASP, 2009). After students are identified as needing tier II support, the next step is to

implement simple interventions, which change the environment to encourage learning and

expected behavior. The target student’s response to these changes provides additional

information to define the student’s needs (McConaughy & Ritter, 2002). Tier III provides highly

individualized and intense services to support student’s academic and behavioral needs (NASP,

2009). Tier II and III may provide skill building lessons that focus on social skills, emotional

23

regulation, and strategies for academic success (McKevitt & Braaksma, 2008). Student’s needs

are often provided with special education services in tier III. In each of the tiers explicit

instruction is frequently provided to students. Explicit instruction teaches behavior expectations

and uses misbehavior to teach replacement (expected) behavior (NASP, 2009). Throughout the

tiers, students are reinforced as they demonstrate expected behavior skills. Reinforcement tends

to address the problem behavior, whether it is a function of a skill-deficit or performance-deficit

(McKevitt & Braaksma, 2008). Multi-tiered models provide additional transparency into the

referral process as behavioral and academic data is collected along the way. This data provides a

basis to target relevant interventions (McConaughy & Ritter, 2002).

Crone & Horner (2003) illustrate the utility of a multi-tiered model in responding to

behavioral concerns using data from office disciplinary referrals. Through systematically

tracking the following variables:

1. Frequency of referrals based-on location (classroom, hallway, locker room, etc.).

2. Time of day each disciplinary referral is distributed.

3. The associated teacher/school professional who assigns the referral.

4. The associated student who received the infraction.

This information alerts school professionals to patterns. This data also provides details

pertaining to the type of problematic behavior displayed (reason for the disciplinary referral) and

provides data to determine high risk locations, times, and interactions, that surround the

problematic behavior (Crone & Horner, 2003).

Mental health support may also serve a vital role in supporting the behavioral and

academic needs experienced by student’s identified with ED. IDEA legislation acknowledges

the role of mental health supports in interventions for ED, and specifies students whom require

24

counseling services to improve learning capabilities should be granted such provisions (U.S.

Department of Education, 2004). The Conners CBRS aligns with IDEA and DSM endorsements

for ODD and CD treatment (Conners, 2008). Chapter 7 of the Conners CBRS Manual (2008)

provides guidelines and suggestions for relevant interventions based on the results of the

assessment. Intervention recommendations focus on behavioral modification programs and

functional behavior analysis, cognitive-behavioral therapy (CBT), and psychosocial modalities to

treat the social, emotional (pharmacological/medication intervention support is also addressed,

because medication is an individual and family choice this modality is irrelevant to school-based

intervention and will not be addressed) (Conners, 2008).

Professional standards directed by the American Psychological Association (APA) and

National Association of School Psychologists (NASP) instructs educational psychologists to

employ evidenced-based interventions in the treatment of EBD, asserting that effective

treatments are multifaceted and encompass cognitive behavior therapy (CBT) to address anger

management and social skills (Mosiewicz & Trammell, 2009). CBT strategies approach anger as

a learned response to environmental and physiological events (Mosiewicz & Trammell, 2009).

Students with ODD and CD often lack the social-cognitive skills expected by peers and

teachers, and as a result encounter rejection due to socially inappropriate behavior (Wilmshurst,

2005). In return, the child’s defenses escalate, further developing the disorder. While anger is

sometimes an accurate response to disturbing event, often children and adolescents with ODD or

CD overly respond with anger in maladaptive ways. Student’s ability to make rational decisions

(choices and plans) to evaluate desired outcomes and a positive course of action (non-harming to

self or others) is essential in developing skills for academic and social success, CBT teaches

new, adaptive responses to events (Mosiewicz & Trammell, 2009). Cognitive-behavior therapies

25

incorporate student-input and monitoring into interventions. Activities such as: self-talk, to

reinforce positive goals and behavior; self-monitoring, to assess physiological signs of stress,

anger, impatience which can be felt when escalating; cognitive problem-solving strategies, to

determine cause and effect of potential behavior and outcomes. CBT can be applied to outward-

observable behavior, such as aggressive actions or frequent incomplete homework assignments

(Mosiewicz & Trammell, 2009). CBT is also applicable with less observable behavior

associated with mental health concerns such as anxiety or depression, which are internalized thus

more difficult for school professionals and parents to detect. Students may hide internalized

struggles, despite the negative effects such disorders have on their academic, social, and

emotional well-being. CBT interventions can also be referenced to help students self-monitor

and use relaxation techniques for emotional regulation (Mosiewicz & Trammell, 2009)

School-Based Intervention and Prevention Programs

Preventative intervention programs target: curriculum, school-wide behavior

expectations, and school-wide responses to behavior (NASP, 2009). Prevention programs

increase awareness and recognition of social, emotional, and behavior needs inside a school

(NASP, 2009). Attending to early risk factors is essential to deliver proactive interventions that

maintain safe and successful schools (Conners, 2008). Evidenced-based strategies used to

prevent or intervene in ODD and CD behaviors and support students’ social-emotional growth at

the universal level include programs and teaching strategies such as the Good Behavior Game

and the Second Step Program.

The Good Behavior Game (GBG). This is an empirically based teaching strategy that

facilitates behavior-management using rewards and positive reinforcement to reshape

maladaptive behavior and reinforce prosocial and adaptive behavior (Schakel, 1984). The GBG

26

is intended for elementary aged students. It was initially tested in 1969 and over the years

several studies have confirmed the efficacy of the program, showing the game significantly

decreases problematic behavior that impedes learning (Ruiz-Olivares, Pino, & Herruzo, 2010).

The goal of the GBG is to increase student engagement and mastery of expected behaviors. This

is accomplished through explicit instruction and reinforcement of the behavioral expectations

during game-time. The GBG increases students awareness regarding how their actions can

positively or negatively impact the group and themselves (Schakel, 1984). Social-emotional

skills supported by the game include strengthening self-monitoring, emotional regulation, and

peer relations as students work as a team.

An advantage of GBG is its simplicity; it requires a few steps to administer. To apply the

game it is first necessary to develop an operationalized definition of a few target behavior

problems. Clearly defining the behavior(s) provides concrete and predictable expectations for

the student and other professionals in the building (Schakel, 1984). This removes subjectivity

and avoids “fairness” debates. Operationalized behaviors are observable and provide

opportunity to give the student direct feedback (this allows the student to reflect on their action

and correct their response). Next, select a time for the game to be played each day. When

selecting a time the following components are important to consider times the entire class is

expected to display the same behavior and lessons that require high-participation, attention,

and/or require students to follow explicit instructions to be successful (Schakel, 1984). The

GBG can be played at the selected time each day, repetition of the game provides in an

additional advantage as students have additional opportunity to practice and master their good

behavior skills making it more likely that the skills will transfer into other times and places

during the day. Once the games operations are finalized, the instructor will introduce the game

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and incentives to the class. The class is divided into teams and during game-time student

behavior is monitored and recorded on a visible chart (Schakel, 1984). Disruptive behavior is

recorded to alter the student and team to correct the problematic behavior (Schakel, 1984).

Teams are permitted to have a certain amount of infractions, the number of permutable

infractions is clearly stated prior to beginning the game. Teams that do not exceed the number of

permitted infractions receive the reward (Schakel, 1984). To ensure the vitality of the GBG

requires the instructor to select appropriate and meaningful rewards that are attractive to the

students in the classroom.

Second Step. This is a violence prevention program intended for students preschool

aged through eighth grade (Beland, 1997). Designed as a primary method of violence

prevention, Second Step targets problematic behavior and social-emotional skill deficits that

increase the likelihood of ED, aggression, violence, drug-use, and academic failure in youth

(Beland, 1997). The philosophy of the Second Step program centers on preventing youth from

developing at risk behavior and delivering intervention for students that display high-risk,

impulsive, aggressive behavior. The program was developed to use in mainstream classrooms,

but is also appropriate for small group instruction (Beland, 1997). The Second Step curriculum

is made-up of lessons that focus on social-emotional skills training, bullying prevention, and

child safety (Beland, 1997). Curriculums are specific to age/grade-level to ensure lessons are

delivered in relation to students’ developmental maturity (Beland, 1997). The Second Step

curriculum uses a variety of empirically-based teaching strategies to build emotional regulation,

empathy, self-esteem, problem-solving and critical thinking, self-regulation, impulse control and

executive function skills in children and adolescents (Beland, 1997). Lessons include multi-

media stimuli (photographs, hand-outs, video clips, props), physical exercises, games, role-plays,

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story-and-discussion, and activities to increase student’s ability transfer the skills to real-life

situations (Beland, 1997). Each age/grade-level curriculum comes with a Teacher Guide to assist

lesson delivery. Second Step teacher guides also provide instructions to facilitate transfer of skill

training using empirically-based teaching strategies (Beland, 1997).

Second Step intentionally incorporates lessons that center on critical thinking and

reasoning skills required to address challenging problems encountered in academics/school-

work, social conflicts with peers and adults, and to respond to inner emotional conflict, faulty

logic, and maladaptive response tendencies, rather than reacting with an initial emotional-

physical response. For example, Verbal Mediation is a strategy to stop and think, before reacting

to a problem. Building this strategy begins by verbally solving the problem out loud. This

technique helps develop critical thinking skills that are needed for problem-solving and assists

children as they learning to transfer the skills taught in Second Step to new environments and use

their learned skills without requiring cues (Beland, 1997).

Whereas schools employ universal preventive intervention programming to build skills

within the entire student body, supplemental intervention and prevention programs are

implemented to provide additional support to children and adolescents displaying continued “at

risk” behavior. These programs and strategies address prevention through delivering increased

direct support, to provide support for students and families at heightened risk for ED, to prevent

problematic behavior from developing into a disorder (such as ODD), or to prevent a disorder

like ODD from developing into CD (or CD from developing into Anti-social personality

disorder). Research shows that parent involvement increases intervention success (Conners,

2008). Supplemental evidenced-based programs used to prevent or intervene in ODD and CD

29

behaviors and support students’ social-emotional growth include Behavior Intervention Plans,

behavior report cards, and comprehensive school based programs like the Fast Track Program.

Behavior Intervention Plan. This is often referred to as a behavior support plan,

Behavior Intervention Plans (BIPS) aligns data complied during a FBA to intervention and

support that addresses student needs. BIP implementation and maintenance requires a team

approach and best practice encourages school practitioners to involve the target student’s parents

in creating the BIP (Sugai, Horner & Gresham, 2002). BIP targets problematic behavior and

provides highly individualized interventions.

FBA data is used to create a “competing behavior pathway”. Competing behavior

pathway is used to conceptualize the motivation behind the student’s behavior (determining the

function of the behavior) (Sugai et al., 2002). A competing behavior pathway includes the

following parts: 1) identifying setting events (setting event pertain to outside variables that

impact student’s needs. Examples include lack of sleep, hunger, conflict with friends, family, or

teachers, academic struggles, among others); 2) identify antecedents; 3) quantify the problem;

behavior; 4) identify consequences that are maintaining the behavior (Sugai et al., 2002). Next,

the evaluation team will brainstorm ways to make the antecedents and problem behavior

ineffective in achieving the function of the behavior (Sugai et al., 2002). Brainstorming also

focuses on making the consequences/maintainers irrelevant (Sugai et al., 2002). Additionally,

the team will have to identify a reasonable replacement behavior and methods/environmental

influences that will encourage the student to respond with the desire (replacement) behavior

(Sugai et al., 2002).

Explicit teaching of behavioral expectations and determining if the problem behavior is a

result of a skill-deficit or performance-deficit is critical to intervention success. Also vital to

30

success is continued progress monitoring and evaluation of the intervention. During evaluation

progress and intervention effectiveness is critiqued to determine if a modification or alternate

approach is necessary (Crone & Horner, 2003).

Behavior Report Card. Is a communication tool between school professionals and

parents that provides descriptive feedback regarding the student’s behavior. A student’s

educational support team operationalizes target behaviors that have been identified by teachers

and parents as significantly problematic to the student’s ability to be successful at school

(Vannest, Davis, Davis, Mason, & Burke, 2010). Each day teachers provide feedback on the

report card describing the student’s performance pertaining to the target behaviors. Behavior

report cards may be used throughout the day or at specific times of the day (example lunch,

math, etc.). Parents review and sign the report card each day, which enhances parent

involvement and home to school collaboration (Vannest, et al, 2010). Parents may also send

messages to school staff via the report card.

A study by Vannest, Davis, Davis, Mason, & Burke (2010) showed that behavior reports

cards were highly effective form of behavior management in primary and secondary schools.

The study also determined that parent involvement is a key component to success using this

strategy (Vannest et al., 2010). Lastly, research shows that the more frequently the behavior

report card is used throughout the day will increase its effectiveness (Vannest et al., 2010).

Cases that used the behavior report card for an hour or less a day had the lowest success rate

(Vannest et al., 2010). Commitment from the students teachers and behavioral support team is

also a vital component, to ensure consistency and accountability.

Fast Track Program. This is a comprehensive prevention program created by members

of the Conduct Problems Prevention Research Group (CPPRG). The Fast Track Program is a

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long-term evidence-based preventative intervention intended for children at risk and identified as

ODD/CD. Students are introduced to the Fast Track Program early in elementary school. The

program centers on behavior management training and implementation, social-cognitive therapy,

transition services, and extended support. Services are provided to the child and parents.

Additionally, schools and teachers are incorporated into the program as progress monitoring

consultants (participating in: interviews, rating scales, and questionnaires), also as collaborators

regarding academic instruction (CPPRG, 2011). The programs success is largely accredited to

its multifaceted approach to intervention, addressing the environmental factors within the child’s

family, social/peer-group, school, neighborhood, and community throughout the child’s school

career. Extended support is another important feature of the intervention, which addresses

criticism met by behavioral interventions with high-drop out rates and unsustainable results once

treatment has terminated (CPPRG, 2011).

The following describes supports provided to the students and families who participated

in a ten-year long study conducted by the CPPRG. The study tracked high-risk students from

kindergarden through 12th grade and provided services beginning in 1st grade through 10th

grade. The program was designed to confront early risk-factors such as: parenting skills and

behavior management, faulty social-cognitive skills, emotional skills, peer relationships, home-

school collaboration, academics, and classroom behavior. Assessment of the students’ home,

classroom, and neighborhood environments were conducted to establish possible risk and need

(CPPRG, 2011). A key component to Fast Track preventive intervention is early identification.

To accomplish this, kindergarden teachers were given rating scales to identify their highest-risk

students; next, parents of the highest-risk students were also administered rating-scales. These

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scores were merged and analyzed to select the treatment group (CPPRG, 2011). During 1st - 5th

grade the intervention included:

Parent training with home visiting, academic tutoring, and child social skill training.

Parent and child group interventions were conducted during a 2-hr “enrichment

program.” These sessions included social skill training “friendship groups” led by

educational coordinators for high-risk children (Bierman et al.,1996), parent-training

groups for parents led by family coordinators, and guided parent-child interaction

sessions. (CPPRG, 2011, p. 336).

Home visits verified improved parenting skills as physical punishments decreased, and teachers

reported increased home-school collaboration. Additionally, social-emotional skills training was

provided with the Promoting Alternative THinking Strategies (PATHS) curriculum (Kusche &

Greenberg, 1993) was provided in classrooms. This curriculum addressed social ecology and

emotional competence universally (class-wide) (CPPRG, 2011).

When students reached 6th - 10th grade, Fast Track introduced programs to ease

transitions to high school, promote adaptive life skills (career options, interviewing skills,

budgeting, student support group, parent skill-building and support groups to address positive

parenting skills), and included a parent-student group focused on sex education, substance abuse,

peer pressure, and careers (CPPRG, 2011). Throughout student’s 7th - 10th grade, regular

assessments and rating scales provided data to guide individualized intervention student and

parent plans. Plans were monitored and adapted as necessary in response to students and parents

needs and risks factors (CPPRG, 2011).

Throughout the intervention, parents and teachers played key roles in progress-

monitoring. In 3rd grade parents and teachers reported a decrease in the target student’s problem

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behaviors (ODD/CD manifestations). In 4th - 5th grade, parents and teachers described

improved social skills, and fewer conduct problems in school, at home, and in the community.

In 9th grade, the highest risk adolescents showed significant improvements, “...in Grade 9,

assignment to the intervention was responsible for preventing 75% of CD cases, 53% of attention

deficit hyperactivity disorder (ADHD) cases, and 43% of any disruptive behavior disorder cases”

(CPPRG, 2011, p. 333).

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Chapter III: Summary, Critical Analysis, and Recommendations

This chapter will review the information presented in this literature review, including a

review of ODD and ED assessment process, appropriate instrumentation to conduct assessment

and monitor intervention progress, and the significance of effective multifaceted interventions in

contending with the on-set and progression of ODD and CD. Additionally, a critical analysis of

the literature presented will evaluate the assessment and intervention methods outlined in this

literature review. This chapter will conclude with recommendations for improving ODD and CD

prevention efforts and interventions, as well as eliciting lasting and meaningful results.

Summary

Research suggests the United States educational system and justice system is failing

youth identified with emotional and behavioral disturbances. This is evident as incarceration and

clinical treatment for emotional disturbances rises (Lahey et al., 2003). Statistically, these

students fail and drop out of school at a significantly higher rate than their peers (Lahey et al.,

2003; Shinn & Walker, 2002). Intervention is an essential component in changing this trend.

Perhaps even more vital are preventive services that center on the identification of risk-factors

associated with ODD and CD, in order to execute meaningful responses.

Because of the significant correlation between home variables and quality of care an

individual receives from infancy through adolescence has in the development of ODD and CD, it

is vital to assess components both inside and outside of school to provide meaningful, direct

support. Quality assessment, with valid and reliable results, are requirements to implement

effective evidence-based interventions. Intervention inside the school must address the

classroom ecology, school ecology, the target student’s academic performance and potential,

35

antecedents and consequences of behavior, and clearly define the variables and behaviors for

assessment, goal-setting and progress monitoring.

It is important to assess if academic struggles are associated with a cognitive or learning

disability (which escalate ODD/CD like behaviors, as students respond to feelings of inadequacy

and a desire to escape overly-difficult academic tasks). Research shows that students with

behavioral problems in school and academic difficulties, particularly difficulties in reading, are

the most likely group of students to drop out of school because reading is so essential to school

success (Shinn, & Walker, 2002).

Research conducted by Farmer & Bierman (2002) identified precursor traits in the

development of ODD and CD in kindergarden and first grade students. Their research highlights

the significance of early intervention in supporting children at-risk of developing ODD/CD.

Results of this study indicates that social skills deficits and cognitive deficits (low IQ and

executive functioning deficits pertaining to emotional regulation and attention) are significantly

linked to academic problems, poor peer relations, poor emotional regulation, and aggression.

Furthermore, this research identified early intervention and prevention methods to that include

delivering social emotional curriculum that targets social skills, emotional competence, and

problem-solving skills at tier I (Farmer & Bierman, 2002). This research supports statements

from the APA and NASP, regarding best practice in supporting children at risk or identified with

ODD/CD with preventative, skills building education (Mosiewicz & Trammell, 2009).

The significance of early intervention is emphasized by prevalence statistics pertaining to

ODD and CD that indicate while CD is an expansion of ODD the maladaptive cycle may be

broken and reformed with intervention. Research shows that 75% of children with ODD will not

go on to develop CD (Wilmshurst, 2005). Such research supports recommendations made by

36

NASP and APA that endorse early intervention as a critical component to treat and prevent an

established disorder from developing further into an escalated disorder that is more difficult to

treat.

Best practice in the assessment of emotional-behavioral referrals requires practitioners to

accurately determine the presence/absence of common co-morbid disorders. This is necessary to

ensure the treatments focus on the target behavior. Because social-emotional/behavioral

disorders are largely defined by the symptoms and behaviors associated with the specific

disorder conceptualizing the target behavior and co-morbid disorders leads to meaningful

interventions that to address the function of the presenting problem. Overt behaviors are

externalized actions (crying, hitting, yelling), these behaviors are observable, thus easily

measured. Treatment and intervention decisions are largely based on overt behaviors, which

may mask the underlying function of the behavior. Assessment of internalized emotions and

thoughts that guide behavior is more problematic and requires measures that can tap into these

variables, such as interviews, and standardized rating-scales and self-report questionnaires.

Rating scales describe likely implications attributed to the behaviors that are displayed by the

subject. Research shows that rating scales and self-report questionnaires are effective tools to

gather information about the child or adolescent’s behavior across multiple environments.

These tools also provide data that details frequency that concerning behaviors are displayed and

provide information pertaining to the presence of co-morbid disorders.

Endorsed by NASP, school-based multi-tiered problem-solving models provide

systematic safeguards to meet the needs of students whom otherwise may “fall between the

cracks” (students who need intervention but have been overlooked) (NASP, 2009). Within a

multi-tiered model schools systematically track student academic achievement and behavior.

37

This method increases awareness of academic and behavioral concerns as they arise. This

provides increased awareness of potential ‘at risk’ students, increasing the frequency of proactive

interventions rather than reactive responses to heightened problems. Teaching adaptive

behavioral and social skills at the universal (tier one) level ensures all students receive

instruction necessary for social-emotional growth, adaptive skills and responses, and knowledge

of behavioral expectations both within school and across settings (NASP, 2009). This supports

social-emotional growth and skill development in all students, and enhances consistent academic

performance and peer relations as students are more equipped to respond to frustration, high-

demands, and aggression in positive ways. As concerns arise regarding student achievement

and/or behavioral conduct school staff are prepared to respond.

The majority of students will have their needs met in tier I. Others will move onto tier II,

which offers heightened support. A small percentage of student needs will remain unmet at tier I

and tier II support. Multi-tiered problem-solving models are prepared for these students with

highly individualized and intense support in tier III. At each tier, explicit teaching of behavioral

expectations and problem identification (skill-deficit or performance-deficit) is critical to

intervention success. Also vital is continued progress monitoring and evaluation of the

intervention. Focusing on the social-emotional well-being of students and recognizing signs of

at-risk behavior as they surface is essential to providing early interventions that prevent at-risk

academic and behavioral concerns from escalating into something larger (Conners, 2008), as

schools proactively provide the necessary support to effectively intervene (interrupting the

disorders escalation).

Prevention programs that target explicit instruction of expected behaviors, social-

emotional skills development, and peer relations at the universal level has proven highly

38

effective in the prevention and treatment of emotional-behavioral outbursts and disorders.

Programs such as Second Step and the Good Behavior Game provide lessons in adaptive

conduct, self-monitoring, and attaining positive peer relations and interactions with adults.

Universal and small-group intervention and prevention techniques often employ CBT. CBT

techniques focus on adaptive skill building through modeling, self-soothing, role-plays, ect. This

view is embraced in the Second Step curriculum, SSiS interventions and progress monitoring

principals, the Fast Track program, and in the Conners CBRS intervention model.

Successful interventions are multifaceted and initiate preventive-intervention services as

soon as possible within a students life, as described and initiated in the Fast Tracks preventive

intervention (CPPRG, 2011). Comprehensive intervention-prevention programs (such as the

Fast Track program) have high efficacy rates. These programs focus on precursor warning signs

to provide early intervention before a problem arises. A key component is parent involvement,

parenting lessons, long-term treatment to ensure success and skill building, and comprehensive

interventions that target school, home, and community variables associated with the onset of ED.

FBA and BIP to achieve individualized and meaningful interventions that target specific problem

behavior(s), detail roles and supports that strengthen the application and consistency, and

provides environmental adaptations that transform maladaptive responses into predictable,

expected behavior.

Critical Analysis

Concerns regarding adolescents whom are successful during treatment yet regress when

the treatment or intervention ends is addressed by interventions that offer extended support, the

Fast Track preventive intervention details this necessity to counter with extenuating

39

environmental factors, also to ensure adaptive behaviors continue to adapt in new environments

and situations (CPPRG, 2011).

Punishing students identified as ODD/CD with detention, suspension, or expulsion may

be an inappropriate and ineffective disciplinary response for misbehavior. The purpose of

disciplinary response is to diminish future occurrence of the problem behavior. An example may

look like the following: a student avoiding oral reading misbehaves by name-calling, throwing

the book, and refusing to participate in the lesson. To address the student’s inappropriate

behavior the classroom teacher instructs the student to go to the principal’s office and read there.

The student’s desire to avoid oral reading is accomplished and the classroom instructor is

satisfied with his actions, having asserted the classroom expectations and regaining control of the

class. Upon closer examination it’s clear the student’s frustration regarding oral reading has not

been addressed and the classroom teacher unintentionally strengthened the student’s

inappropriate problem-solving method for avoiding reading. Removing the student from the

classroom deprives the student from instruction and academic intervention needed to strengthen

his literacy skills. Punishments that interfere with class time (such as suspensions) removes the

student from school, a stable, healthy environment that delivers behavior and academic

interventions. Research shows that children from low SES, neglectful, violent, and broken

homes have the highest risk of developing ODD and CD. Not only does suspension remove the

child from school supports, it likely places the child in an unstructured and maladaptive

environment. Underlying risk-factors related to missed class-time are especially problematic for

this population. As these student’s have less exposure to instruction, teacher, and class-

materials. Whereas those in class are provided immediate feedback and opportunities to ask

questions and receive clarification. Perhaps even more crucial is missed academic, social,

40

emotional, and behavioral support from individualized interventions. Multi-tiered problem-

solving models provide necessary supports and safe-guards that systematically collect data used

to describe the function of the students behavior and meaningful responses.

Research supports the use of empirically based prevention and intervention methods

when confronting ODD/CD. Empirically based programs such as Second Step and SSiS

interventions have high reliability and validity in addressing problem behavior and building

adaptive social, emotional, and behavioral skills in children and adolescents. Data driven

proactive interventions are accomplished through multi-tiered problem-solving models. School

practitioners are also encouraged to use evidenced-based strategies such as FBA in problem-

identification and BIP to ensure successful interventions. Whatever strategy is used to apply the

intervention and support services, research shows it is necessary to provide opportunities for the

student to interact with appropriate applied-behavior in various environments. Repetition across

a continuum of situations and places reinforces and legitimizes the benefits of the desired

behavior and the outcome and strengthens the likeliness the student will independently respond

with adaptive behavior.

Recommendations

The following recommendations address effective intervention and prevention methods

for students at high risk and/or diagnosed as ODD and CD. Recommendations are derived from

the information accessed in this literature review.

Research has consistently demonstrated the effectiveness of early intervention in ODD

and CD has the highest success rates, also that early intervention and prevention efforts are

systematically addressed in three-tiered models. Research also suggests that teachers are often

the first to identify academic and behavioral concerns in children and adolescents. Thus, it is

41

recommended that schools employ multi-tiered problem-solving models that explicitly teach

expectations, systematically provide proactive support for academic and behavioral concerns,

and encompass several approaches that address early identification.

Because so many students with emotional behavioral problems also experience academic

difficulties, it is recommended that practitioners use data-driven strategies (such as FBA and

BIP) that target problem behaviors, meaningful interventions, progress monitoring, and

evaluation. Data-driven strategies use empirically-based interventions that include contingency

management and behavior modification.

Because research shows that interventions are more successful when parents are involved

in goal-setting and implementation, it is recommended that schools seek prevention and

intervention strategies that actively encourage parent involvement and home to school

collaboration.

Research shows that students identified with ODD and CD like behaviors tend to have

poorly developed social skills, emotional regulation, or a repertoire of socially accepted

responses. Providing prevention and intervention skills training that includes CBT is

recommended to accommodate this needs through skill building lessons that focus on the

application of the behavior/skill. Intervention and prevention efforts must address the

maladaptive behavior corresponding to the disorders must be addressed and replaced with

adaptive and appropriate responses.

Lastly, prevention and intervention strategies pertaining to ODD and CD will also

require, progress monitoring, and critique/revision in the evaluation process.

42

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