“Group Intervention Program For Oppositional, Noncompliant and Aggressive Preschoolers”

By Vera Auerbach, Reg Nixon, Karen Nixon, Shylaja Gooley, Gundula Gemke

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ABSTRACT

The READY program is an innovative group treatment program designed for aggressive and non-compliant preschool aged children. Building upon the work of Hembree-Kigin and McNeil, READY is a twelve week program, with additional booster sessions two and four weeks after completion of the weekly sessions. Treatment is intensive and targets behavioural difficulties at several levels. The treatment comprises of (1) group instruction of specialised behaviour management techniques for parents, (2) social skills training and techniques to improve self-esteem for the children, and (3) a supportive psychotherapy group for parents.
Professional Areas / Key Words: Clinical Psychology, Preschoolers, Child & Family Health.
Please Note: A version of this article was published in Clinical Psychologist, Summer 1999, Vol. 3 No. 2, p 30-34.

CONTENTS

Introduction
The READY Program
The Setting / Staffing
Program Outline
1. Parent Stream
2. Preschoolers Stream
Assessment/Outcome Measures
Comments/Discussion
Authors & Acknowledgements
References

INTRODUCTION

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Behaviour problems account for 33-75% of child and adolescent referrals to mental health services (Wells and Forehand, 1985). Oppositional, aggressive, disruptive, antisocial and conduct disordered are all terms used in the literature to describe what are broadly known as externalising behaviours or conduct disorders. The prevalence of conduct problems in the child population varies depending on sample population, assessment methods and the severity of the behaviour, however is estimated to range from 2-16% (American Psychiatric Association, 1994).

Behavioural difficulties in childhood are associated with peer rejection (Coie and Koeppl, 1990) along with reading and academic difficulties (Campbell, 1990). In addition, children exhibiting oppositional and externalising type behaviours frequently possess poor social skills (Elliot, Barnard and Gresham, 1989; Vaughn, Hogan, Lancelotta and Shapiro, 1992). Longitudinally, behaviour problems in preschoolers have been found to be predictive of problems in adolescence (Lerner, Inui, Truipin and Douglas, 1985). Children displaying conduct problems are more likely in adulthood to become involved in crime, suffer poor physical health and develop drug and alcohol problems as well as developing antisocial personality disorder (see Kazdin, 1985; Kazdin, 1987a for a review). In addition, studies are now showing that conduct problems are transmitted across generations (Kazdin, 1987b).

Externalising problem behaviour which occurs in the preschool years has been shown to be stable throughout infancy and childhood (Campbell, Ewing, Breaux and Szumowski, 1986; Campbell and Ewing, 1990; Rose, Rose, Feldham, 1989), and is maintained in later childhood and adolescence (Egeland, Kalkoske, Gottesman and Erikson, 1990; Fischer, Rolf, Hasazi and Cummings, 1984). These findings suggest that behaviours which are predictive of later difficulties can be identified in early childhood. This offers researchers and clinicians some hope of being able to prevent the development of more serious behaviours by initiating interventions at the preschool level.

A number of studies utilising predominantly preschool aged samples have demonstrated that parent training is often an effective method of addressing behavioural disturbances (eg. Eyberg, Bogg and Algina, 1995; Webster-Stratton, Hollinsworth and Kolpacoff, 1989). However, there remains a proportion of parents who do not appear to benefit from parent training programs (Webster-Stratton, 1991). A number of factors have been implicated in poor treatment outcome. These include difficulty generalising behaviour management skills (Brody and Forehand, 1985); parental socioeconomic status (Dumas, 1986), as well as single parent status, low income and limited education (Webster-Stratton, 1985). Life stress, parental depression, and marital conflict have also been implicated (Webster-Stratton and Hammond, 1990). On average 28% of participants drop out of standard parent training programs (Forehand, Middlebrook, Rogers and Steffe, 1983).

Some parent training programs have developed treatment regimens to address the difficulties associated with poor treatment outcome. Griest, Forehand, Rogers, Breiner, Furey and Williams (1982) targeted mothers’ personal and marital adjustment in addition to teaching behavioural management techniques. To augment the generalisation of child management skills of parents in both stable families (Sanders and Christensen, 1985; Sanders and Dadds, 1982) and ‘multi-stressed parents’ (Dadds, Sanders and James, 1987) ‘planned activities’ have been developed. By offering such additions, it is hoped that parent training programs will be made more effective, aiding more families, and preventing premature drop-out. Despite moderate successes investigations of the efficacy of programs often suffer from limited sample size. These programs have continued to focus on parent training techniques with additional adult components, however, they miss the additional opportunities available by providing direct intervention with the children.

THE READY PROGRAM

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The READY program aims to augment the effectiveness of an already established treatment for behaviourally disturbed preschool-aged children (Parent-Child Interaction Therapy – described in detail by Hembree-Kigin and McNeil, 1995).

The ‘Redbank Early intervention program for Aggressive and oppositional Difficulties in Young children’ (READY) utilises a variety of treatment modalities to target oppositional, aggressive and noncompliant behaviour on a variety of fronts. Treatment modalities include:

(1) Specialised behaviour management techniques.

(2) Child-directed play skills for parents

(3) Group format and peer support for both parents and children to aid in the acquisition of (relationship) skills.

(4) Preschool social skills training and preschool skills group

(5) Visit to public settings to aid generalisation.

(6) Adult supportive psychotherapy group for parents.

The program is designed to include follow-up of clients at three month, six month and twelve months post treatment; and then again at primary school entry, late primary and high school entry.

THE SETTING/STAFFING

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Redbank House, Department of Child, Adolescent and Family Psychiatry, Westmead Hospital, Sydney provides a tertiary service for Western Sydney and the Blue Mountains. The Early Childhood Unit (ECU) is a specialised Unit that services under five year old children and their families. The READY program was designed for 2 – 4 year old oppositional children and runs as a one day per week program (10am – 2.15 p.m.) for twelve weeks. It has the following staff: 3 Clinical Psychologists, 1 Occupational Therapist/Psychologist, 2 Registered Nurses, 2 Clinical Psychology Students and 2 Volunteers (Preschool teachers or Psychology interns). In total the program requires 12 staff hours per week (below follows the break-up of these).

PROGRAM OUTLINE