The primary focus of my research has been developing psychological treatments for children who engage in extreme aggressive and antisocial behavior. Such behaviors are relatively prevalent (approximately 9–10 percent of children in the United States) and are among the most frequent bases for referring children to treatment (up to 33 percent of cases of children seen in treatment). The behaviors occur in both boys and girls but are much more prevalent among boys. In the long term, children with aggressive and antisocial behaviors are at greatly increased risk for mental health problems (e.g., psychiatric disorders, substance abuse), physical health problems (e.g., early death from disease), and criminal behavior (e.g., domestic violence, child abuse). The problem of aggressive and antisocial behavior is very costly for society because the children require many social and hospital services, are often taken to emergency rooms for behaviors that are dangerous or uncontrollable, are in special classes at school, and are in repeated contact with the criminal justice system. Until recently, no interventions had been shown to have impact on the problem – not medication, psychotherapy, special experiences (e.g., wilderness camps), or special diet.

Contribution and Its Importance

My clinical research has focused on children hospitalized or seen in out-patient treatment for extremes of these behaviors. The children get into frequent fights, destroy property, steal, set fires, and run away from home, in addition to exhibiting many other less severe but still problematic behaviors such as tantrums, oppositional behavior, and bullying. The constellation of behaviors constitutes a psychiatric disorder referred to as Conduct Disorder. As with many other psychiatric disorders (e.g., major depression, autism), there are varying degrees of severity and impairment.

We have developed two treatments, referred to as parent management training (PMT) and cognitive problem-solving skills training (PSST) (please see References at end of chapter). PMT trains parents very concretely in new ways to interact with their children in the home. Parents meet individually with a therapist. The parents learn how to administer antecedents, such as instructions, prompts, or cues on how to perform the behavior; to focus the child on practicing the behavior by gradually reinforcing approximations of the behavior; and on consequences to increase prosocial behaviors by delivering praise and tokens. The therapist uses role-playing of parent–child interactions, repeated practice, modeling of the desired parent behaviors, feedback, and praise.