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This study reported on the efficacy of Reciprocal Skills Training (RST), a family-based treatment modality for childhood externalising disorders. Children (N = 57) ranging from 7 to 12 years old who fulfilled diagnostic criteria for oppositional defiant disorder were randomly allocated to RST (in either a hospital or clinical setting) or a waiting-list control group. At posttreatment, no significant differences were observed across the two treatment settings. Results indicated that 95.5% of children in the hospital setting and 72.2% of children in the clinical setting no longer met criteria for oppositional defiant disorder, compared to 30% of children on the waiting list. Children in the treatment groups also obtained significantly lower scores on the Externalising scale of the Child Behaviour Checklist, compared to the waiting-list group. In addition, mothers' levels of stress and depression were significantly reduced at posttreatment, compared to mothers of children on the waiting list. These findings suggest that RST is an effective treatment modality for children displaying externalising behaviours, as well as for their mothers. The results are discussed in terms of limitations of the current study and future directions for research and clinical practice.
Sharing is an important social behaviour for promoting reciprocal interaction and interactive play among peers, but previous studies have only trained giving and accepting behaviours. We trained appropriate asking in addition to giving, and tested for functional independence. Three socially isolated children were first trained either to ask appropriately for their turn with a toy, or else to offer the toy to a confederate child, and this was reversed after stability. There was an immediate increase in whichever behaviour was trained, but the other behaviour showed no increase until it was directly trained. This was replicated with two nondisabled children. Follow-up assessments on all five children showed some maintenance up to a month after training. These studies demonstrate that appropriate giving and asking are functionally independent, at least in this experimental setting; that this is not restricted to socially isolated children; and that asking does not emerge from training giving alone. It was argued that, while these results could be due to instructional control rather than the more natural consequences of sharing, such social rules or norms are typically taught as instructions from teachers and parents.
The assessment of sexual offenders consists of the systematic collection of clinically relevant information in order to detect clinical problems and to provide clear treatment targets. A key but neglected issue in the area of sexual offending concerns the role of individual case formulations in the determination of offenders' treatment needs. In this paper, we investigate the relative strengths and weaknesses of manual-based treatment (MBT) and formulation-based treatment (FBT) for sex offenders. On the one hand, FBT has the advantages of greater flexibility and a more individualistic focus, and arguably is better equipped to deal with more complex clinical presentations. On the other hand, MBT has the advantages of standardisation and less reliance on clinicians' (flawed) judgement, and may be a more efficient use of scarce resources. We conclude that clinicians should initially provide manual-based treatment rather than that based on individualised case formulations. However, we also suggest that there are at least four situations where FBT represents a valuable strategy, namely when confronted with particularly complex or unusual cases, when standardised treatment has failed, or when there are significant threats to the therapeutic relationship. Finally, we briefly discuss some possibilities for research, and caution that our mixed model is only proposed as a temporary solution and that ultimately any model concerning treatment selection needs to be empirically based and conceptually defensible.
Obsessional thoughts or “pure” obsessions and overvalued ideation represent two salient phenomena within obsessive-compulsive disorder (OCD) that remain somewhat treatment-resistant. Treatment issues regarding these phenomena are discussed in the context of two clients attending a state health community psychiatry clinic. Both clients displayed significant improvement over the course of treatment on measures of OCD and depression. Pertinent issues are raised concerning the timing of specific treatment components, measurement processes, and the general direction of treatment research in this area.