Using Behavioral Modification Therapy With Conduct Disordered Teens

Behavior Modification Therapy for Troubled Teens "We just came back from talking to the court-appointed psychologist. She says Bobby may have a conduct disorder and suggests residential treatment. Maybe we shouldn't have called the police when he smashed the shed but he just doesn't seem to obey any rules.

"Last month, he ran away from home for the third time and didn't come back for a week. He has been caught shoplifting and made to appear before our town's Juvenile Conference Committee. Last week, our neighbor's van was broken into and someone said they saw Bobby in the vicinity. It is no better at school. He has skipped classes and been truant since sixth grade.

"What is it a conduct disorder and why can't we keep him at home? He is only 14-years-old. That's just too young to be separated from his family."

My heart went out to Charles and Elaine P. when I heard this news. I knew how long they had been struggling with Bobby's behavior and also how much they loved their son. Previous therapists had suggested Bobby suffered from Oppositional Defiant Disorder (ODD), a milder form of Conduct Disorder (CD), and helped the P family implement a behavior modification program at home.

Behavioral Modification at Home

"We even had a home contract with Bobby," sighed Mrs. P.

"We targeted specific behaviors, like staying home after curfew and not losing his temper. It was very clear what was expected - such as being at home by 8 o'clock - and we posted his signed agreement on the refrigerator door.

"We even made sure to ask what reward he wanted for appropriate behavior. Bobby asked to extend his curfew to 10 o'clock for one night for every week of obeying the existing curfew. We all agreed that the consequence of being more than 30 minutes late was that the following week's curfew would be two hours earlier. I think we were pretty consistent in applying these standards and tried hard not to get angry when he walked in two hours late anyway."

I nodded, remembering how hard it was for Charles and Elaine to enforce this behavioral modification program.

Bobby was the master of what psychologists call "triangulation" or playing one adult against another. He would sincerely swear to one parent that the other had agreed to a special later curfew. Or, he would lie and say his teacher wanted him to attend an evening tutoring session or that the principal was having evening detention at the school.

"Elaine and I got to the point of checking every statement that Bobby made, both with each other and with the school. It was amazing how boldly he would lie and then smile mischievously when caught, as if it was all some sort of a game. But nothing seemed to change his behavior.

"Actually, we are starting to get scared that he will hurt someone or destroy something in one of his outbursts. Smashing our shed felt like he was smashing us. I guess we are getting scared for our own safety.

"All this said, I just don't understand how sending Bobby away will help him. What is it about a Conduct Disorder that responds better to residential treatment than making home contracts?"

What is Conduct Disorder?

According to the current Diagnostic and Statistical Manual of Mental disorders (DSM-IV), conduct disorder is defined as "a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated ."

It is one of the most serious childhood psychiatric disorders. Estimates of prevalence range from 6 to 10 percent of boys and 2 to 9 percent of girls.

Criteria include aggression to people and animals (bullying, initiating fights, harming with weapon, physical cruelty to people and animals, face-to-face stealing), destruction of property (fire setting or deliberate destruction of property), deceitfulness or theft (breaking into property or vehicles, lying, nonface-to-face stealing) and serious violation of rules (breaking curfew, running away, skipping school).

But some psychologists say that the kind of fear that Mr. and Mrs. P. are starting to feel for their own safety and that of their neighbors is a significant indicator that their child may have moved from Oppositional Defiant Disorder to full blown Conduct Disorder.

Why Residential Treatment

By the time most children reach their teen years, they have a strong sense of right and wrong. They have a conscience and have internalized "society" as having the right and power to make and enforce valid rules.

Youths that step over the line into Conduct Disorder do not have such a strong sense of their role in society. Their marching song is often "I don't care what you say or do, I will do what I want to do when I want to do it. If you stand in my way, I will step either on or over you."

Such teens often respond positively to round-the-clock enforcement of stated rules. They do best when consequences are clearly stated, nonnegotiable, and applied immediately. Every incident, good or bad, must be acknowledged and receive a response.

Most families cannot provide this 24-hour a day, seven days a week structure. Some item of behavior will be missed and "getting away with something" feeds the omnipotence of the conduct-disordered teen.

How it Works

A residential treatment setting provides opportunities for a teen to learn new patterns of living in society. The entire structure is set up on a reward basis based on obtaining desired privileges. To progress from level to level, roles must be fulfilled responsibly and the entire treatment community - peers and staff - vote on promotion.

For example, when Bobby arrived at the residential center, he was immediately placed on Level 1. That meant that he could not leave his unit without being accompanied by a staff member. He had no radio, CD player, or personal possessions aside from his clothes. Outside phone calls were forbidden.

In order to progress to Level 2 he had to complete all psychological and educational testing and not break any Center rules for a week. House rules included making his bed every day, being respectful to staff and peers, doing his daily task of vacuuming the main meeting room, and obeying lights out. And he had to get approval from the community.

Level 3 included the privilege of leaving the unit to walk around campus with a staff member, make limited phone calls, and buy things from the Center store. Levels 4 and 5 offered additional autonomy and privileges. In order to progress, a resident had to continue to evidence positive behavior.

If a minor rule was broken, he would drop down a level. If it was major, she might have to start all over from Level 1.

Bobby began Level 1 six times before rising to level 5 and maintaining it for three months. He is currently at home and receiving outpatient psychological and vocational assistance. The family is in counseling and there have been no incidents of violence for the past six months. The home contract is still in place.

Time will tell if Bobby will need additional treatment to stay on track. If this need occurs, Elaine and Charles are prepared to do their part.

Call today!(866) 746-6907

Using Behavioral Modification Therapy With Conduct Disordered Teens

Call today!
(866) 746-6907