Promoting the Emotional and Behavioral Success of Youths : A Practical Guide for Clinicians

Clinicians often have difficulty helping the parents of youth with emotional and behavioral difficulties and fail to recognize that often it is the youth’s cognitive and learning weaknesses that drive their maladaptive behaviors. This book aims to help clinicians further understand the roots of youth’s maladaptive behaviors. It also addresses the impact of youth’s varied cognitive abilities on their behaviors and problems with self-esteem, particularly in youth that do not meet the diagnostic criteria for a formal learning disability. While many clinicians view learning deficits as impairments in specific academic skills, these deficits go beyond varied learning abilities and often experience difficulties in emotional, social, and behavioral functioning. These impairments vary from child to child and it is crucial to develop practical interventions for improved self-esteem and emotional success. Varied learning abilities reflect a neurodevelopmental problem in youth that can lead to difficulties with their emotional, social, and academic functioning and limit their intellectual potential. There are often treatment impasses when a youth’s behavioral problems do not improve with traditional forms of psychotherapy and medication. The practical individualized interventions recommended in this book will: 1) decrease conflict in day-to-day interactions between youth and parents, 2) improve self-esteem and 3) help to achieve realistic social, emotional and academic goals. The text will help clinicians determine which maladaptive behaviors are a result of cognitive deficits and not “symptoms” of a disease-based mental disorder. Written by experts in the field, Promoting the Emotional and Behavioral Success of Youths reviews appropriate interventions in the context of the public health strategies that address the prevention of secondary socio-economic aspects as a result of cognitive weaknesses, such as realistic educational needs, career and employment choices. Clinicians will be able to use this book to develop “best fit” multimodal interventions to help parents of youth develop adaptive behaviors. Foreword Preface The Authors’ Journeys Personal Journey Professional Journey Acknowledgments Contents About the Authors Chapter 1: Introduction: Biological, Emotional, and Social Development Biological Development Emotional Development Social Development How to Use this Book References Chapter 2: The Four Pillars through a Contemporary Diagnostic Interview The Four Pillars Understanding Michelle, Sadie, and Rachel Psychologically Understanding Sadie and Rachel from a Disease-Based Model Approach Understanding Sadie and Rachel Developmentally Understanding Weaknesses in the Four Pillars of Hospitalized Youth From Psychiatric DSM–5 to Contemporary Diagnostic Interview The Contemporary Diagnostic Interview (CDI) Beginning the Interview Attending to the External Attributes of the Patient and Parents Assessing Temperament in the Contemporary Diagnostic Interview Assessing Cognition in the Contemporary Diagnostic Interview Cognitive Weaknesses Identifying Cognitive Weaknesses in the Contemporary Diagnostic Interview Birthday Conversation Learning Disorders in a Contemporary Diagnostic Interview Visual-Spatial Abilities Cognitive Flexibility (Theory of Mind) in a Contemporary Diagnostic Interview Cognitive Flexibility in Adolescents A Brief Assessment of Cognitive Flexibility in Adolescents Cognitive Flexibility in Preschool and Elementary School-Age Youth A Brief Assessment of Cognitive Flexibility in Preschool and Elementary School-Age Youth Personality: Internal Working Models of Attachment (IWMA) in a Contemporary Diagnostic Interview Secure Attachment Style Insecure Attachment Styles: Ambivalent/Anxious, Avoidant/Dismissive, and Disorganized Diagnostic Formulation Limitations of the Four Pillars and the Contemporary Diagnostic Interview References Chapter 3: Temperament: The Building Block of Personality Temperament Temperament Traits Activity Level Distractibility Intensity Rhythmicity Sensory Threshold Approach/Withdrawal Adaptability Persistence Mood Temperament Styles The Easy/Flexible Temperament Style The Slow-to-Warm-up Temperament Style The Difficult/Feisty Temperament Style The Mixed Temperament Style Temperament in Clinical Work References Chapter 4: Intelligence: “Why Don’t You Behave?” Introduction to Intelligence Does Knowing a Youth’s Cognitive Abilities Help Parents Have Realistic Emotional and Behavioral Expectations? Intelligence: The Second Pillar The Intelligence Quotient Controversy of IQ Tests The WISC-V Subtest Indices Academic Achievement Tests Moving Intelligence out of the Classroom Variability in Cognitive Assessments Are Full-Scale IQ Scores Clinically Helpful? Are Full-Scale IQ Scores Clinically Helpful in Inpatient Care? Special Evaluations The WISC-V Subtest Indices (Continued) Clinical Cases Verbal Comprehension Weakness: The Impostor DSM–5 Relevant History Contributing Family, Social, and Educational History Contemporary Diagnostic Interview Formulation Results of Psychological Testing Summary of Psychological Testing: WISC-V Primary Drivers Secondary Drivers Formulation After Psychological Testing Clinical Highlight Maladaptive Patterns Treatment and Intervention Recommendations Suggested Interventions Relevant Cross-References Verbal Comprehension Weakness: The Impostor DSM–5 Relevant History Contributing Family, Social, and Educational History Contemporary Diagnostic Interview Formulation Results of Psychological Testing Summary of Psychological Testing Primary Drivers Secondary Drivers Formulation After Psychological Testing Clinical Highlight Maladaptive Patterns Treatment and Intervention Recommendations While medications are not specifically indicated, some clinicians might use α 2 agonists or SGAs to address impulse control. However, these medications may not improve emotional regulation or maladaptive behaviors. Suggested Interventions Relevant Cross-References Fluid Reasoning Weakness: The Demanding Youth DSM–5 Relevant History Contributing Family, Social, and Educational History Contemporary Diagnostic Interview Later in the Interview Results of Psychological Testing Summary of Psychological Testing: WISC-V Primary Drivers Secondary Drivers Formulation After Psychological Testing Clinical Highlight Maladaptive Patterns Treatment and Intervention Recommendations Suggested Interventions Relevant Cross-References Visual-Spatial Weakness: The Worried Builder DSM–5 Relevant History Contributing Family, Social, and Educational History Contemporary Diagnostic Interview Formulation Results of Psychological Testing Summary of Psychological Testing: WISC-V Primary Drivers Secondary Drivers Protective Drivers Formulation After Psychological Testing Clinical Highlight Maladaptive Patterns Treatment and Intervention Recommendations Suggested Interventions Relevant Cross-References Working Memory Weakness: The Storm Chaser DSM–5 Relevant History Contributing Family, Social, and Educational History Contemporary Diagnostic Interview Formulation Results of Psychological Testing Summary of Psychological Testing: WISC-V Primary Driver Secondary Drivers Additional Drivers Formulation After Psychological Testing Clinical Highlight Formulation of Marissa’s Parents Maladaptive Patterns of a Storm Chaser Treatment and Intervention Recommendations Suggested Interventions Relevant Cross-References Working Memory Weakness: The Storm Chaser DSM–5 Relevant History Contributing Family, Social, and Educational History Contemporary Diagnostic Interview Formulation Results of Psychological Testing Summary of Psychological Testing: WISC-V Primary Drivers Secondary Drivers Protective Drivers Clinical Highlight Formulation After Psychological Testing Maladaptive Patterns of a Storm Chaser Treatment and Intervention Recommendations Suggested Interventions Relevant Cross-References Working Memory Weakness: Not a Storm Chaser DSM–5 Relevant History Contributing Family, Social, and Educational History Contemporary Diagnostic Interview Formulation Results of Psychological Testing Summary of Psychological Testing: WISC-V Primary Driver Secondary Driver Protective Drivers Formulation After Psychological Testing Clinical Highlight Maladaptive Patterns Treatment and Intervention Recommendations Suggested Interventions Additional Comments Relevant Cross-References Processing Speed Weakness: The Brave Turtle DSM–5 Relevant History Contributing Family, Social, and Educational History Contemporary Diagnostic Interview Formulation Results of Psychological Testing Summary of Psychological Testing: WISC-V Primary Driver Secondary Driver Protective Factors Formulation After Psychological Testing Clinical Highlight Alternative Formulations Maladaptive Manifestation Treatment and Intervention Recommendations Suggested Interventions Relevant Cross-References Special Situations Dyslexia and Nonverbal Learning Disorder (NLD) Dyslexia DSM–5 Relevant History Formulation Results of Psychological Testing Formulation After Psychological Testing Primary Driver Protective Factors Treatment and Intervention Recommendations Suggested Interventions Nonverbal Learning Disorder (NLD) DSM–5 Relevant History Formulation Results of Psychological Testing Formulation After Psychological Testing Primary Driver Secondary Driver Protective Factors Treatment and Intervention Recommendations Suggested Interventions Closing Remarks References Chapter 5: Cognitive Flexibility (Theory of Mind): “Being in your Shoes” Cognitive Flexibility/Theory of Mind Executive Functioning Mentalization Cognitive Flexibility/ Theory of Mind Clinical Assessment Cognitive Flexibility/Theory of Mind Testing Rorschach Test | Ages 6+ Theory of Mind Task Battery | Ages 2–18 Behavior Rating Inventory of Executive Function, Second Edition- BRIEF2 | Ages 5–18 NEPSY-II | Ages 3–16 Affect Recognition Theory of Mind Cases Adolescent with Low Average Working Memory, Below Average Theory of Mind Struggles Engaging in Psychotherapy DSM–5 Relevant History Contributing Family, Social, and Educational History Contemporary Diagnostic Interview History Formulation Results of Psychological Testing Summary of Psychological Testing–WISC-V Primary Driver Results of Cognitive Flexibility/ToM Testing Summary of Cognitive Flexibility/Theory of Mind–NEPSY-II Secondary Driver Discussion of NEPSY-II Formulation After Psychological Testing Maladaptive Manifestation Treatment and Intervention Recommendations Goals Suggested Interventions Relevant Cross-References Adolescent with very low average working memory and processing speed, well below average theory of mind and low average fluid reasoning and visual-spatial abilities DSM–5 Relevant History Contributing Family, Social, and Educational History Contemporary Diagnostic Interview History Formulation Results of Psychological Testing Summary of Psychological Testing–WISC-V Primary Drivers Results of Cognitive Flexibility/Theory of Mind Testing Summary of Cognitive Flexibility/ToM Testing –NEPSY-II Secondary Drivers Discussion of NEPSY-II Results of Personality Testing Primary Drivers Formulation After Psychological Testing Why Are Youth like Brooke Labeled as Having Affective Disorders? Maladaptive Patterns Treatment and Intervention Recommendations Goals Suggested Interventions Relevant Cross-References References Chapter 6: Personality: “My Friends Are Just Like Me” Personality Attachment Theory Attachment Styles Secure Attachment Insecure Attachment Ambivalent Attachment/Anxious Avoidant Attachment/Dismissive Disorganized Attachment Attachment Theory Across Lifespan Personality Disorders (Attachment Disturbances) Personality Testing Validity and Reliability of Personality Testing Commonly Used Personality Tests Projective Personality Tests Projective Testing Rorschach Test | Ages 6+ Children’s Apperception Test (CAT) | Ages 3–10 Thematic Apperception Test (TAT) | Ages 10+ Human Figure Drawing (House-Tree-Person; Draw-A-Person) | Ages 3–17 Objective Personality Tests Objective (Self-Report) Personality Tests Millon’s Theory of Personality Millon Adolescent Personality Inventory (MAPI) | Ages 13–19 Millon Adolescent Clinical Inventory, Second Edition (MACI-II) | Ages 13–19 Millon Pre-Adolescent Clinical Inventory (M-PACI) | Ages 9–12 Minnesota Multiphasic Personality Inventory-2 (MMPI-2) | Ages 17–64 Minnesota Multiphasic Personality Inventory–Adolescent (MMPI-A) | Ages 14–18 Personality Inventory for Children, Second Edition (PIC-2) | Ages 3–16 Personality Inventory for Youth (PIY) | Ages 9–18 The Shedler-Westen Assessment Procedure (SWAP) Cases Borderline Personality Disorder in Adolescence Cognitive Profile of Adolescent with Borderline Personality Disorder: A Storm Chaser Olivia DSM–5 Relevant History Contributing Family, Social, and Educational History Formulation Contemporary Diagnostic Interview Results of Psychological Testing Summary of Psychological Testing: WISC-V Primary Drivers Secondary Drivers Results of Personality Testing Summary of Personality Testing: MACI Formulation After Psychological Testing Maladaptive Manifestation Treatment and Intervention Recommendations Cross-References Cognitive Profile of Adolescent with Borderline Personality Disorder: Not a Storm Chaser Jade DSM–5 Relevant History Contributing Family, Social, and Educational History Formulation Contemporary Diagnostic Interview Results of Psychological Testing Summary of Psychological Testing: WISC-V Primary Drivers Secondary Drivers Formulation After Psychological Testing Maladaptive Manifestation Treatment and Intervention Recommendations Cross-References Narcissistic Personality Disorder in Adolescence Cognitive Profile of Adolescent with Narcissistic Personality Disorder: A Demanding Youth Harrison DSM–5 Relevant History Formulation Contemporary Diagnostic Interview Results of Psychological Testing Summary of Psychological Testing: WISC-V Primary Driver Personality Test (MACI) Summary of Personality Testing: MACI Primary Drivers Formulation Discussion Treatment and Intervention Recommendations Antisocial Personality Disorder in Adolescence Treatment References Chapter 7: Putting it all Together: Adapting to Youths’ Strengths and Weaknesses Emphasis on Two-Person Psychology How to Use this Chapter Integration of Four Pillar Concerns with Psychiatric Diagnosis Working Alongside Parents: Successes and Struggles The “Art” of Giving Practical Parenting Strategies to Parents of at-Risk Youths Temperament Youth with Difficult/Feisty Temperament A 9-Year-Old Boy with a Difficult/Feisty temperament Elicits a Reaction in an Experienced Clinician Interventions for Youths with Difficult/Feisty Temperament Behavior: Is Defiant and Resistant to Reason; Creates Negative Interactions with Others Intervention Behavior: Blames Misunderstandings and Mishaps on Siblings or Peers; Encourages Parents to Collude with their Point of View that they Were Treated Unfairly Intervention Behavior: Reacts Negatively to Planned or Unplanned Transitions Intervention Behavior: Becomes Oppositional when Asked to Complete Chores or Tasks Intervention Employment Opportunities Interventions for Youth with Slow-to-Warm-up Temperament Behavior: Displays Reluctance to Participate in Activities, Even though he or she Wishes to Engage Intervention Behavior: Displays Low Self-Esteem Intervention Employment Opportunities Cognition Interventions for Youths with Verbal Comprehension Weakness Behavior: In Preschool and Elementary Years, Fails to Understand Others: “What do you mean?” Intervention Behavior: In Middle- and High-School Years, Reacts with Anger when Given Complex Verbal Directions Intervention Behavior: Misinterprets Verbal Information and Experiences the Frustration of Others as Rejection Intervention Employment Opportunities Interventions in Youths with Visual-Spatial Weakness Behavior: Struggles to Evaluate Visual Details Intervention 10-Year-Old Boy with Visual-Spatial Weakness Playing with LEGOs Behavior: Becomes Frustrated when Following Directions in Complex or Competitive Activity Intervention Employment Opportunities Interventions in Youths with Fluid Reasoning Weakness Behavior: Becomes Frustrated in Situations in which he or she can’t Identify Solutions; Demands Answers from Others Intervention Behavior: Has Difficulty Generalizing Past to New Experiences Intervention Employment Opportunities Interventions for Youths with Processing Speed Weakness Behavior: Is Reluctant to Participate in Activities, Even though he or she Wishes to Engage Intervention Behavior: Takes Longer than Others to Reason and Integrate Social Information Intervention Employment Opportunities Interventions for Youths with Working Memory Weakness Behavior: Fails to Develop Adaptive Ways of Managing Complex Social Situations Intervention Behavior: Unknowingly Pushes Family or Friends Away Due to an Inability to Resolve Day-to-Day Conflicts Intervention Behavior: Feels Social Norms Are Unrealistic or Rigid and Defies them Intervention Employment Opportunities Personality Interventions in Youths with Borderline Personality Traits or Disorder Behavior: Develops Unstable Relationships (Becomes Overly Attached and Quickly Disappointed for Not Having Undivided Attention and Emotional Needs Met) Intervention Behavior: Displays Impulsive Risk-Taking behaviors (Substance Use, Sexual Activity, Runaway Activity, Nonsuicidal Self-Injury [NSSI], or Suicidal Attempts) Intervention Employment Opportunities Treatment for Borderline Personality Disorder in Youth Dialectical Behavior Therapy (DBT) Skills and Techniques Mentalization-Based Therapy for Adolescents with BPD Interventions for Youths with Narcissistic Personality Traits or Disorder Behavior: Displays a Strong Sense of Entitlement, Exaggerates Achievements, and Monopolizes Conversations Intervention Behavior: Takes Advantage of Others Intervention Behavior: Displays Poor Cognitive Flexibility; Is Unable to Recognize the Feelings and Needs of Others Intervention Employment Opportunities Special Issues Bullies Bullying Victims Suicidal Behaviors Substance Use in Adolescents Focus on Opioids Treatment for Substance Use in Adolescents Resources Social Media and Technology Having a Digital Strategy at Home Use of Technology Medication Adherence in Youth Future Direction References Chapter 8: Parenting Principles to Help Youths: Debunking Common Parenting Myths Introduction A Brief Review of the Four Pillars Understanding Parents Four Pillar Parenting What Should Parents Do When their Child Is Defiant, Oppositional, or Disrespectful? Divorce Elsa and Julian React to their Parents’ Divorce Divorced Parents Divorced Parents Should be on the Same Page. Right? Sometimes It’s Okay to Not be on the Same Page Stepparents and Adoptive Parents Parents and stepparents with Good Four Pillars (Adaptive Responses) Parents and Stepparents with Deficits in Cognitive Flexibility (Maladaptive Responses) What Is a Clinician Supposed to Do? Section I Parenting Principles Parenting Principles for Infants Being Responsive to the Infant’s Needs Sharing your Values and Understanding your Infant’s Moral Development Recognizing Concerning Development in your Infant Parenting Principles for Preschoolers (2 to 5 Years of Age) Terrible Twos Promoting Growth in Preschool Children Modeling Flexibility for Preschool Children Introducing Preschool Children to their Parents’ World Promoting Self-Regulation in Preschool Children Teaching Limit-Setting for Preschool Children DEAR Moments The Wait, Watch, and Wonder Approach Lying, Defiance, and Oppositional Behavior in Preschool Children Grandparents Think We Are Parenting Wrong Common Struggles for Parents of Preschool-Aged Children (Fig. 8.2) My Child Can’t Sleep My Child Asks for One More (Glass of Water, Trip to the Bathroom, YouTube Episode) at Bedtime Can my Child Take Melatonin for Sleep Problems? My Child Has Nightmares My Child Has Night Terrors My Child Has Potty-Training struggles (Enuresis and Encopresis) A 5-Year-Old Girl Is Afraid to “Poop Because the Angels Could Get Mad” My Child Displays “Nervous Habits,” Including Nail-Biting and Skin-Picking Parenting Principles for Elementary- and Middle-School-Aged Youths (6 to 13 Years of Age) Parent Principles for Elementary School-Aged Youths Parenting Principles for Middle-School-Aged Youths Helicopter Parents with Elementary- and Middle-School-Aged Youths Transitions Limit-Setting in Elementary- and Middle-School-Aged Children Lying, Defiance, and Oppositional Behavior in Elementary- and Middle-School-Aged Youths Why Do Elementary- and Middle-School-Aged Youths Lie? Why Are they, at Times, Defiant and Oppositional? Parenting Principles for High-School-Aged Youths 14 to 18 Years of Age (Adolescence) How Can Parents Promote Independence? Parenting the Adolescent as he or she Begins to Date Setting Limits with Adolescents Lying, Defiance, and Oppositional Behavior in Adolescents I Am a Good Parent, but this Week, I Am Exasperated with my Teenager! Section II Parenting Myths You Must Obey Me Because I Am Your Parent My Parents Used Time-Outs, so they Must Work If You Tell the Truth, You Will Not be in Trouble The Same Rules Go for all Siblings Parents Must Provide Structure at Home Chelsea That’s Not True; You Don’t Feel That Way You’re Intentionally Making Me Mad The Helicopter (DRONE) Parent (Fig. 8.6) When Is Looking over a Youth’s Shoulder Helpful? Special Situation: COVID-19 It Won’t Hurt/You Will be Fine/There Is Nothing to be Afraid of Helpful Comments for Youths Who Experience Pain If you Sign up for an Extracurricular Activity, you Must Finish it They Need to Learn to Live in the “Real World” An Adolescent’s “Real World” Final Thoughts References Appendix A Index