A few days ago, police in Orange County, California conducted a sweep and picked up youths who were on the streets after the county's curfew without an adult. This sweep was focused on areas where criminal activity is high. and is an attempt to prevent youths from making decisions that lead them to criminal behavior.
While I commend the police for protecting the community, they need the help from parents and the community to be able to have any realistic chance of curtailing juvenile crime. First of all, they are only able to catch kids a fraction of the time offenses may be committed. If you consider the number of times people drive over the speed limit compared to the number of times they get caught, the lesson about effectiveness is clear. The more effective effort would be for parents to have a punishment at home for each time a child was out past curfew, their curfew or the legal curfew. If people received a ticket for each time their car crossed over the speed limit, they would stop speeding.
A second point is that there is no reason to believe that crime can not be commited by juveniles prior to the established curfew. They may make it home by curfew, but could have stolen, sold drugs, or commited any number of offenses prior to the curfew. It is noteworthy that the youths picked up in Orange County were in high crime areas. A big predictor of juvenile crime is the association with delinquent peers. These youths were clearly not under any meaningful supervision, as evidenced by their being out beyond curfew, and were in high crime areas. It's clear that they were not associating with kids intent on following the law. If we were successful in having these youths in their homes by the curfew, we still have no idea what they were doing until that time. It is extremely important that families understand where their kids are going, with whom they associate, and what they are doing.
This sweep is an example of a significant police effort, but it also shows that police are not able to accomplish the goals on their own. Many youths are arrested several times, which is the police role, before committing a significant crime. Parents are the most powerful forces in their child's lives. If the police could accomplish it alone, they would have done so by now. Parents can do the job, but many need help. They may have their own challenges that serve as barriers, may not be experienced in the necessary skills, may need practical or emotional support etc.There are evidence-based practices that can provide the training and support. The research community has proven it as has the service community. If we support such programs, parents, youths, communities, and police will appreciate it.
Tuesday, May 14, 2013
Tuesday, May 7, 2013
ADHD Diagnosis Warrants Scrutiny
As professionals prepare for the new DSM-V, the Diagnostic and Statistical Manual of Mental Disorders, Dr. Winston Chung, a psychiatrist with Sutter Pacific Medical Foundation, appropriately labeled his concerns with the criteria for ADHD. ADHD is a disroder characterized by symptoms of inattention and hyperactivity. ADHD has been diagnosed when a person exhibits six of nine possible behaviors, but the DSM-V will reduce that to a threshhold of five. This presence of a package of behaviors may be enough to yield the diagnosis without consideration of the context of the behavior which may explain it and lead to a different approach than medication. The new standards will increase the probability of such a diagnosis and the likelihood of a prescription for stimulants where it could be avoided.
I worked with a case involving an eight-year-old boy who had been referred due to impulsive behavior in school. The referral indicated that he was never in his seat, never completed assignements, did not follow instructions and was generally disruptive in class. In order to fully understand the behavior, I requested to observe the class; I was very curious to see how the child's behavior could be as disruptive as described.
When I observed the class, I did notice that the child was out of their seat and not following directions as described, but I also saw that everyone in the class was behaving the same way. The students in this class were literally walking around the rooom, stepping over desks and generally using the classroom as a playground; it may have been a safety risk to be seated in the class. I was unsure of why they singled out this one child - perhaps they didn't.
In this case, which is admittedly an obvious one, the context of the behavior explained it more than a disorder, or at least made it difficult to diagnose under those conditions. Rather than pursue a medical intervention, the parents requested a change in classrooms and we worked to develop parenting skills to help them administer discipline at home and to coordinate with school.
As stated previously, this is an obvious example, but children's behavior is often maintained by elements of their ecology that include influences at school, parenting strategies, peer influence etc. It's important to understand the sequences of behavior and the contexts that maintain behavior in order to diagnose it well and treat is as safely and effectively as possible. This is increasingly important as the diagnostic criteria are weakened.
I worked with a case involving an eight-year-old boy who had been referred due to impulsive behavior in school. The referral indicated that he was never in his seat, never completed assignements, did not follow instructions and was generally disruptive in class. In order to fully understand the behavior, I requested to observe the class; I was very curious to see how the child's behavior could be as disruptive as described.
When I observed the class, I did notice that the child was out of their seat and not following directions as described, but I also saw that everyone in the class was behaving the same way. The students in this class were literally walking around the rooom, stepping over desks and generally using the classroom as a playground; it may have been a safety risk to be seated in the class. I was unsure of why they singled out this one child - perhaps they didn't.
In this case, which is admittedly an obvious one, the context of the behavior explained it more than a disorder, or at least made it difficult to diagnose under those conditions. Rather than pursue a medical intervention, the parents requested a change in classrooms and we worked to develop parenting skills to help them administer discipline at home and to coordinate with school.
As stated previously, this is an obvious example, but children's behavior is often maintained by elements of their ecology that include influences at school, parenting strategies, peer influence etc. It's important to understand the sequences of behavior and the contexts that maintain behavior in order to diagnose it well and treat is as safely and effectively as possible. This is increasingly important as the diagnostic criteria are weakened.
Monday, May 6, 2013
Utah Referee Case - Sports/Jobs Not Always the Answer for Delinquent Teens
I have spoken before about the fact that the two direct predictors of delinquent behavior are past offenses and associating with delinquent peers. In attempts to remove some of that peer influence, therapists and families often work to involve kids in prosocial activities, and they should. However, not all activities are created equal.
The recent case of the soccer referee in Utah who was killed when he was punched by a player reminded me of a caution I give to therapists and families. In the Utah case, there was a history of violence in the soccer league toward officials in the form of player violence and fan fury. In such situations, the soccer team and the fans may support violent behavior and negate the effort to remove the child from such an influence.
In other cases, it's very common for parents and therapists to push for a child to be employed, a seemingly good choice. However, there may be other kids employed at the same place who are also getting into trouble and use breaks at work as a time to use drugs.
I don't want to suggest that sports are bad or that employment is bad. I am suggesting that if your child has a history of getting into trouble, you may not want to accept at face value that the new activity is a step in the right direction. I have had clients say they wanted a job and found out that their friends all worked at the same place, and the manager sold drugs. Just as you should diligently assess your child's friends, you must also assess the new activity. Are the kids on the team violent or is that prevalent in the league? Who are the child's coworkers? What do they do on breaks or when they take out the trash at work? Each of these questions may require you to go and investiage, take names, ask about people, watch what's going on and make your assessment.
If you are trying to get a child involved in a prosocial activity; that's great. I only offer these words of caution so that your tremendous effort yields the result you want for you and your family.
The recent case of the soccer referee in Utah who was killed when he was punched by a player reminded me of a caution I give to therapists and families. In the Utah case, there was a history of violence in the soccer league toward officials in the form of player violence and fan fury. In such situations, the soccer team and the fans may support violent behavior and negate the effort to remove the child from such an influence.
In other cases, it's very common for parents and therapists to push for a child to be employed, a seemingly good choice. However, there may be other kids employed at the same place who are also getting into trouble and use breaks at work as a time to use drugs.
I don't want to suggest that sports are bad or that employment is bad. I am suggesting that if your child has a history of getting into trouble, you may not want to accept at face value that the new activity is a step in the right direction. I have had clients say they wanted a job and found out that their friends all worked at the same place, and the manager sold drugs. Just as you should diligently assess your child's friends, you must also assess the new activity. Are the kids on the team violent or is that prevalent in the league? Who are the child's coworkers? What do they do on breaks or when they take out the trash at work? Each of these questions may require you to go and investiage, take names, ask about people, watch what's going on and make your assessment.
If you are trying to get a child involved in a prosocial activity; that's great. I only offer these words of caution so that your tremendous effort yields the result you want for you and your family.
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