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NRNP 6640 Walden University Week 9 Alternative Therapeutic Approach Discussion

Description

Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.
2 paragraphs
5-6 sentences each paragraph
2 references

Student Response #2

The Blaming Child
The patient selected for this case discussion is the adolescent boy who stole and drove his gym instructor’s car. His initial reaction was of anger and denial of his responsibility passing the blame to his parents and even to his gym instructor for leaving the keys in the car. He was resentful that another kid had reported him landing him in the counseling office. The key features of anger, argumentative/defiant behavior, and vindictiveness give basis to the diagnosis of oppositional defiant disorder per DSM-5 criteria (American Psychological Association, 2013). DSM-5 also points out that these behaviors must be observed for at least six months. For the patient to have counseling, it can be inferred that the oppositional defiant behaviors have been replicated over a period enough for the parent and school to seek professional attention for the patient. It is worth mentioning that ODD and attention-deficit/hyperactive disorder (ADHD) have a strong co-morbidity with anger–irritability dimension of ODD traced to ADHD (Ghosh et al., 2017). Taking only the distinctive symptoms that the patient presents, ODD is the likely diagnosis.
Parents who have children with ODD may not be adequately prepared to handle the challenges of ODD, which may affect the family dynamics and further exacerbating the problem (Mackler et al., 2015). Parents may impose harsh penalties, provide inconsistent parenting skills, and become angry and aggressive themselves, necessitating the need to teach parenting skills (Amini Naghani et al., 2020). Foremost on the list of therapeutic approaches for ODD is Parent management training (PMT) which uses social learning and practices to modify revising ineffective parent-child interactions to promote a more socially acceptable behavior on the side of the child (Bruce & Jongsma, 2011). PMT involves teaching parents to reinforce positive behaviors and ignore or set limits on negative behaviors (Bruce & Jongsma, 2011). PMT also uses modeling, prompting and fading, shaping, practice and repeated rehearsals, extinction, and mild punishment (Kazdin, 2017). PMT is often touted as the primary therapy in ODD because of numerous empirical evidence (Ollendick et al., 2016). However, PMT was less beneficial for children above eight years old (Bruce & Jongsma, 2011).
Positive parenting program (PPP) which is also based on the social learning theory uses a multilevel strategy to improve parenting skills, reduce disputes, and develop social wellbeing (Amini Naghani et al., 2020; Sanders, 2012). The rationale for its multi-level strategy is due to the unique degree of dysfunction between a child and adolescent, while parents also have their distinctive needs and so PPP adapts to this combination of parent and child therapy requirements (Sanders, 2012).
Therapy that is geared towards the child can include the widely used cognitive-behavioral therapy (CBT) to control impulsive behavior and anger. In general, the focus of CBT is for the child and to learn principles and strategies to create a change in thought, emotion, and behavior (Sukhodolsky et al., 2016). CBT strategies include behavior rehearsal which can be used to practice socially acceptable behaviors, contingency management which uses a reward system to reinforce positive behaviors and problem-solving and cognitive restructuring techniques (Clevenger, 2014).
Although there is no approved medication for ODD methylphenidate and dextroamphetamine are used by practitioners with positive results (Garg et al., 2015; Golubchik & Weizman, 2017). If the patient has aggressive behaviors, risperidone, aripiprazole, and quetiapine can also be given (Riley et al., 2016).
There is an impetus to recognize ODD symptoms early and take part in therapy early because ODD down the road can lead to more serious behavioral and/or legal problems. The end-product of the parent and child-directed therapies can be commonly summed as better family functioning, for the parents to use skills that promote prosocial skills and for the child to replace dysfunctional thoughts and behaviors into positive ones. The achievement of better behavior controls helps the ODD patient become more productive with life with better social engagement leading to a happier state.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental health disorders.
(5th ed.). Washington, DC: Author
Amini Naghani, S., Najarpourian, S., & Samavi, S. A. (2020). Comparing the effectiveness of the triple
p-positive parenting program and parenting program of acceptance and commitment therapy on
parent-child relationship and self-efficacy of mothers with oppositional defiant disorder children.
Journal of Research and Health, 10(2), 111-122. http://jrh.gmu.ac.ir/browse.php?a_id=1743&sid=
1&slc_lang=en&html=1
Bruce, T. J. and Jongsma, A. E. (Directors). (2011). Evidence-based treatment planning for disruptive
child and adolescent behavior [Video/DVD]. Retrieved from https://video-alexanderstreet-com.
ezp.waldenulibrary.org/watch/evidence-based-treatment-planning-for-disruptive-child-and-adolescent
-behavior
Freeman Clevenger, S. (2014). Cognitive behavioral therapy. In Wheeler, K. (ed). Psychotherapy for
the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.).
New York, NY: Springer Publishing Company.
Garg, J., Arun, P., & Chavan, B. S. (2015). Comparative efficacy of methylphenidate and atomoxetine
in oppositional defiant disorder comorbid with attention deficit hyperactivity disorder. International
Journal of Applied & Basic Medical Research, 5(2), 114–118. https://doi.org/10.4103/2229-516X.157162
Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: current insight. Psychology
Research and Behavior Management, 10, 353–367. https://doi.org/10.2147/PRBM.S120582
Golubchik, P. & Weizman, A. (2017). The possible effect of methylphenidate treatment on empathy in
children diagnosed with attention-deficit/hyperactivity disorder, both with and without comorbid
oppositional defiant disorder. Journal of Child and Adolescent Psychopharmacology, 27(5), pp429-432.
http://doi.org/10.1089/cap.2016.0111
Kazdin, A. E. (2017). Parent management training and problem-solving skills training for child and
adolescent conduct problems. Evidence-based Psychotherapies for Children and Adolescents,
142-158. The Guilford Press.
Mackler, J. S., Kelleher, R. T., Shanahan, L., Calkins, S. D., Keane, S. P., & O’Brien, M. (2015). Parenting
stress, parental reactions, and externalizing behavior from ages 4 to 10. Journal of Marriage and
Family, 77, 388 – 406. http://dx.doi.org/10.1111/jomf.12163
Ollendick, T. H., Greene, R. W., Austin, K. E., Fraire, M. G., Halldorsdottir, T., Allen, K. B., Jarrett, M. A.,
Lewis, K. M., Whitmore Smith, M., Cunningham, N. R., Noguchi, R. J., Canavera, K., & Wolff, J. C. (2016).
Parent management training and collaborative & proactive solutions: A randomized control trial for
oppositional youth. Journal of Clinical Child and Adolescent Psychology, 45(5), 591–604. https://doi.org/
10.1080/15374416.2015.1004681
Riley, M., Ahmed, S., & Locke, A. (2016). Common questions about oppositional defiant disorder. American
Family Physician, 93(7), pp586-589. https://eds-a-ebscohost-com.ezp.waldenulibrary.org…
pdfviewer?vid=2&sid=0d5a2601-f68e-4b59-9df0-c2b18065a81a%40sessionmgr4006
Sanders M. R. (2012). Development, evaluation, and multinational dissemination of the triple P-Positive
Parenting Program. Annual Review of Clinical Psychology, 8, 345–379. https://search-ebscohost-com.ezp.
waldenulibrary.org/login.aspx?direct=true&db=edsgea&AN=edsgcl.284578537&site=eds-live&scope=site
Sukhodolsky, D. G., Smith, S. D., McCauley, S. A., Ibrahim, K., & Piasecka, J. B. (2016). Behavioral Interventions
for Anger, Irritability, and Aggression in Children and Adolescents. Journal of child and adolescent
psychopharmacology, 26(1), 58–64. https://doi.org/10.1089/cap.2015.0120

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