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.
Author(s): Sergio V. Delgado, Ernest V. Pedapati, Jeffrey R. Strawn
Publisher: Springer
Year: 2022
Language: English
Pages: 342
City: Cham
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
