Enhancing Quality in
School Mental Health

Guidelines for talking with parents

When caregivers learn that their child displays disruptive behavior at school, their initial reaction may be one of acceptance, defensiveness or denial.
Knowing that family involvement is integral to successful treatment outcomes, school mental health clinicians should explain the causes and development of child behavior in a way that engages and empowers families.
This article provides a guideline for talking with parents of children who present with defiant or noncompliant behavior. Clinicians can also use this information in conjunction with the resources provided on parent psychoeducation for DBD.
The Four-Factor Model of Oppositional Behavior in Children.
When answering the question, “where did my child’s oppositional behavior come from?”, clinicians can describe the following four contributing factors:
Factor 1: Impaired child and family management practices.
Caregivers must first recognize that ineffective and inconsistent child management methods often promote noncompliance and defiance. Rather than criticize their parenting style, clinicians should emphasize the bi-directional nature of parent-child behavior. (i.e., poor or inconsistent child management leads to oppositionality, which in turn may lead to increased difficulties in parenting).
Also, clinicians may highlight how children and adolescents use disruptive behavior as a means for escape and avoidance. Pointing this out to parents can help them modify their approach to creating and enforcing different disciplinary standards.
Factor 2: Child temperament and cognitive characteristics.
While poor family functioning may intensify the level of disruptive behavior, clinicians can inform caregivers that certain children have temperaments and/or cognitive characteristics that make them more likely to be oppositional and aggressive.
For example, children and adolescents who exhibit high emotionality and poor habit regulation are more likely to display disruptive behavior; this, in turn, creates a greater potential for conflict between caregiver and child.
Clinicians should account for the impact of co-occurring symptoms when explaining to caregivers potential treatment approaches for their child.
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“I refuse to bribe my child”

Some families may regard tangible rewards as a form of bribery. When presenting the idea of token systems to caregivers, school mental health clinicians should explain the value of rewards in shaping appropriate behavior.
The following list provides key points to emphasize with caregivers when talking about the role of tangible rewards in treating disruptive behavior disorders.
Define bribery in terms the caregivers can understand. According to the Oxford English Dictionary, bribery constitutes “the practice of offering something (usually money) in order to gain an illicit advantage.”
Explain how tangible rewards differ from bribery. Namely, tangible rewards represent a “fair payment” for appropriate behavior on the part of the child or adolescent. Unlike bribery, tangible rewards provide incentive for licit behavior.
Describe how disruptive behavior disorder serves as a behavioral handicap in the child or adolescent. In the absence of a well-defined reward system, these children cannot readily overcome their handicap.
Remind parents that normal children receive rewards for good behavior as well. The primary difference for children and adolescents with disruptive behavior disorders, though, is that their behavior needs to be rewarded more systematically than that of their peers.
Barkley, R.A., Edwards, G.H., & Robin, A.L. (1999). Defiant teens: A clinician’s manual for assessment and family training. New York: Guilford Press.

Etiology of Disruptive Behavior

Factor 3: Parent temperament and cognitive characteristics.
School mental health clinicians know that children may inherit or model disruptive behavior from their caregivers. Parents who employ coercive behavior model negative behaviors that their children may later display at home and in school.
When developing a treatment plan for the student, clinicians ought to consider the impact of parent temperament on positive outcomes.
Factor 4: Larger contextual events.
Events both within and outside of the family may increase the risk for defiant behavior. Maternal social isolation and maternal marital status are two factors associated with the onset of disruptive behavior disorders; the children of single and unmarried mothers with a male partner often present with more aggressive behavior than children of married mothers.
Social adversity places an additional stress on children and adolescents, which could precipitate the onset or development of disruptive behavior disorders.
School mental health clinicians must remain mindful of the competing factors that influence student behavior. Although it may be difficult to address each of these factors during a session, effective treatment considers and responds to each factor.
Barkley, R.A., Edwards, G.H., & Robin, A.L. (1999). Defiant teens: A clinician’s manual for assessment and family training. New York: Guilford Press.