Haim Omer

COERCIVE AND DISRUPTIVE BEHAVIORS IN PEDIATRIC OBSESSIVE-COMPULSIVE DISORDER

Background: This study explored the nature of disruptive and coercive behaviors in pediatric obsessive–compulsive disorder (OCD). Method: Thirty children with OCD and a disruptive behavior disorder (DBD) were compared to 30 children with DBD alone using the Child Behavior Checklist and a novel 18‐item questionnaire focused on distinctive coercive and disruptive behaviors seen in pediatric OCD (CD‐POC). Results: Although youth with DBD alone had higher ratings of Externalizing Behaviors on the CBCL compared to the youth with OCD + DBD, their ratings on the CB‐POC scale were lower. For example, 83% of OCD + DBD parents reported that their child “Imposes rules or behaviors on others due to tactile or other sensitivity and reacts to disobedience with rage or violence (e.g. forbids certain sounds, demands specific temperature settings)” compared to 23% of the parents of youth with DBD alone. Other highly discriminating behaviors included: “Demands special ‘cuddling’ or ritualized contact without regard for the will of others” and “Forbids the use of objects in his/her vicinity because of feelings of fear or disgust (e.g. knives, scissors, creams).” Total scores on the CD‐POC were also correlated with OCD severity (P<.01). Conclusion: The results suggest that the nature of DBD in pediatric OCD may be distinctive and worthy of further study. Depression and Anxiety, 2011.© 2011 Wiley‐Liss, Inc.

NONVIOLENT RESISTANCE: A TREATMENT FOR PARENTS OF CHILDREN WITH ACUTE BEHAVIOR PROBLEMS

Nonviolent resistance (NVR) is a new training model aimed at helping parents deal effectively with their helplessness, isolation, and escalatory interactions with their children. The purpose of this study is to evaluate training in NVR with the parents of children with acute behavior problems. Seventy-three parents (41 families) were randomly assigned to a treatment group and wait-list control group. Measures were taken at pretreatment, posttreatment, and a 1-month follow-up. In comparison with the wait-list group, parents who received training in NVR showed a decrease in parental helplessness and escalatory behaviors, and an increase in perceived social support. The childrens negative behaviors as assessed by the parents also decreased significantly.

Coercive and disruptive behaviors in pediatric obsessive compulsive disorder: a qualitative analysis.

OCD is a common disorder in children and adolescents. Disruptive or coercive behaviors among children with OCD have not been a focus of much research until recently. Family accommodation of OCD is strongly related to symptom severity, level of impairment, and treatment outcomes. The possibility of family accommodation being forcefully imposed on family members against their will has not been investigated systematically, although clinical experience points to the existence of such situations. The present study represents an early, qualitative exploration of such situations. The parents of 10 children and adolescents with OCD, who reported the existence of violent or disruptive behavior on the part of the child, were interviewed and their narratives analyzed using grounded theory methodology. Findings from the interviews point to the existence of a pattern of coercive behaviors in which rules and prohibitions, driven by the child’s OCD, are aggressively imposed on parents and siblings. The emergent themes are analyzed in relation to obsessive compulsive symptom dimensions and in relation to the means and goals they represent for the obsessive compulsive children.

The Anchoring Function: Parental Authority and the Parent‐Child Bond

Descriptions of parental authority and of the formation of a secure parent-child bond have remained unconnected in conceptualizations about parenting and child development. The parental anchoring function is here presented as an integrative metaphor for the two fields. Parents who fulfill an anchoring function offer a secure relational frame for the child, while also manifesting a stabilizing and legitimate kind of authority. The anchoring function enriches the two fields by: (1) adding a dimension of authority to the acknowledged functions of the safe haven and the secure base that are seen as core to a secure parent-child bond, and (2) adding considerations about the parent-child bond to Baumrinds classical description of authoritative parenting.

Adaptation and Evaluation of a Nonviolent Resistance Intervention for Foster Parents: A Progress Report.

Foster care faces serious challenges, such as behavioral problems in foster children and parental stress and ineffective parenting behavior in foster parents. The results of a pilot study that evaluated a training program for foster parents based on nonviolent resistance are described. In a pretest-posttest design, data were collected from 25 families. Significant reductions in externalizing, internalizing, and total problem behavior in the foster children and in parenting stress were found. Using a reliable change index, significant improvements in externalizing, internalizing, and total problem behavior were found in, respectively, 72, 44, and 80% of the cases. Most improvements proved to be clinically relevant. Effect sizes ranged from medium to large for problem behavior, and from small to medium for parenting stress.

Therapeutic Impact in Treatments for Smoking and Test-Anxiety

The concept of therapeutic impact was implemented and tested in two treatment studies, the first of smoking and the second of test-anxiety. Two impact factors previously defined, special states and activism, were employed in the creation of impact-enhanced treatment conditions, which were then compared to a basic treatment in each study. The three treatment conditions, taken together, were superior to the wait-list condition. In the smoking study, the impact-enhanced conditions were significantly superior to the basic treatment condition. In the anxiety study, the impact-enhanced conditions did not demonstrate statistically significant superiority over the basic treatment. The overall results were interpreted as supporting the impact model and as indicating that the impact variables may be of importance in structuring more effective treatments. Das konzept des therapeutischen «Nachdrucks» Wurde in Zwei Therapiestudien implementiert und uberpruft, die erste bezog sich auf eine Raucherentwzohnung, die zweit...

Engaging Fathers in Parent Training: A Qualitative Study

ABSTRACT Numerous studies have described fathers’ low participation in child psychotherapy. Few studies, however, have explored the clinical challenges involved in the process of engaging fathers effectively. The present study sought to address this gap by assessing the clinical process that takes place when the father joins therapy. Treatment supporters in a counseling program for child behavior problems were interviewed about clinical cases involving attempts to engage fathers. Qualitative analysis of the interviews revealed three main themes: The father’s initial suspiciousness, the father’s prior involvement at home, and the mother’s perception of the father’s help. Based on study results, a new model for fathers’ engagement is proposed.

Nonviolent resistance: helping caregivers reduce problematic behaviors in children and adolescents

In this review, the principles of nonviolent resistance (NVR) and studies examining its acceptability and efficacy are reviewed. Originating in the sociopolitical field, NVR has been adapted for numerous settings including parents of youth with externalizing and other problems, foster parents, teachers and school personnel, and caregivers of psychiatric inpatients. NVR has also been applied to reduce accommodation of highly dependent adult children and to improve novice driving habits. The principles of NVR include refraining from violence, reducing escalation, utilizing outside support, and maintaining respect for the other.

A Process Scale for Impact-Promoting Activities

An Impact Factors Process Scale (IFPS) was developed to assess impact-promoting activities in directive therapy. The IFPS focuses on three major therapist activities: (1) the creation of special, surprising, and arousing events; (2) the attraction of attention; and (3) the mobilization of commitment and effort. The IFPS was shown to be consistent and reliable. It successfully ranked the level of directiveness of different therapeutic approaches, displayed a sessions climax (or its absence), and provided a profile of the therapists impact-promoting activities in the session.

Helping Parents Cope with Suicide Threats: An Approach Based on Nonviolent Resistance

Parent training in nonviolent resistance was adapted to deal with situations of suicide threat by children, adolescents, and young adults. The approach aims at reducing the risk potential and the mutual distress surrounding the threat-interaction. Parent training in nonviolent resistance has been shown to help parents move from helplessness to presence, from isolation to connectedness, from submission to resistance, from escalation to self-control, and from mutual distancing and hostility to care and support. Those emphases can be crucial for the diminution of suicide risk. Parents show good ability to implement the approach and report gains on various areas over and beyond the reduction in suicide threat. A particular advantage is that the method can be used also in cases where the young person threatening suicide is not willing to cooperate.