The purpose of this study is to evaluate the effectiveness of an intervention model designed to enhance practitioners’ biological lens when using a biopsychosocial-spiritual model of holistic assessment and planning. The specific intervention utilized is a course curriculum developed to broaden human service professionals’ (including clinical social work professionals) understanding of attachment theory, neuroscience and trauma informed methods of practice. The course teaches professionals how to apply this knowledge to clinical assessment and intervention planning with youth who have experienced significant trauma in their lives and exhibit problems of conduct. Using an experimental design, participants from a large private mental health organization were asked to evaluate the impact of curriculum on their 1) knowledge of attachment theory, trauma informed practice and neurobiology; 2) attitudes concerning the relevance of trauma-informed practice, the biological perspective and consequence focused models of intervention; and 3) assessment and intervention planning strategies. The curriculum focused its application on youth who have experienced significant levels of trauma and display conduct related behavior problems. Group differences for the workshop intervention group and waitlist control group are discussed. Additionally, a preliminary evaluation of differences between two different intervention groups (participants in the Distance Learning version of the course and the Workshop Seminar version of the course) was conducted.

Conduct disorder is characterized by behaviors that take a large toll on the individuals, families, and communities afflicted. Thus, improving treatment effectiveness should be a high priority. Currently, common intervention programs do not address parental depression, even though it has been linked to adolescent conduct disorder behaviors in some studies. The current study assessed whether the relation between maternal depression and adolescent conduct disorder behaviors is mediated by another factor which has been linked to conduct disorder behaviors, maternal monitoring. Results did not support the hypothesized mediated association, but did show significant individual associations for both maternal depression and maternal monitoring with adolescent conduct disorder behaviors. Secondary analyses showed that adolescent age and household income were significantly related to maternal monitoring and maternal depression, respectively. Findings also suggested that child disclosure may drive the association between maternal monitoring and adolescent conduct disorder behaviors. Implications for intervention are discussed.

Nesta dissertação, procuramos compreender os sentidos e significados que os profissionais de serviços de saúde e de assistência social de um município do interior paulista têm acerca dos transtornos de comportamento em crianças e adolescentes. Para tanto, foi realizado um estudo qualitativo em dois serviços de saúde e 2 conselhos tutelares de um município do interior paulista. Participaram do estudo 13 profissionais. A coleta de dados foi realizada através de uma entrevista semiestruturada realizada em local escolhido pelos participantes. Para a organização e tratamento dos dados foi utilizada a técnica de análise de conteúdo de Bardin, que nos permitiu construir três categorias temáticas: \"Transtornos de comportamento: que comportamento é esse?\" \"Transtornos de comportamento: como se desenvolvem?\" \"Ações (des)articuladas entre os setores saúde e assistência no atendimento à crianças e adolescentes com transtorno de comportamento\". Verificamos que o conhecimento acerca da aplicabilidade diagnóstica dos transtornos de comportamento não é clara para os profissionais de nosso estudo, o que acaba dificultando a identificação e o encaminhamento dessas crianças e adolescentes aos serviços de saúde mental e assistência social. Para os profissionais de nosso estudo, os principais fatores de risco atribuídos ao desenvolvimento dos transtornos de comportamento em crianças e adolescentes são aqueles que ocorrem nas relações entre as crianças e seus familiares, como a violência doméstica, a desestruturação familiar, a falta de afeto e as práticas educativas, fatores que podem inclusive potencializar ou não a predisposição genética da criança ou adolescente a desenvolver transtornos de comportamento. Já os fatores macrossociais, como as condições sociais e culturais, a ação do estado e as características da sociedade nas quais vivem as crianças e adolescentes são pormenorizados como colaboradores para o desenvolvimento de transtornos de comportamento pelos profissionais de nosso estudo. Por fim, constatamos que as ações de prevenção à violência juvenil e de atendimento à crianças e adolescentes com transtornos de comportamento dos profissionais de nosso estudo não atendem às diretrizes e normas estabelecidas pela OMS e pelas políticas nacionais de prevenção à violência no que diz respeito ao trabalho integrado e intersetorial, no desenvolvimento de ações preventivas, na consolidação do atendimento pré-hospitalar sistematizado, hierarquizado e subsidiado por práticas baseadas em evidências e na capacitação adequada dos recursos humanos / In this dissertation, we seek to understand the senses and meanings that the professionals working in health and social welfare services from a city of the countryside of São Paulo have about behavior disorders in children and teenagers. For this purpose, we performed a qualitative study in two health services and two guardianship councils from a city in the countryside of São Paulo. This study was attended by 13 professionals. Data collection took place by means of semi-structured interviews held in a place chosen by the participants. In order to organize and treat data, we used the Bardin\'s content analysis technique, which enabled us to draw up three thematic categories: \"Behavior disorders: what behavior is this?\" \"Behavior disorders: how do they develop?\" \"(Dis) articulated actions between the health and social welfare sectors in meeting the demands of children and teenagers with behavior disorders\". We have found that the knowledge about the diagnostic applicability of behavior disorders is not clear to the professionals who took part in our study, which ends up hindering the identification and referral of these children and teenagers to mental health and social welfare services. According to the professionals who attended our study, the main risk factors blamed on the development of behavior disorders in children and teenagers are those that occur in relationships between children and their relatives, such as domestic violence, family breakdown, lack of affection and educational practices, which are factors that may or may not increase the genetic predisposition of the child or teenager to develop behavior disorders. Conversely, macro-social factors, such as social and cultural conditions, state action, and the characteristics of the society where children and teenagers live are specified as collaborators for the development of behavior disorders by the professionals of our study. Lastly, we have noted that the actions to prevent youth violence and to meet the demands of children and teenagers with behavior disorders carried out by the professionals of our study do not comply with the guidelines and standards established by the WHO and the national policies on violence prevention with respect to the integrated and intersectoral work, development of preventive actions, consolidation of a systematized prehospital care, i.e., hierarchized and subsidized by evidence-based practices, and appropriate training of human resources

Nossa Dissertação teve sua origem no contato com as idéias e com o trabalho clínico de Michael Wernet, nosso professor na Universidade de Freiburg-Alemanha e supervisor dos estágios que realizamos na instituição na qual é o psicólogo responsável. A apresentação do referencial teórico que embasa nosso trabalho inicia-se com a abordagem gestaltista de Wernet acerca do desenvolvimento do ato de perceber (Affolter, apud Wernet), o que implicou a exposição de conceitos básicos da Teoria da Gestalt (Wertheimer, Köhler, e comentadores como Castilho-Cabral, Engelmann, Ramozzi-Chiarottino). Tal perspectiva foi complementada com a apresentação da abordagem de Ayres acerca da Integração Sensorial e com o estabelecimento de relações entre o desenvolvimento do ato de perceber, segundo Affolter, e a construção do real segundo Piaget. O método utilizado em nossa dissertação foi o “estudo de caso". Analisamos comportamentos de cinco sujeitos (entre 22 e 44 anos), todos com transtornos severos do comportamento e danos no funcionamento cerebral. Nosso objetivo foi mostrar o sentido dos atos dos sujeitos, que compreendemos ser expressão da lei da pregnância de Max Wertheimer, e a tentativa de reorganizá-los visando a socialização dos sujeitos. A partir dessa compreensão, a intervenção que pudemos produzir tornou-se conseqüentemente pregnante, uma vez que cada etapa foi “requerida" pela anterior, representando uma mudança qualitativa em nossa relação com os sujeitos em questão. Os resultados mostram o sucesso de nosso intento: de um modo geral, constatamos uma diminuição na freqüência de surtos, uma substituição de comportamentos com seqüelas negativas para o sujeito por condutas alternativas sem as seqüelas anteriores, bem como uma melhoria na possibilidade de interação com o outro. / Our dissertation sprung from the contact with the ideas and the clinical work of Michael Wernet, our Professor in the University of Freiburg – Germany, and supervisor of the courses which we attended in the institution where he is the psychologist in charge. The theoretical basis of our work is compounded by the gestaltic approach of Wernet to the development of the act of perceiving (Affolter, apud Wernet), which led us to the basic concepts of the Theory of the Gestalt and latter commentaries on it (Wertheimer, Köhler, Castillo-Cabral, Engelmann, Ramozzi-Chiarottino). Such point of view was complemented by the approach of Ayres concerning the Sensorial Integration as well as by the establishment of connections between the development of the act of perceiving, according to Affolter, and the construction of the reality, according to Piaget. The methodology of our work is based on five case-studies. We examined the behaviour of five subjects (between 22 and 44 years-old), all of them with severe prejudices of behaviour and damaged cerebral functions. Our purpose was to show that their actions had a constructive meaning, which we believe to be the expression of the “law of pregnancy" of Max Wertheimer. It was also our objective to try to reorganize the subjects, aiming at their further socialization. Following this point of view, the result was that our intervention became pregnant, since each stage was demanded by the previous one. That represented a change of quality in our relationship with the subjects. The results point to the achievement of our goal: generally speaking, we obtained a decrease in the frequency of break-downs as well as a substitution of the so called “self aggressive behaviour" for other ways of response without negative sequels. Another result was the improvement of the possibility of the subjects to interact with other people.

This research examines interventions with adolescents in out-of-home care diagnosed with severe conduct disorder. Interventions from the service sectors of mental health, juvenile justice, child protection and welfare are reviewed and discussed. The research centred around three hypotheses. Firstly, that adolescents in out-of-home care diagnosed with severe conduct disorder have poor treatment outcomes. Secondly, that adolescents in out-of-home care diagnosed with severe conduct disorder are a particularly difficult client group to work with because of issues of attachment. Thirdly, that a diagnosis of severe conduct disorder negatively impacts upon the work professionals undertake with these young people. These hypotheses were considered in the context of an extensive literature review as well as findings gleaned from interviews and questionnaires conducted with research participants drawn from the abovementioned service sectors. Research participants were senio r practitioners and managers with many years of practice and experience working with adolescents in out-of-home care diagnosed with severe conduct disorder. The main findings from the research were that all three hypotheses appeared to be supported. These were that adolescents in out-of-home care diagnosed with severe conduct disorder have poor treatment outcomes and that one of the particular difficulties of working with this client group is the issue of attachment. Also, that the diagnosis of severe conduct disorder negatively impacts upon the work professionals undertake with these young people. These findings are discussed within the theoretical frameworks of attachment theory and critical theory, which are utilised in exploring the alienation and oppression of these young people on intrapersonal, interpersonal and societal levels. Finally, implications for social work research and practice are considered.

<p>The general objective of this thesis was to examine aspects of adolescents perceived interpersonal relations, in view of the association between adolescents’ interpersonal problems and self-concepts, and considering influential factors such as behavioural problems, depression, perceptions of parental rearing styles, type of relationships and sex. All of the studies examined participants from the four-year longitudinal research project in Umeå, which was designed to investigate the psychic health and social context of adolescents with psychological and antisocial problems (Armelius & Hägglöf, 1998), except for the normal adolescents in study I, who took part in a project with purpose to determine norms for an intake interview that is used for adolescents in different settings in Sweden. Study I addressed the impact of type of relationship on adolescents interpersonal behaviour, and the results were discussed in terms of interpersonal theory and the complementarity principle. Study II investigated the association between self-concept and interpersonal problems in normal adolescents. Different interpersonal problems were systematically related to three self-concept patterns, and showed the importance of considering the combination of self-love and self-autonomy to understand interpersonal problems in adolescents. In study III the associations between self-concept, and interpersonal problems were investigated, also considering depression as a factor, in a group of adolescents with conduct problems. This study revealed sex differences: boys’ interpersonal problems mainly were associated with self-control, an imbalance between self control and autonomy, and depression, whereas girls’ interpersonal problems mainly were associated with low self-love and depression. Study IV examined the relationship between memories of perceived parenting styles and interpersonal problems. Also in this study, sex differences were shown. It was found that for boys the perceived parenting styles of the fathers had the strongest associations to interpersonal problems, and for girls the perceived parenting styles of the mothers had the strongest associations to interpersonal problems.</p>

The general objective of this thesis was to examine aspects of adolescents perceived interpersonal relations, in view of the association between adolescents’ interpersonal problems and self-concepts, and considering influential factors such as behavioural problems, depression, perceptions of parental rearing styles, type of relationships and sex. All of the studies examined participants from the four-year longitudinal research project in Umeå, which was designed to investigate the psychic health and social context of adolescents with psychological and antisocial problems (Armelius &amp; Hägglöf, 1998), except for the normal adolescents in study I, who took part in a project with purpose to determine norms for an intake interview that is used for adolescents in different settings in Sweden. Study I addressed the impact of type of relationship on adolescents interpersonal behaviour, and the results were discussed in terms of interpersonal theory and the complementarity principle. Study II investigated the association between self-concept and interpersonal problems in normal adolescents. Different interpersonal problems were systematically related to three self-concept patterns, and showed the importance of considering the combination of self-love and self-autonomy to understand interpersonal problems in adolescents. In study III the associations between self-concept, and interpersonal problems were investigated, also considering depression as a factor, in a group of adolescents with conduct problems. This study revealed sex differences: boys’ interpersonal problems mainly were associated with self-control, an imbalance between self control and autonomy, and depression, whereas girls’ interpersonal problems mainly were associated with low self-love and depression. Study IV examined the relationship between memories of perceived parenting styles and interpersonal problems. Also in this study, sex differences were shown. It was found that for boys the perceived parenting styles of the fathers had the strongest associations to interpersonal problems, and for girls the perceived parenting styles of the mothers had the strongest associations to interpersonal problems.

Callous-unemotional (CU) traits are associated with severe and aggressive youth antisocial behavior (ASB) and are under consideration as a potential specifier for the diagnosis of Conduct Disorder in DSM-5 (Frick & Moffitt, 2010). This proposal demands more inquiry into the impact that CU traits have on behavioral subtypes of youth ASB. Normal-range personality traits, trait levels of anxiety, and hormonal stress reactivity (i.e., changes in the stress hormone, cortisol) are all factors that have been studied extensively in relation to ASB, but these relationships have not yet been considered in combination with CU traits. The purpose of the current set of studies was to examine the extent to which CU traits moderated links between these three factors and both overall and behavioral subtypes of ASB. In the first study, data were collected on children’s personality, CU traits, and three behavioral categories of ASB (physical aggression, relational aggression and non-violent rule-breaking behavior) for community (N = 742) and clinical (N = 183) samples of children. In the community sample, CU traits moderated links between Neuroticism, Extraversion, Agreeableness, Openness to Experience and ASB overall and externalizing behaviors, between Neuroticism, Extraversion and physical aggression and between Agreeableness, Extraversion and rule-breaking behaviors. In the clinical sample, CU traits moderated the link between Agreeableness and externalizing behaviors. In the second study, data were collected on children’s trait anxiety, CU traits, and the same three behavioral categories of ASB in a follow-up adolescent community sample (N = 145). Reactivity of cortisol in response to an unanticipated social stress test was also measured. Results revealed that CU traits moderated links between trait anxiety and ASB overall, externalizing behaviors and physical aggression. In females only, CU traits also moderated links between cortisol reactivity and ASB overall and externalizing behaviors. Combined, the results of these studies support the proposal that CU traits are a clinically useful diagnostic specifier with different implications for behavioral subtypes of ASB. Further, the present findings allow recommendations to be made for future research to further our understanding of the role CU traits play in CD, and to develop targeted interventions.

Callous-unemotional (CU) traits are associated with severe and aggressive youth antisocial behavior (ASB) and are under consideration as a potential specifier for the diagnosis of Conduct Disorder in DSM-5 (Frick & Moffitt, 2010). This proposal demands more inquiry into the impact that CU traits have on behavioral subtypes of youth ASB. Normal-range personality traits, trait levels of anxiety, and hormonal stress reactivity (i.e., changes in the stress hormone, cortisol) are all factors that have been studied extensively in relation to ASB, but these relationships have not yet been considered in combination with CU traits. The purpose of the current set of studies was to examine the extent to which CU traits moderated links between these three factors and both overall and behavioral subtypes of ASB. In the first study, data were collected on children’s personality, CU traits, and three behavioral categories of ASB (physical aggression, relational aggression and non-violent rule-breaking behavior) for community (N = 742) and clinical (N = 183) samples of children. In the community sample, CU traits moderated links between Neuroticism, Extraversion, Agreeableness, Openness to Experience and ASB overall and externalizing behaviors, between Neuroticism, Extraversion and physical aggression and between Agreeableness, Extraversion and rule-breaking behaviors. In the clinical sample, CU traits moderated the link between Agreeableness and externalizing behaviors. In the second study, data were collected on children’s trait anxiety, CU traits, and the same three behavioral categories of ASB in a follow-up adolescent community sample (N = 145). Reactivity of cortisol in response to an unanticipated social stress test was also measured. Results revealed that CU traits moderated links between trait anxiety and ASB overall, externalizing behaviors and physical aggression. In females only, CU traits also moderated links between cortisol reactivity and ASB overall and externalizing behaviors. Combined, the results of these studies support the proposal that CU traits are a clinically useful diagnostic specifier with different implications for behavioral subtypes of ASB. Further, the present findings allow recommendations to be made for future research to further our understanding of the role CU traits play in CD, and to develop targeted interventions.

Diss. (sammanfattning) Stockholm : Karolinska inst.itutet, 2005. / Härtill 4 uppsatser.