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Disruptive Behavior Disorders: Evidence-Based Practices

Characteristics and Needs-Risk Factors

1. Considerable research has identified family, neighborhood, school, and societal factors that may place youth at risk for long-term negative outcomes, including each of the following EXCEPT:

A. Poverty, abuse, and neglect

B. Harsh or inconsistent parenting and parent criminality

C. Low IQ and lack of involvement in extracurricular activities

D. Emotional, physical, or sexual abuse


Diagnostic Criteria for Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)

2. Oppositional Defiant Disorder is characterized by a persistent pattern of behavior in which the basic rights of others are violated with such behaviors as bullying and intimidating others, as well as being cruel to people and animals.

A. True

B. False


Prevalence of Condition

3. Both ODD and CD occur fairly frequently among children, with ODD occurring in _______ percent of youth, and CD occurring in _______ percent.

A. 2 to 16; 6 to 9

B. 4 to 14; 8 to 11

C. 6 to 12; 10 to 13

D. 8 to 14; 12 to 15


Evidence-Based and Promising Practices-Triple P – Positive Parenting Program

4. Triple P-Positive Parenting Program is a multilevel system of parenting and family support programs that aim to prevent or reduce severe behavioral, emotional, and developmental problems in children by enhancing the knowledge, skills, and confidence of parents.

A. True

B. False


5. Triple P is designed to be delivered by a range of specialists for families with children from ages:

A. Birth to 12

B. Birth to 14

C. Birth to 16

D. Birth to 18


6. Level Two Triple P services include advice for specific child behavior problems, and may be self-directed or involve telephone or face-to-face interaction with a clinician, or participation in group sessions.

A. True

B. False


Possible Barriers

7. Successful implementation of Triple P or any parenting or family intervention may be compromised when the agency or staff are not willing to work with families at times that are convenient for the families.

A. True

B. False


Project ACHIEVE-Characteristics of the Intervention

8. Project ACHIEVE is a comprehensive school based prevention program that focuses on each of the following areas EXCEPT:

A. Academic engagement and achievement

B. Positive behavioral support systems

C. Parent and community involvement

D. Reduction of student-teacher-parent conflict


9. The Strategic Planning, Organizational Analysis, and Development Component of Project ACHIEVE assesses interactive and interpersonal processes within a school such as the organizational climate, administrative style, and:

A. Professional development-related activities

B. Staff decision making

C. The teacher-instructional process

D. All of the above


Second Step: Characteristics of the Intervention

10. Which of the following is NOT one of the main skill-building areas of the The Second Step prevention program designed to reduce impulsive and aggressive behavior in children?

A. Empathy

B. Impulse control and problem solving

C. Anger management

D. Positive communication


11. The Second Step program is divided into four age groups covering children ages three to sixteen.

A. True

B. False


Second Step: Research Base and Outcomes

12. Research outcomes indicated that students who participated in the Second Step lessons increased social skills knowledge and prosocial and empathy skills.

A. True

B. False


Implementation and Dissemination-Possible Barriers

13. Leadership changes in administration and lack of funding may affect the ability to sustain the implementation of prevention programs such as Second Step over time.

A. True

B. False


Promoting Alternative Thinking Strategies (PATHS)

14. Promoting Alternative Thinking Strategies (PATHS) is a universal prevention program for elementary schools that strives to increase social and emotional competencies while:

A. Reducing aggressive, acting out behaviors

B. Improving self-regulation of emotions

C. Developing prosocial behavior and social reasoning

D. Assisting with peer interaction skills and rule-adherence


15. For children in the latter elementary years, PATHS teaches readiness and self-control through metaphorical storytelling and behavioral support.

A. True

B. False


Promoting Alternative Thinking Strategies: Research Base and Outcomes

16. Randomized designs that measured the effects of the PATHS intervention on a child’s emotional understanding showed increased range in discussing emotional experiences, in beliefs regarding management of emotions, and in developmental understanding of some aspects of emotions.

A. True

B. False


First Steps to Success-Characteristics of the Intervention

17. Which of the following correctly describes the components of First Steps to Success?

A. The program comprises four interconnected components and is implemented in 5 to 6 months

B. First Steps is designed to work with children ages 6-8 who show early signs of conduct disorder

C. The home intervention component of the program uses a contingency reward system that offers direct feedback using color cards to identify behavior

D. Coaches are trained to work with children with challenging behaviors, aggression, and acting out, who victimize others in the school environment


18. The six First Step skills are that practiced in the home to help children succeed in the school environment are communication and sharing, cooperation, limit setting, problem solving, developing confidence, and:

A. Self-control

B. Independence

C. Friendship making

D. Leadership


Research Base and Outcomes

19. The research on First Steps to Success points to a number of positive changes in the behavior of children identified to be at risk of developing a serious pattern of antisocial behavior.

A. True

B. False


Early Risers: Skills for Success-Characteristics of the Intervention

20. The Early Risers program provides comprehensive mental health promotion services to children displaying early onset aggressive, disruptive, and socially withdrawn behaviors, and it is grounded in family systems and cognitive-behavioral theoretical perspectives.

A. True

B. False


21. Which of the following is NOT one of the four domains emphasized in the Early Risers program?

A. Social and environmental confidence

B. Child academic competence

C. Parent investment

D. Child behavioral self-regulation


22. The primary goal of the family-focused component of Early Risers is to bridge family and community in order to foster continued success in learning and social growth.

A. True

B. False


Research Base and Outcomes

23. Overall, research supports significant relationships between children’s level of participation throughout the Early Risers program (more than 1 year or more) and which areas:

A. Goal setting, family relationships, and self-confidence

B. Social competence, school adjustment, and academic achievement

C. Behavioral management, peer support, and emotional stability

D. None of the above


Adolescent Transitions Program (ATP)-Background

24. ATP was designed as a group psychoeducational intervention focused on family management practices and reducing deviant peer influences, and was offered to high-risk adolescents and families.

A. True

B. False


Characteristics of the Intervention

25. Which of the following is an accurate statement about the different levels of ATP interventions?

A. Selective assessment, identification, and professional support for at-risk children and their families occur in the universal level of intervention

B. The goal at the indicated intervention level is working with school and community professionals on topics of identification and effective treatment of at-risk students

C. The selective level of the intervention consists of direct support focused on parents to help change clinically significant problems through a variety of services

D. None of the above


Research Base and Outcomes

26. Research supports the ATP intervention in successfully reducing adolescent problem behaviors of substance use as well as increasing family communication and relationships.

A. True

B. False


Incredible Years-Characteristics of the Intervention

27. The goal of the Incredible Years intervention is to reduce child aggression (ages 2 to 12) by teaching parents and teachers how to manage children’s misbehavior and promote children’s problem-solving strategies, ______________ and social competence.

A. Reasoning skills

B. Peer interactions

C. Emotional regulation

D. All of the above


28. The core component of Incredible Years is the The ADVANCE program which addresses discipline issues, communication skills, parental empathy, and problem-solving skills.

A. True

B. False


Helping the Noncompliant Child-Characteristics of the Intervention

29. Helping the Noncompliant Child’s primary treatment goal is the secondary prevention of serious conduct disorder problems in preschool and early elementary school-aged children, and the primary prevention of subsequent juvenile delinquency.

A. True

B. False


30. The parent-training component of the program is divided into differential attention and compliance training phases with typically ________sessions for both training periods that last approximately _________ minutes.

A. 10 to 12; 30 to 45

B. 8 to 10; 75 to 90

C. 6 to 8; 45 to 60

D. 4 to 6; 60 to 75


Parent-Child Interaction Therapy-Characteristics of the Intervention

31. During the phases of Parent-Child Interaction Therapy (PCIT), parents learn how to strengthen attachments to their child through being warm, responsive, and sensitive to their child’s behavior, and they learn how to be strong authority figures through: 

A. Giving directions in age-appropriate, positive ways

B. Setting consistent limits

C. Learning how to appropriately implement consequences

D. All of the above


Implementation Challenges

32. When implementing PCIT, it may be difficult to keep families interested and motivated to complete each phase because it often takes longer to master skills than prescribed.

A. True

B. False


Parent Management Training — Oregon (PTMO)-Characteristics of the Intervention

33. The five essential implementation components of PTMO are skill encouragement, discipline, monitoring, problem-solving skills, and:

A. Positive involvement

B. Boundary management

C. Supervision

D. Contingent reinforcement


Brief Strategic Family Therapy

34. Brief Strategic Family Therapy (BSFT) is a family therapy intervention for children and adolescents aged 6 to 18 years that was initially developed for use with foster children with substance use issues and behavioral problems.

A. True

B. False


Characteristics of the Intervention

35. During the _____________ component of BSFT, the therapist deciphers family patterns of interactions and develops specific plans to change maladaptive patterns. 

A. Diagnosis

B. Joining

C. Restructuring

D. Feedback


Problem-Solving Skills Training-Characteristics of the Intervention

36. Which of the following is a correct statement about Problem-Solving Skills Training (PSST)?

A. PSST is a cognitive behavioral approach for treating children ages 5 to 18 years with substance abuse and delinquency related problems

B. The therapist works with parents or caregivers as the agents of change to help identify and address the child’s maladaptive thinking and behaviors

C. PSST is administered in 10 therapeutic sessions that last approximately 60 to 75 minutes each

D. Problem Solving Skills Training is most effective for children working in groups, as they are more able to address interpersonal situations in a group setting


Research Base and Outcomes

37. Research has continued to demonstrate that the PSST intervention significantly decreases aggression at home and in school, decreases deviant behaviors, and increases prosocial behaviors.

A. True

B. False


Coping Power-Characteristics of the Intervention

38. Children with disruptive and aggressive behaviors cognitively distort incoming social cues and situations, inaccurately interpret events, and have an inability to effectively problem solve.

A. True

B. False


39. During Coping Power parent component sessions, the therapists emphasize behavioral and personal goal setting, awareness of feelings, and perspective taking, while in the child component sessions emphasis is on identification of prosocial behaviors, establishing rules and expectations, and creating open communication.

A. True

B. False


Mentoring

40. Mentoring programs are the formal mechanisms for developing positive, supported, professional relationships between at-risk youth and caring adults, and the process includes inquiry, orientation, volunteer screening, youth assessment, matching, and:

A. Match supervision and closure

B. Match monitoring and evaluation

C. Match recommendations and termination

D. None of the above


Research Base and Outcomes

41. The largest favorable effects of mentoring programs were observed with youth at risk due to individual-level characteristics and significant personal problems, rather than those at risk due to environmental conditions or disadvantage.

A. True

B. False


Multisystemic Therapy (MST)-Characteristics of the Intervention

42. MST treatment is a multi-faceted family and community-based treatment for youth who are at imminent risk of out-of-home placement due to serious antisocial behavior and substance abuse problems.

A. True

B. False


43. Which of the following is NOT one of the guiding principles of MST?

A. Therapeutic contacts emphasize the positive and use systemic strengths as levers for positive change

B. Interventions are designed to promote responsible behavior and decrease irresponsible behavior among family members

C. Interventions focus on sequences of behavior within and between multiple systems that maintain the identified problems

D. Interventions are strength-focused and process oriented, emphasizing general and universal problems


Research Base and Outcomes

44. Published studies on the effectiveness of multisystemic therapy showed improved family relations, decreased behavior problems, and decreased association with deviant peers.

A. True

B. False


Functional Family Therapy-Background

45. Functional Family Therapy (FFT) is an empirically based clinical system that focuses on youth who are at risk of, or currently displaying, aggressive behavior, violence, and substance-use, and more than_________ of the current practices of FFT are implemented in the juvenile justice system.

A. 60 percent

B. 50 percent

C. 40 percent

D. 30 percent


Characteristics of the Intervention

46. One of the main goals of FFT that is fundamental to the success of the program is reducing the personal, societal, and economic consequences that can result from various disruptive behaviors of youth.

A. True

B. False


Multidimensional Treatment Foster Care (MTFC)-Characteristics of the Intervention

47. While MFTC and MTFC-P are recommended interventions for youth who have been placed outside the home in the child welfare, mental health, or juvenile justice systems, at-risk children who are still living in their homes are not eligible for these services.

A. True

B. False


Research Base and Outcomes

48. Each of the following is an accurate statement about MFTC research outcomes EXCEPT:

A. Youth in MFTC have fewer runaway incidences and are arrested less often than youth in group care

B. MTFC youth have significantly fewer days in locked settings at followup

C. Elementary aged youth in MFTC experienced a decrease in aggressive symptoms and a decrease in minor crimes

D. For preschool children, those in MTFC-P had fewer placement disruptions in followup


How to Use the Evidence-Based Practice Kits: Background and Purpose

49. Evidence-based practices (EBPs) are scientifically supported interventions that offer hope that the lives of children and youth with disruptive behavior disorders (DBDs) can be enhanced.

A. True

B. False


50. Although scientific evidence supports adopting EBPs, these practices may still not be readily available in some communities or as part of the usual array of services offered by most mental health providers.

A. True

B. False


Implementation Considerations

51. According to the authors, which of the following in NOT one of the factors that an advisory board may consider when selecting and adopting a new evidence-practice?

A. Identifying a need for an evidence-based practice

B. Considering various factors and issues that could affect decisions about implementing EBPs in a program

C. Examining what treatments and services exist to address identified needs

D. Determining an organization's level of commitment to a new practice


What Are Disruptive Behavior Disorders (DBDs)?

52. Disruptive Behavior Disorders occur across the stages of child and youth development and:

A. Have a significant impact on a child’s functioning across many social settings

B. Involve multiple service sectors (mental health, education, child welfare, juvenile justice, etc.)

C. Can result in great social costs to communities when untreated

D. All of the above


What Are the Evidence-Based Practices Presented in this KIT?

53. Evidence-based practices for DBDs are designed to prevent disruptive behavior disorders or treat the symptoms of disruptive behavior disorders and they include family involvement, _______________ approaches, and parent training.

A. Multi-systems

B. Cognitive-behavioral

C. Interpersonal

D. Psychodynamic


Table 3: Multi-Level Practices

54. An increase in the ability to label feelings, a decrease in classroom aggression, and an increase in self control were positive outcomes shown in which intervention?

A. Early Risers: Skills for Success

B. Project ACHIEVE

C. Promoting Alternative Thinking Strategies

D. First Steps to Success


Table 4: Treatment Practices

55. The prevention practices Coping Power and Mentoring include critical family components which focus on parent education workshops, individualized family support, and family management groups.

A. True

B. False


56 Implementation Considerations-Build Support for Change: Five Steps for Consensus Building-Step 1

56. Stakeholders who may be involved in implementing an EBP include agency personnel at all levels, mental health authority staff, family organizations, family members, youth, researchers, policymakers, and funders.

A. True

B. False


Integrate the EBP into Policies, Procedures, and Financing

57. Policies and procedures should be examined early in the process of implementing an EBP program as this will help ensure the sustainability of the program.

A. True

B. False


Figure 2: Assessments for Integrating EBPs into Service Systems

58. The Organizational Readiness for Change instrument assesses the readiness of an organization to implement EBPs, and it includes each of the following areas EXCEPT:

A. Motivational readiness (perceived need for improvement, training needs, pressure for change)

B. Staff attributes (value placed on professional growth, efficacy, willingness and ability to influence co-workers, adaptability)

C. Financing capabilities (adequacy of financial plan, available start up capital, future conversion potential)

D. Organizational climate (clarity of mission and goals, staff cohesiveness, staff autonomy, openness of communication, level of stress, openness to change)


Understand Medicaid

59. Medicaid is an essential resource for funding many EBP programs, as it now funds more than __________ of public mental health services administered by states.

A. Two-thirds

B. One-half

C. One-third

D. One-fourth


60Range of Medicaid Financing Mechanisms for Home and Community-Based Services for Children and Youth

60. States can provide non-hospital-based community services through a clinic option, which is typically used to expand home and community-based services, and includes training in social skills and telephone counseling services.

A. True

B. False


Illustration of Michigan's 1915(c) Home and Community-Based Waiver

61. The Home and Community-Based waiver for children with serious emotional disturbance (SED) assists children who are at risk of inpatient psychiatric hospitalization, and it includes a __________ framework of physician services, medication management, and family therapy.

A. Child-centered

B. Comprehensive

C. Needs-based

D. Wraparound


Train All Levels of Staff in the Agency

62. Although most skills that practitioners need may be enhanced through supervision, on-the-job consultation, and coaching, research indicates that the most effective way to teach EBP skills is through formal training.

A. True

B. False


Monitor and Evaluate Regularly

63. Process measures give agency staff an objective, structured way to gain feedback about program development and about how services are provided, while helping to diagnose program weaknesses and to clarify strengths.

A. True

B. False


Why You Should Collect Outcome Measures

64. Outcome measures capture a program’s results, and some are concrete and observable, while others are:

A. Tangible and exact

B. Subjective and private

C. Subtle and acute

D. Unofficial and introspective


Table 1: Measurement Instruments for Assessing Child and Family Outcomes

65. The measurement instrument used for 3-6 year olds to assess the quality of parent-child social interactions is the:

A. Dyadic Parent-Child Interaction Coding System III

B. Parenting Coding Scale

C. Ekberg Child-Parent Behavior Inventory

D. Parent-Child Assessment Scale


Address Cultural Competence and EBPs

66. Cultural competence is described as the delivery of services responsive to the cultural concerns of racial and ethnic minority groups, and numerous research studies have been dedicated to identifying and implementing its key ingredients.

A. True

B. False


What Culture Is and How it Affects Care

67. Culture affects whether people attach a stigma to mental health problems and how much trust they place in providers, while the professional culture of agencies, administrators, and practitioners influences how care is organized and delivered.

A. True

B. False


Medication Management-Introduction

68. Traditionally, medication research has focused on studying the symptoms that are key hallmarks of DBDs, which has assisted in identifying psychopharmacologic interventions that are appropriate for these disorders.

A. True

B. False


Atypical (Second Generation) Antipsychotic Medications

69. The primary reason for referral to child psychiatric clinics in the United States is:

A. Behavioral disturbances

B. Depressive symptoms

C. Aggression

D. None of the above


Table 1: Side Effects Associated with Atypical Antipsychotics

70. Common side effects of atypical antipsychotics include insomnia, headache, nausea, increased appetite, and:

A. Restlessness

B. Dizziness

C. Tardive dyskinesia

D. Sedation


Mood Stabilizers

71. Mood stabilizers such as clonidine and guanfacine have a long history in the treatment of seizure disorder and Bipolar Disorder, and more recently have been proven effective in the treatment of impulsivity associated with DBDs.

A. True

B. False


Figure 1: Treatment Recommendations for the Use of Antipsychotics for Aggressive Youth

72. Atypical antipsychotic medications should be tapered or discontinued in patients who show a remission in aggressive symptoms for ______ months or longer.

A. Twelve

B. Nine

C. Six

D. Three


Selecting EBPs-Introduction to the Six-Step Decisionmaking Process

73. Indicated prevention programs focus on helping specific subpopulations improve behavior problems, while selected programs focus on preventing disruptive behavior disorders within an entire population.

A. True

B. False


Step 1: What is The Evidence for a Practice?

74. The amount of evidence that supports an intervention is categorized based on the type and amount of rigorous scientific study that a practice has undergone, and best support criteria includes the following:

A. Experiments must be conducted with treatment manuals

B. Characteristics of the client samples must be clearly specified

C. Effects must have been demonstrated by at least two different investigators or teams of investigators

D. All of the above


Race and Ethnicity

75. Diverse ethnicities are frequently underrepresented in studies evaluating the effectiveness of interventions, so cultural adaptations of existing evidence-based practices and use of culturally specific interventions are recommended to ensure culturally competent EBPs for children and families of color.

A. True

B. False


Step 3: Are Outcomes Meaningful to a Local Population

76. Which of the following in NOT one of the more commonly desirable outcomes for children and adolescents with Disruptive Behavior Disorders?

A. A decrease in symptoms of depression and anxiety

B. A reduction in school absences and failure

C. In increase in positive peer relationships

D. An improvement in the ability to access other services


Step 4: How Does a Practice Fit With an Agency?

77. When adding EBPs to existing services, the closer the fit between the characteristics of an EBP with an agency’s mission and functions, the easier the accommodation may be for the agency.

A. True

B. False


Table 5A: Fit With Agency: Monitoring and Financing Options-Prevention/Multilevel EBPs

78. Safe and Drug Free Schools funding may be a financial option for which of the following Evidence-Based Practices?

A. First Steps to Success

B. Second Step

C. Early Risers: Skills for Success

D. Adolescent Transitions Program


Step 6: How Does a Practice Fit With Youth and Family?

79. Mental health services focusing on families and youth should respect the family's voice as a whole rather than the individual needs, and must incorporate ability-based principles.

A. True

B. False


Hints on Understanding Research Study Designs

80. Randomized control trials are considered to have stronger “proof” than other types of studies, and when they are conducted in different locations, by different researchers, in settings that resemble the real world, these interventions tend to obtain the highest rating in terms of evidence.

A. True

B. False


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