Monday, January 18, 1999

New treatment for troubled kids pays off in the long term

Carol Milstone, PhD
National Post

Anti-social behaviour. Conduct disorder. Oppositional defiant disorder. Delinquents. The diagnostic labels for these troubled kids aren't pretty, but neither are the behaviours that define their lives. The milder cases lose their tempers too often and are spiteful and vindictive; they continually defy rules and annoy others. The tougher crowd engage in physical cruelty, theft, and destruction of property. None of these kids functions well in school or at work, if they show up at all. Many drink and do drugs. And while they may have lots of other bad apples to "hang" with, they sorely lack true friends.

Therapy for these kids is a Herculean task because, typically, so many things are wrong. They often suffer from attention-deficit disorder, foetal alcohol effects, Or depression and anxiety. Their parents (or more often, single mother) can be emotionally cold, or functionally withdrawn. Psychiatric conditions, substance abuse, and promiscuity are no strangers to their households. These kids won't join the Scouts or church groups to learn a wayout, and placement in a foster home, treatment centre, or prison are the likely outcomes.

Recognizing the futility of traditional therapy with this bunch, Multisystemic Treatment of Antisocial Behavior in Children and Adolescents (Guilford Press) was recently published to teach professionals a better way. The main tenet of multisystemic treatment (MST) is that these youth require attention to all dysfunctional aspects of their lives. The therapist, with a caseload of no more than six, might assess the youth's family at home, visit the school, and collaborate with the youth's coaches, neighbours or extended family.

The most difficult agent for change is often the parents, who may require psychiatric care, substance abuse treatment, or counselling on anger management and parenting skills. Peers can also hamper treatment. Key strategies are to increase supervision by adults, prohibit contact with deviant peers, redirect the youth to new activities, and coach them on self-respect and social skills.

Although MST is costly in the short run, U.S. studies show improved family relations, fewer placements in foster care, reduced criminal activity, and long-term savings to the welfare and justice systems. MST was developed by a Medical University of South Carolina team led by psychologist Scott Henggeler and is being tried in three Ontario communities.

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