Program Empowers Parents To Deal With Conduct Disorder

Thirty years ago, Canadian child psychiatrist Harvey Armstrong, M.D., was a man ahead of his time— and perhaps still is.

Working in a family-court clinic, Armstrong observed that many of the boys and girls who came through the court system were “more powerful than their parents. They would charm the judges and receive few penalties. The parents felt isolated, alone, ashamed. Therapy for the kids did not work unless the kids thought that it would give them control.”

So Armstrong helped found a nonprofit charitable organization called“ Parents for Youth: Helping and Supporting Parents of Difficult Youth.” The goal was to empower the parents of such children.

Armstrong, an associate professor of psychiatry at the University of Toronto and a staff psychiatrist at Toronto's Hospital for Sick Children, discussed his program at the recent annual meeting of the Canadian Psychiatric Association in Toronto. And as far as he knows, there is no other program like it in either Canada or the United States, he told Psychiatric News.

In addition to Armstrong, the program staff consists of individuals who have worked for a long time in child mental health services.

If a parent of a troubled child wants to participate in the program, which generally lasts a year, the parent must sign a contract. The contract requires the parent to attend at least six weekly sessions; give a two-session notice before leaving the program and discuss the reasons why; agree to pay for all sessions, including missed sessions (the payment is $30 Canadian per person per session); and acknowledge that many of the children of parents participating in the sessions are at high risk for suicide. The reason for this last stipulation is that almost a half of the children of the parents who enter the program have already threatened suicide, and some 12 percent have already made serious attempts. Program participants also receive a book instructing them on how to get the most out of the sessions.

The weekly sessions are held in the evening, with nine to 12 parents meeting in one of six groups. This means that about 60 parents come through the program each week.

Many of the parents who participate in the program are single mothers who come from other countries and have very traumatized backgrounds. For instance, one had had a tyrant for a father, had been raped as a teen, and had served as a sentry for her mother when her mother engaged in affairs. But others have different profiles. One parent was a physician whose son had stolen an expensive car.

“Many of these parents have invested heavily in their children,” Armstrong explained, “but they are often afraid to set limits with their youngsters because of the traumas they themselves have experienced. They talk, threaten, but don't act. You should see the number of holes in the walls, the number of doors torn off their hinges by these youngsters. The parents are afraid to go home.”

The goal of the program is to teach participants how to set limits with their youngsters. Indeed, findings from a large Canadian study support this goal, Armstrong pointed out. It found that if parents rarely praise their child, the child has only a 1.3 times greater risk of engaging in conduct disorder than does a child with more positive parents. But when parents are ineffective at parenting, a child's risk of antisocial behavior is 37 times greater than if parents are effective at raising their children.

Questionnaires that some 1,200 parent participants have filled out over 30 years have helped Armstrong assess the results of the program.

For example, at the start of one group program, he asked 450 parents to score themselves regarding their sense of competence as a parent, feelings of guilt as a parent, understanding of what could and could not be done about their child's behavior, ability to set limits on their child, and ability to positively influence their child. At the end of the program, which on average was a year later, he asked the parents to score themselves again on the same parental skills. The before-and-after comparison indicated that the parents had made highly significant improvements in all domains.

Staff observations have also helped Armstrong evaluate the strengths of the program, he added.

For instance, the stress levels of parents when they start the program are very high, especially among mothers. “But I actually see the stress drop after two or three sessions,” he said. As their stress levels drop and they become more self-confident, they are more likely to risk setting consequences if their children do not obey. And as the parents start providing“ firm, caring, supportive structure,” their children's destructive behaviors—say, suicide attempts—occur less frequently.

“Most of the kids recover,” Armstrong reported, “and most of the parents are satisfied with their kids' outcomes.” For instance, a son of one of the parents is now getting a doctorate in criminology, another has become a successful businessman.

The groups offer another benefit as well: as some parents start the program, others are nearing the end, and the latter support the former.“ They provide a comfort for each other I could not give,” he observed.

The Parents for Youth Web site can be accessed at<www.parentsforyouth.com/people.html>.▪