Clients also may need to learn how to solve prob-
lems effectively. Problem-solving involves identify-
ing the problem, exploring all possible solutions,
choosing and implementing one of the alternatives,
and evaluating the results (see Chap. 16). The nurse
can help clients to work on actual problems using
this process. Problem-solving skills are likely to im-
prove with practice.
PROMOTING SOCIAL INTERACTION
Clients with conduct disorder may not have age-
appropriate social skills, so teaching social skills is
important. The nurse can role-model these skills and
help clients to practice appropriate social interaction.
The nurse identifies what is not appropriate, such as
profanity and name-calling, and also what isappro-
priate. Clients may have little experience discussing
the news, current events, sports, or other topics. As
they begin to develop social skills, the nurse can in-
clude other peers in these discussions. Positive feed-
back is essential to let clients know they are meeting
expectations.
PROVIDING CLIENT AND FAMILY EDUCATION
Parents also may need help learning social skills,
solving problems, and behaving appropriately. Often
parents have their own problems, and they have had
difficulties with the client for a long time before treat-
ment was instituted. Parents need to replace old pat-
terns, such as yelling, hitting, or simply ignoring be-
havior, with more effective strategies. The nurse can
teach parents age-appropriate activities and expecta-
tions for clients such as reasonable curfews, house-
hold responsibilities, and acceptable behavior at home.
The parents may need to learn effective limit setting
with appropriate consequences. Parents often need
to learn to communicate their feelings and expecta-
tions clearly and directly to these clients. Some par-
ents may need to let clients experience the conse-
quences of their behavior rather than rescuing them.
For example, if a client gets a speeding ticket, the
parents should not pay the fine for him or her. If a
client causes a disturbance in school and receives de-
tention, the parents can support the teacher’s actions
instead of blaming the teacher or school.
Evaluation
Treatment is considered effective if the client stops
behaving in an aggressive or illegal way, attends
school, and follows reasonable rules and expectations
at home. The client will not become a model child in
a short period; instead, he or she may make modest
progress with some setbacks over time.
20 CHILD ANDADOLESCENTDISORDERS 499
COMMUNITY-BASED CARE
Clients with conduct disorder are seen in acute care
settings only when their behavior is severe and only
for short periods of stabilization. Much long-term
work takes place at school and home or another
community setting. Some clients are placed outside
their parents’ home for short or long periods. Group
homes, halfway houses, and residential treatment
settings are designed to provide a safe, structured
environment and adequate supervision if that cannot
be provided at home. Clients with legal issues may be
placed in detention facilities, jails, or jail-diversion
programs. Chapter 4 discusses treatment settings
and programs.MENTAL HEALTH PROMOTION
Parental behavior profoundly influences children’s
behavior. Parents who engage in risky behaviors,
such as smoking, drinking, and ignoring their health,
are more likely to have children who also engage
in risky behaviors including early unprotected sex
(Davis, 2002). Gross & Grady (2002) found that group-
based parenting classes are effective to deal with
problem behaviors in children and to prevent later
development of conduct disorders.
Moyer (2002) reports that an early intervention
program for children at risk for anxiety disorders
improved behavior. The program consisted of parent
sessions, child anxiety management, parent-child
sessions emphasizing coping skills, and graduated
exposure to anxiety-provoking situations.
The SNAP-IV Teacher +Parent Rating Scale is
an assessment tool that can be used for initial eval-
uation in many areas of concern such as ADHD, op-
positional defiant disorder, conduct disorder, and
depression (see Box 20-2). Such tools can identify
problems or potential problems that signal a need for
further evaluation and follow-up. Early detection and
successful intervention are often the key to mental
health promotion.◗ CLIENT/FAMILYTEACHING
FORCONDUCTDISORDER
Teach parents social and problem-solving skills
when needed.
Encourage parents to seek treatment for their own
problems.
Help parents to identify age-appropriate activities
and expectations.
Assist parents with direct, clear communication.
Help parents to avoid “rescuing” the client.