The development and evaluation of a home-based behavioural approach to the assessment and treatment of hyperactive and conduct disordered children.

I joined Martin Herbert at the School of Social Work, University of Leicester in October 1974, as he required assistance in his work with children presenting serious behaviour problems. A few months previously he had become involved with the Paediatric Assessment Centre (PAC) at the Leicester Royal Informary, acting as a consultant clinical psychologist for children assessed there as being "hyperactive" or in some other way problematic. These children were referred to him for a behavioural assessment and treatment, and as their numbers increased help from another psychologist became imperative. What was evident was the increased vulnerability of physically disabled children to behaviour disorders. My role in elaborating, evaluating and standardizing the evolving assessment and treatment procedures soon emerged. These developments occurred within the context of a community-based service, with the primary aim of providing an effective and efficient therapy, - one which would produce favourable changes in behaviour capable of being maintained after the withdrawal of the therapists. The focus of the procedures involved was not usually on any particular aspect of activity (despite the fact that the majority of the children was being referred for hyperactivity); rather it was on the more anti-social, so called "acting-out" behaviour problems found in all the children assessed. Behaviours such as temper tantrums, non-compliance and aggression were reported by almost all the children's mothers and were usually perceived by them as more problematic than any overactive behaviour. It appeared that children with the basic problems of high or disorganised activity patterns (often associated with a short concentration span) were especially prone to the development of so-called conduct disorders. Indeed diagnosis of hyperactivity is often taken to include many problem areas other than motor activity, and discussion of this issue is taken up in chapter 2. The decision to concentrate on the behavioural problems such as non-compliance and aggression was due to a personal interest which emerged with regard to why these problems developed and were maintained in these particular children. In October 1975, Theresa Smith joined us and the team founded an agency called the Child Treatment Research Unit (C.T.R.U.) aided further by social workers on a nine-month training placement with us during their second year of a social work Diploma course. Theresa Smith's interest developed and focused on the meaning, the reliability and validity of the diagnostic label "hyperactivity" and the measurement and control of motor activity itself. Her work therefore complemented my own (advising parents on management techniques for anti-social behaviours), with her concentration on specific motor targets and use of inhibitory motor training with the children directly. Not all the children seen in the pilot and research projects were referred for hyperactivity. The criteria for referral to the C.T.R.U. (and more specifically myself), became broader and more and more concerned with the presence of conduct disorder problems such as serious temper tantrums, and out-of-control behaviours such as persistent non-compliance. Some of the children were therefore presenting these types of behaviours without any evidence of problems to do with activity levels or concentration. They were often simply described as a management problem. All the children retained in the pilot and research projects can therefore be said (after assessment had rejected inappropriate referrals) to have been manifesting problems of a conduct disorder type, (see chapter 1), with many of them additionally showing problems associated with hyperactivity. This means that any evidence that accrues for the effectiveness of the procedures detailed in this thesis is applicable for use with a fairly broad band of children identified as displaying conduct disorders whether or not associated with hyperactivity.