Too often, bone loss, low bone mass, or systemic bone disorders go unrecognized and undiagnosed, while rehabilitation efforts can seem to lose ground as quickly as it's gained. The Bone Disorders Program's mission is to effectively treat children and young adults with bone disorders, allowing patients to go on to resume their normal lives.
Problem behaviors such as noncompliance, physical aggression, temper tantrums, poor impulse control, self-injury (mild), disruptive behaviors, bedtime/sleep problems, toileting difficulties, fears/phobias and social skills deficits are frequent presenting concerns. The Behavior Management Clinic is one of three outpatient clinics serving a diverse patient population referred to the Outpatient Behavioral Psychology department at Kennedy Krieger Institute. The clinic's mission and focus centers on clinical service, training and community outreach (through consultation).The clinic serves children with varying levels of functioning, including those with typical development as well as those with mild cognitive and/or speech impairment. The clinic serves children from ages 2 through 12, although most children seen in the clinic fall between 2 and 10 years of age.
The Behavior Management Clinic offers a behavioral treatment program primarily focused on caregiver training in effective behavior management techniques and procedures. However, children may also be treated individually or in groups to address internalizing problems such as fears, phobias, poor anger control or social skills deficits. Treatment is mostly clinic-based, but often includes home visits and occasional community-based sessions in order to tailor treatment and facilitate generalization and maintenance of treatment gains. Off-site service delivery also includes consultation with a broad range of community agencies (e.g., daycare centers, preschools, school programs) where the focus is on assessment, intervention, teacher training and/or participation in student support and IEP teams.
Prior to treatment, a behavioral assessment is conducted utilizing indirect methods such as clinical/behavioral interview (parent and/or child) and administration of standardized behavior rating scales and questionnaires. Baseline, direct observation of parent-child interactions, both naturalistic and analog, is also conducted. Caregiver training is conducted in an active, directed fashion using behavioral skills training procedures and with the expectation that caregivers will demonstrate 80 percent correct usage of procedures during acquisition and maintenance phases of treatment. Specific, measurable treatment objectives for parent and child, delineated at the outset of treatment, are revisited throughout treatment; they also prescribe the timing of treatment termination.
Like other clinical services in Behavioral Psychology at Kennedy Krieger, the Behavior Management Clinic has a strong commitment to training. The clinic is part of the Institute's pre-doctoral internship program accredited by the American Psychological Association; it also offers post-doctoral fellowships. Trainees gain knowledge and experience in behavioral assessment and application of databased and empirically validated treatment interventions within an outpatient pediatric setting. Though limited, opportunities also exist for trainees to conduct outpatient clinical research.
Primary Program Goals:
The goals of the clinic are to provide the following:
- Clinical service to children and adolescents
- Caregiver training
- Community outreach
The clinic treats youngsters with common behavior problems, disruptive behavior disorders and mild to moderately severe co-morbid disorders. The training program serves pre- and post-doctoral candidates. The community outreach portion of the clinic includes consultation with a broad range of community agencies.
D.M. was an 8-year-old male diagnosed with attention deficit hyperactivity disorder (combined type), disruptive behavior disorder and mild intellectual disabilities. Presenting concerns at intake included school difficulties, (i.e., disruptive behavior, poor academic achievement), short attention span, hyperactivity, physical aggression, arguing with twin sister, interrupting and noncompliance. At the time of the initial evaluation, D.M.'s attention deficit and mild retardation had not been diagnosed; therefore, referrals were initiated to KKI Developmental Pediatrics and Neuropsychology services. The child had a history of in utero drug exposure and removal from biological parent's care. He and his twin sister were cared for by the maternal great grandmother. Outpatient treatment focused on caregiver training in behavior management and assistance in ADHD diagnosis and education. The caregiver was trained in the use positive reinforcement, planned ignoring, three-step guided compliance and time-out. Following training and mastery of these skills, the caregiver received assistance in developing and implementing a home reinforcement program. Over the course of treatment, D.M. had a 93 percent reduction in aggression, 85 percent reduction in sibling arguing, 80 percent reduction in interrupting and an 80 percent reduction in noncompliance. The family was seen for 19 sessions in all (three devoted to intake, direct observation, and feedback, 12 treatment sessions, four maintenance sessions). Over the course of treatment, D.M. was also started on stimulant medication.
Change Your Appointment or Schedule a Follow-Up Appointment:
To reschedule an appointment or to schedule a follow-up appointment, please call the Care Center at the following locations:
- Aliceanna location: (443) 923-7500
- Fairmount location: (443) 923-4500
- Columbia location: (443) 923-4360
- Broadway location: (443) 923-2900
- Odenton location: (443) 923-4110
Related Materials and Information:
- The Resource Finder: A Project of Kennedy Krieger Institute
- Association for Behavior Analysis International
- The Association for Advancement of Behavior Therapy
- American Psychological Association
- Children and Adults with Attention-Deficit/Hyperactivity Disorder
- The Association for the Advancement of Retired Persons