Differentiating Behavioral & Traditional Case Formulations for Children with Severe Behavioral & Emotional Problems

In this paper, a behavioral case formu lation is contrasted with traditional mental health formulations about children presenting severe behavior problems. It appears to be the conventional wisdom of today that sending children with severe problem behaviors to “counseling” or “therapy” is the best method for changing these behaviors. This belief predominates despite a lack of empirical evidence demonstrating that s evere behavior problems of children are not effectively treated with such an approach. Behaviorists treat these children by altering the maintaining contingencies in the current environment. However, once the structure of the altered environment is no longer present, treatment effects often fail to generalize and the child returns to pre-treatment levels. The traditional mental health model is used to explain why this occurs. A behavioral case formulation approach is presented. It is contrasted with traditional mental health formulations about children presenting severe behavior problems. A real life case example illustrates the utility of a behavioral case formulation and its direct relationship to treatment.