Psychology

Adolescents and children are treated in the mental health system everyday for a variety of mental disorders.  The focus of this research will be centered on Cognitive Behavioral Therapy and Client Centered Therapy as it relates to Conduct Disorder and Oppositional Defiant Disorder.  The therapeutic approach will examine both individual and group psychotherapy settings.  A thorough examination will be given on the named conditions and named therapies.  Comparatively, it will determine which therapeutic approach is most effective when treating each mental disorder in children and adolescents.

Cognitive Behavioral Therapy and Client Centered Therapy for
Children and Adolescents with Conduct Disorder and Oppositional Defiant Disorder
Children and adolescents are curious minded individuals for the most part.  They engage in various activities with an uninhibited and innocent level of insight.  Their level of logic is surprising, and at the same time can be a refreshing change.  Now suppose that the amusing behavior and logic were to take a sudden turn.  Imagine a child who constantly challenged authority from all angles and exhibited extreme fits of rage and anger.  Imagine a child who only needed two hours of sleep a night and could run throughout the entire day at full-throttle.  What would be the initial impression and reaction of the onlooker

Conduct Disorder
Children and adolescents suffering from Conduct Disorder (CD) often display the symptoms mentioned.  Parents, teachers, and family frequently appear to be exhausted after having spent only moments with the child.  It is tantamount that one understands that the child or adolescent has absolutely no control over the afflicting mental disorder.  Their behavior is unintentional.  At this juncture, the child or adolescent believes him or herself to be as normal as everyone else.
   
Clinicians have collectively termed CD as a group of behavioral and emotional problems in children and adolescents displayed through socially unacceptable behavior (American Academy of child and Adolescent Psychiatry, 2004 Burke, Loeber,  Birmaher, 2002).  Children and adolescents diagnosed with CD are known for their illegal temperaments.  They have been reported to be overly aggressive and physically threatening towards animals and people alike.  They are destructive of property of their own and that which belongs to others.  They will steal without reason and lie at will.  It should also be noted that these behaviors are correctable and manageable if the proper treatment is facilitated.
   
The origin of this childhood mental disorder has been related to several contributing factors.  The first instance pertains to possible brain damage or a neurological impairment.  Members of the medical community contend that the neurological damage could be attributed to reduced or lack of adequate oxygen during labor and childbirth.  Neurological damage could also likely be substantiated by the child being a victim of child abuse whereby he or she may have experienced blows to or about the head.  Emotional trauma and genetics are among other sustaining factors believed to be at the epicenter of the disorder.  Children and adolescents who have parents that suffer from mental illness are more apt to develop a mental disorder before completing puberty.
   
The prognosis for a child or adolescent perplexed by CD is a positive one.  Behavioral therapy coupled with medication seems to be the most effective means for managing CD. For the purpose of this paper, cognitive behavioral therapy and client centered therapy will be closely examined for accuracy in both an individual and a group clinical setting (Harty, Miller, Newcorn,  Halperin, 2008).  As a whole, the treatment for CD is individualized.  The therapist will conduct important diagnostic tests in order to find out the severity and true existence of the Conduct Disorder.  Once a decision has been made, the therapist will put together a treatment plan in order to get the child or adolescent back on a healthier path of living.

Oppositional Defiant Disorder
Oppositional Defiant Disorder (ODD) is very similar characteristically to CD.  Both disorders appear in childhood and adolescence, but they are usually seen in conjunction with other mental disorders such as depression and Attention Deficit Hyperactivity Disorder (ADHD).  ODD is surmised by uncooperative and hostile behavior absent any physical or emotional trigger (Skoulos  Tyron, 2007 Oatis, 2009).  Children and adolescents are known to throw acute temper tantrums, argue, have a lack of respect for authority in any form, act in deliberate defiance, antagonize others, refuse to assume responsibility for their actions, and have a general hateful and spiteful attitude (American Academy of Child and Adolescent Psychiatry, 2009).  This behavior significantly interferes with the child or adolescents ability to function in or out of the home.  Psychologists agree that children and adolescents diagnosed with ODD have a higher rate of developing Antisocial Personality Disorder or depression as an adult.
   
The origin and nature is believed to be of a biological, psychological, or social factor.  The biological conclusions are drawn from a family history of mental illness or in the form of a chemical imbalance.  Despite the chemical imperfection, medication is not a productive means of treatment in ODD.  The psychological aspect and how it contributes to the existence of ODD relies heavily on a child or adolescents personal life up to the present.  The child or adolescent is believed to have been a victim of child abuse or neglect.  They could be the product of an undiagnosed co-morbid condition that excels ODD behavior or a number of other psychological reasons, however the diagnosing psychiatrist will make the final determination.  There are a number of social factors that are thought to be the origin of ODD as well.  Peer hazing or taunting, low self-esteem, lack of solid friendships, or lack of a structured living environment at home and elsewhere are believed to have a direct effect on the development of ODD in children and adolescents.  ODD is one of the most commonly diagnosed mental disorders among children and adolescents.
   
The methods of treatment for ODD are limited at best (Kelsberg  St. Anna, 2006).  Children and adolescents with ODD do not generally respond well to the administration of any drug.  Therapy, either cognitive behavioral therapy or client centered therapy, is the best alternative.  Parent training is another technique endorsed for treating ODD.  Parents attend a training seminar that teaches redirection and positive reinforcement.  The how-to process of parent training enables the parent to implement the techniques therapeutically at home.  Family therapy is sometimes used depending on the demands of the child or adolescents responsiveness to other methods of therapy.

Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is a form of therapy that attempts to re-program how one interprets a situation.  Actions and reactions are predetermined by the cognitive thought processes of the mind.  In children and adolescents, there are five basic concepts of thinking.  The focuses are interpersonal and environmental, physiological, emotionally functioning, behavior, and cognition (Durlak, Fuhrman,  Lampman, 1991 Friedberg  McClure, 2002).  The interpersonal and environmental concept focuses on the client being able to differentiate between a feeling and a thought.  The physiological focuses on becoming aware of thoughts that produce a negative influence on feelings.

The emotionally functioning concept learns and understands the occurrence of automatic thoughts.  In the behavioral concept, one learns to analyze the automatic thoughts for accuracy and bias.  Finally, the cognition concept develops the skill needed to control and correct any bias energy associated with independent thought (ABCT, 2010).  Children and adolescents with CD or ODD benefit from CBT because the issues of emotional rejection, secondary physical symptoms, and the illogical thinking process are addressed.

In Conduct Disorder
Children and adolescents with CD are frequently treated with CBT.  Cognitive behavioral therapy planning for children and adolescents involves the evaluation of logical and analytical structures of thought as they relate to the clients social perspective taking abilities (Kinney, 1991).  This is especially important in the individual therapy setting.  Therapists working with children and adolescents with CD tend to take on a teaching role when using CBT (Grohol, 2004).  This direct approach in counseling is validated through progress.
   
The general idea of Cognitive Behavioral Therapy in children and adolescents is based on the ideas of modeling and re-enforcement.  A productive social learning environment can be achieved through role playing, modeling, Rational Emotive Therapy (RET), and the use of other reinforcement strategies (Grohol, 2004).  These approaches are based conclusively on the exact problems associated with CD in relation to how the client presents.  CBT for children and adolescents with CD is estimated to be short-term, three to nine months in duration, and include 10-35 sessions in total.  Single sessions do not produce a positive result (Journal of American Academy of Child and Adolescent Psychiatry, 1997).
   
Some forms of CBT are found in places that many would not consider.  Young children can benefit from CBT in Head Start programs readily available in most communities.  These pre-school academic models are designed to aid in the intellectual, academic, and social dynamic of the child while in a playful and fun setting.  Visually, the head start program is a group setting, but the individual client is placed into the program for the educational, social function, and modeling benefits.  Consequently, older children and adolescents are often placed into a vocational training setting as a means of raising self-esteem, modeling, improving the educational abilities of the adolescent, and developing a positive social skill and function (Kinney, 1991 American Academy of Children and Adolescent Psychiatry, 1997).
   
Cognitive Behavioral Therapy has been found to be more beneficial when administered in the child or adolescents natural environment.  Home based CBT is a plus if available to the client.  Age is not a variable in CBT since there are many approaches that can be utilized and administered.  Younger children respond well to toy play, puppet play, games, drawing, and crafts (Friedberg  McClure, 2002).  Adolescents find a useful connection in CBT through the use of movies, television, and music as these activities incite verbal communication during therapy sessions.  Constant focus must be centered on the positive.
   
The identification of thoughts and their correlation to feelings plays an important role in CBT.  The use of a facial expression chart is often introduced into therapy sessions with young children.  Communication barriers inhibit young children from verbally expressing their feelings.  Facial expression charts allow the child an alternative form of communicating their exact feelings (Johnson, 2010).  The uses of picture books permit the same emotional components to be factored into the session.  Older children and adolescents are able to communicate their feelings without hesitation, including those of a negative connotation.
   
Some clients, both children and adolescents, are intent on remaining silent and unresponsive.  This evasive uncooperativeness can be viewed as a passive aggressive behavior aimed at retaliating against those thought to be responsible for mandating the therapy.  The therapist must then divert to other ways of communicating with the client.  This is a good opportunity for the therapist to begin working with the client on connecting the physical with the sensations of the emotional.  Questions can be proposed in relation to school or family in relation to physical areas such as the stomach or the head.  A classic example question that a therapist could ask would be, when you found out you were coming here today, how did that make your body feel  This open question allows the adolescent to answer honestly.  It opens the lines of communication for other questions and conversation.  Later questions pertaining to immediate thought and ideas associated with the clients thought process can be explored.  At this point, the client would begin focusing on identifiable thoughts and connecting them with associated feelings.

In Oppositional Defiant Disorder
Therapy is the key treatment in ODD since it is relatively unaffected by any medication (American Academy of child and Adolescent Psychiatry, 2009 American Psychiatric Association, 1994).  CBT in children and adolescents with ODD teaches them how to view situations differently than they had.  The time-out system is a form of CBT.  The brief but isolating period gives the young child an opportunity to think about how they behaved in an unacceptable manner.  When the period of isolation is over, the child is then asked why he or she was subjected to a time-out.  This question presents the child with the opportunity to show that they have learned a lesson concerning their behavior.  The question also signifies that the behavior redirection session is over for the moment.
   
Therapy is a given for children and adolescents with ODD.  Cognitive Behavioral therapy should be initiated in all aspects of the clients life including the academic setting.  CBT techniques can be put into practice on the home front as well through specialized parental training.  A ready to use routine is a plus for a child or adolescent with ODD.  Once a regular routine for treatment has been devised, the client will over time begin to experience less stress and anxiety.  Life stressors are major triggers associated with ODD.  The family, the school, and the mental health practitioner should form an open line of communication to provide a more probable outcome for the client.
   
The school system can provide a Cognitive Behavioral therapy based environment to the child or adolescent through the special education program.  Teachers in the special education program are specially trained to handle not only the educational needs of the student, but the emotional needs as well.  Mental health professionals need make their presence available for any Individualized Educational Planning (IEP) for children and adolescents who are actively in therapy.  This would ensure that the school can devise a plan that would coincide with the current treatment course of action already in place.  Parents of the child should take an active role in both planning processes as they will ultimately be spending the most time with the child or adolescent.
   
Many of the same therapeutic techniques are incorporated into the CBT for a child or adolescent with ODD as is in a child or adolescent with CD.  Sessions usually average from 10-15 depending on the progress of the client.  ODD can hinder a client from fully participating in therapy at times due to outbursts of anger, disruptive behavior, and the constant need to refocus the client.  Role playing, play therapy, and one-on-one individual CBT have proven to be a successful treatment plan in young children.  Sometimes, older children and adolescents fare better when the CBT is started in an inpatient hospital setting.  The decisions, the how and when to begin CBT, belong to the treating mental health professional.  The severity of ODD in the client has a major impact on the intensity of the treatment as well.  It is necessary to stabilize the patient before enveloping them into a therapeutic process.  One time sessions do not provide stabilization, nor are they effective forms of treatment for ODD (Kelsberg  St. Anna, 2006)

In a Group
CBT to treat CD or ODD in a group setting is very similar to that of treating just the individual client.  School and vocational locations do provide a group therapy atmosphere and encourage group participation.  Group CBT promotes increased feedback from its clients.  The modeling approach gives children and adolescents a chance to see firsthand how others, within the same age perimeter, handle and cope with specific situations (PsychCentral, 2001).
   
Coping strategies and social skills are two benefits of group CBT.  The following is an example of how these lessons are taught and learned in a group CBT session.  The lead therapist treating a group of ten adolescents with CD or ODD decides to take the group on a bowling outing as part of the group therapy session in action. The parents of the adolescents agree to go as well as this is a therapeutic outing.  While out bowling, little Johnny becomes very agitated and angry when he sees that he is the only one who has yet to bowl a strike.  His anger steadily increases and he erupts by throwing his bowling ball into the floor.  In doing so, he smashes his own foot.  The other adolescents in the group stand in awe of little Johnnys outburst.  The therapist immediately goes over to little Johnny and asks him how his foot is.  Johnny does not answer.  The therapist then asks him how his body felt when he threw the ball.  Johnny states that his body felt lighter, but his foot is pounding.  The therapist then asks Johnny how his body felt before he threw the bowling ball onto his foot.  Johnny states that he felt hot and that his body felt really tight.  The therapist explains to Johnny and the rest of the group that what Johnny was feeling was called anxiety.  She further explains that everyone feels a little anxious whenever they play a game because it is a competition.  She reiterates the fact that bowling is just a game and nothing more, but that what Johnny was feeling was very real and was because of the game.
   
The other adolescents observed the conversation between the therapist and Johnny.  In a group therapy setting, there sometimes exist live examples to learn from.  This instance also gave way for improved social skills and communication.  It allowed for a positive interaction between the therapist and the other clients as well.  Group therapy generally does not have more than twelve participants at any given time.  If there are more than twelve, then the clients can be too easily distracted and the group session becomes a sort of disorganized chaos.  In the matter of Cognitive Behavioral group therapy, less is more, and that is a good thing for all seeking treatment.

Client Centered Therapy
Client Centered Therapy (CCT) is a behavioral therapy developed by Carl Rogers in the 1930s (Rogers, 1939).  This approach to counseling places the responsibility of treatment onto the client.  Some therapists see client centered therapy as a way to increase the clients level of insight through self-understanding.  Client centered therapy is based on three fundamental basics of success.  These criteria are congruence, unconditional positive regard, and empathy (jrank, 2010).  Since no child or adolescent behavior or attitude is the same every day, it is crucial that the treating therapist be flexible in their own thinking and thoughts in order to recognize the emotional needs of the client.
   
Congruence depicts a therapists ability to be personable and equal to the client on a human level of existence.  Therapists who come off as being better-than or condescending and judgmental will assuredly fail the client.  In CCT, the client is looking for acceptance and reassurance.  These needs can be met by the therapist through unconditional positive regard.  The therapist can develop a solid therapeutic relationship with the client by merely listening without interrupting or interjecting opinions of judgment.  Finally, empathy must be asserted in CCT I order to gain trust from the client (Green, 1996).  A client will not cooperate, open-up, or express any therapeutic effort if they feel misunderstood.  Empathy is a major portion of CCT and relies solely on the treating therapist.  Much of the work in CCT is centered to the attitude of the therapist.  CCT for children and adolescents provides a safe and effective solution to many behavioral problems through a therapist who acts like a human being and not a robot (Psychology, 2010).

In Conduct Disorder
Client centered therapy gives children and adolescents the freedom to discuss concerns and relevant matters with the therapist.  Since the CCT approach puts the emphasis on the client, the therapist generally takes a passive role in therapy.  In CD, the therapist initiates some focus on issues of impulse control, problem solving, and anger management (Tryon, 1999).  This is achieved by using a four step process of understanding.  The therapist begins by using the modeling technique and proceeds by adding rehearsal and role playing.  The final outcome is delivered when the child or adolescent develops an internal voice used for self-evaluation (Kazdin, 1987).
   
There are various methods of client centered therapy used in treating conduct disorder.  The first is Parent Management Training (PMT).  Parents or caregivers of the child or adolescent are taught by the therapist, or in a group class, how to effectively set limits, redirect the child, and use positive behavioral reinforcement.  Research has shown this to be a very important and productive part of treating CD (Teusch, Bohme, Finke,  Gastpar, 2001).  The PMT is often used in conjunction with family therapy (Sanders  Dadds, 1993).  Family therapy provides outlets for all family members, and not just the child or adolescent with CD.  Sibling issues and parental power struggle issues can be addressed and resolved within this therapeutic setting.  Family therapy is used to reinforce the family dynamic through CCT (Searight  Rothneck, 2001).
   
Age is an important variable to be considered in CCT.  Children and adolescents diagnosed with CD before age ten seem to do more poorly from CCT than do those who were diagnosed with CD after the age of ten (Dishlon  Andrewa, 1995 Rogers, 1939).  It can be asserted that children and adolescents under the age of ten are still more formularizing in their thinking.  Their behavior and thought process is still in the abstract stage.  This allows the child to be more easily manipulated and thought patterns can be redirected (Cantwell  Baker, 1988 Kaplan, 2008).  Children and adolescents older than the age of ten seem far more rigid and stubborn than younger children, but in a therapeutic setting, the children are more open to suggestion and change.  It is important that the therapist include self-reflection in the CCT as a way to help the client understand their maladaptive behaviors.
   
Peer relationships are a form of CCT in a school based setting (Dulcan  Weiner, 2006).  Social skills and interactions of clients diagnosed with CD can be closely monitored and modified if necessary.  School academic clubs or sports organizations provide a good therapeutic CCT environment for the adolescent or child.  The primary purpose is helping the child or adolescent to use problem solving skills in every situation as a way to control the impulses that trigger anger and physical acts of violence.  Client centered therapy is prosocial and usually consists of twelve sessions (Rutter  Taylor, 1994).
In Oppositional Defiant Disorder
   
Early intervention and CCT treatment for children and adolescents with ODD holds much promise.  The goals of CCT in treating clients diagnosed with ODD are parallel with the treatments for CD.  Therapy focuses on self-esteem issues and self-understanding.  These individual focuses enable the client to be more open to the therapeutic process, relieve insecurities, decrease defensive cognition, and eliminate any residual guilt (Ellis, Abrams,  Abrams, 2009 Rogers, 1951).  In young children, ages 3-11 years, play therapy is very effective in an ODD diagnosis.  Essentially, treatment is short-term, 12-25 sessions (Barkoukis, Reiss,  Dombeck, 2008).  Young children are able to articulate their feelings by playing games or interacting with toys.  Therapists watch carefully for behaviors that indicate problem areas.  In turn, these areas are addressed and the focus turns to the client.  Questions can be proposed in reference to, what do you think should be done here Or what would you like to do (Martin  Pear, 1999).  Children seem to be more receptive to the questions when they feel that they are in control.
     Parental Management Training (PMT) is also used for ODD clients in CCT.  Parents have reported a high success rate and increasing positive behavior after having PMT (Casey  Berman, 1985 Forehand  Long, 1996).  Family therapy is also integrated into the treatment plan.  CCT is included in special education programs in the public school sector.  Guidance counselors and special education teachers are able to monitor the child and adolescents progress in an academic and social environment.  The social skills perspective is also examined through the child or adolescents peer group (Sungerg, Weinberger,  Taplin, 2001).

In a Group
Client centered therapy with a group consists of a group of 3-5 children or adolescents.  Desensitation exercises are introduced and used for eliminating stress (Brown  Prout, 2007).  There is much organic interaction between the children and adolescents.  The therapist opens the floor for discussion or delivers a topic for discussion to the group.  Dialogue and talk therapy help the client to develop and utilize problem solving skills and participate in a social perspective (Rogers, 1942 Shirk  Karver, 2008).  This can be performed through organized athletics, community groups, body and girl scouts, and church group activities.  Family therapy is also associated with group therapy, and is used to treat both CD and ODD in a CCT environment.  The prognosis for children and adolescents is promising.  Children and adolescents seem to respond well to CCT.

Analysis
Rutter and Taylor reported in 1994 that 5 of children in the United States have Conduct Disorder, and 20 of children and adolescents have Oppositional Defiant Disorder.  The first child to receive psychotherapy was in 1905, and the therapy was administered by Sigmund Freud (Reinecke, Dattilio,  Freeman, 2006).  Children and adolescents go through phases of oppositional behavior and conduct abnormalities as they grow.  This is considered to be a normal part of childhood development.  When the disruptive behaviors linger and persist, it is necessary to have a psychologist perform an assessment to determine if there is a mental disorder (American Academy of Child and Adolescent Psychiatry, 2007 Reich, 2000).
   
In a study performed by Shirk and Karver, it was determined that CCT and CBT produced a modest outcome for children and adolescents diagnosed with disruptive behaviors like CD and ODD (Shirk  Karver, 2008).  The study made several findings concerning psychotherapy in children and adolescents.  Children displayed a poorer response to CBT where CD and ODD were co morbid.  Hostility, as associated with CD and ODD, prevented the child from forming relationships with other children (Gresham, 1986).
   
The Helsinki Psychotherapy Study monitored patients for twelve months after the onset of therapy.  It was determined that 46.86 of patients dropped out of psychotherapy before completion (Wierzbicki  Pekanik, 1993).  Throughout their study, they discovered that different therapies required a different number of sessions.  Solution focused therapy required a maximum of twelve session, and short-term psychotherapy required twenty sessions over a 5.7 month period (Knekt  Lindfors, 2004).  Children and adolescents being treated for ODD and CD usually participate in CBT and CCT for periods of less than twenty sessions.  Solution focused therapy is very similar to CBT and CCT in that they identify the problem and work to find a solution.  It focuses on positive feedback and home assignments as well.  There is still much research needed in order to truly determine the effectiveness of CBT and CCT for conditions of CD and ODD in adolescents and children (Maxwell  Delaney, 2003).

Discussion
There are still concerns where CD and ODD are concerned in reference to the possibility of co-morbid conditions.  ODD and CD are commonly found to co-exist with ADHD, depression, and anxiety.  In these other conditions, ODD is merely a coping mechanism to the primary condition.  Over half of the children and adolescents with ODD also have ADHD (Keisberg  St. Anna, 2006).  Some clinicians have questioned whether CD and ODD are simply pre-ambles to future more serious mental disorders.  There is a correlation between CD and antisocial personality disorder.  Some would argue that intervention was not implemented soon enough therefore the original condition had more time to fester and evolve into a more damning condition.
   
Not every member of the mental health community is in agreement with regard to the conditions of CD and ODD, nor is everyone in agreement as to how the conditions should be treated.  It has been suggested that an inpatient hospitalization would be more a more productive way to evaluate a child for Conduct Disorder or Oppositional Defiant Disorder.  This is argued from the other side in that a child will naturally produce adverse reactions when taken out of their natural environment.  The initial trauma of being separated from their parents or caregivers can actually cause more damage than good.
   
If mental health intervention is delayed for too long, the likelihood of the child or adolescent becoming involved with the legal system is greater.  Some juvenile court systems are ignorant to how mental conditions can affect ones behavior.  Instead of referring the children and adolescents for mandated counseling and a psychological assessment, many judges view the child as encourageable or as a bad seed who needs to be taught a lesson.  These children and adolescents find themselves in shock incarceration, boot camps, and solitary confinements within a juvenile detention facility.  While there are licensed therapists and psychologists on staff at these facilities, there are less empathetic to the emotional needs and conditions of the child.  They are often overrun with heavy caseloads and have little time to even acknowledge the child as an inmate. This behavior is counterproductive when one has a mental disorder.
   
It must be noted that misery loves company and that monkey-see-monkey-do.  Some behaviors exhibited in children are mimicked of other children.  If a child is acting out and crying, for instance in a daycare setting, that somehow triggers every child in the room to begin whining and crying as well.  It is like a domino effect.  The true behavior patterns of a child must be examined closely against any flaw of assumed behavior.  Psychological testing and assessments can assert underlying behaviors that must be addressed immediately.  Not every child is in crisis, but when a childs behavior disrupts their ability to function in and out of the home, it is necessary to give the matter top priority.
   
Insofar as communications are concerned, it is ultimately up to the parents or caregivers to sign the necessary releases so that therapists, schools, physicians, and other authorities over the child and adolescent can keep one another informed or report any concerns.  This is a vital part of the treatment process, but it often goes overlooked.  A teacher should be able to talk to the parent and the attending physician if they feel that a medication may be too strong or too weak.  In turn, a physician should be afforded the opportunity to speak with a teacher to make them aware of any medication changes or specific behaviors to keep an eye out for.  The only way to effectively treat a child or adolescent with CD or ODD is through honesty, openness, and a willingness to aid the child in any way possible.

Conclusion
Conduct Disorder can be treated with medications in conjunction with therapy however ODD cannot be treated with medications unless there is a diagnosis of a co-morbid condition.  Children and adolescents present with many symptoms which require psychological assessment in order to determine the best treatment route.  Clinicians believe that CBT and CCT are the most effective forms of treatment for disruptive behaviors.  Parents concur to therapy as they also participate in a PMT in order to help their child from the home setting.  Special education teachers and guidance counselors are trained to aid children and adolescents experiencing emotional battles.  While treatment is relatively short-term, it can seem to drag on forever when dealing with a child who is hostile, violent, disruptive, disrespectful, and sometimes even criminal.  Parents must educate themselves as to what is within the normal confines of childhood development and what is out of the ordinary.  Parents are the first step to a child receiving the proper diagnosis and treatment for any emotional or mental condition.
   
Therapists must conduct their sessions with the upmost integrity towards the patient.  Empathy and understanding are key factors in treating children and adolescents.  Trust can be established more easily between client and therapist if the therapist is personable and relaxed.  Therapists take on the role as teachers when working with a client in a CBT setting.  A good therapist must be able to be transverse and be able to adapt to the need of the client.
   
Clients, children and adolescents, who have CD and ODD, are still human beings. They have no idea that there is even anything wrong with them.  They function within their own reality of normal.  Some symptoms of CD and ODD make therapy challenging for both the therapist and the client.  Hostility and anger issues usually present with the most problems. All in all, the prognosis for children and adolescents with CD and ODD looks good, but it will probably get a whole lot worse before it gets any better.

There is a general consensus that the use of alcohol beverages has been with us since times immemorial. Across the globe, alcohol has over the time grown to play an important role in the lives of people for one reason or another. To this end, the consumption of alcohol has undoubtedly become fully integrated in our lives. For instance, it is usually consumed with meals as well as used for religious or medical purposes. Alcohol has at the same time been used during celebrations in several special or important occasions in addition to being used as a tool for social facilitation. A closer look into the countries alcohol consumption trends reveals that its consumption per capita is arguably the highest across the globe.

Additional statistics with particular reference to the trend of alcohol consumption is based on age indicate that it is increasing sharply during early teens all the way to mid-twenties. This is then followed by a decline thereafter as it is presented by NIAAA (2000). In one of the surveys conducted by Michigan University, it was found out that there was, indeed, a positive correlation between the age and the rates of intoxication as well as lifetime amongst students in high schools within the country, according to Johnston (1998). In comparison between other drugs and alcohol, it was revealed that the latter is the most and widely consumed substance within America just as it is the case with respect to dependence prevalence (SAMHSA, 1999a).

Alcohol Related Problems in the U.S.A
Risky situations in the context of the use of alcohol refer to the drinking pattern and behavior that is characterized by blood alcohol concentration levels just below 0.08 gm. This is normal, given the much needed impetus by frequent drinking pattern, whereby an individual consumes not more than five portions of a drink at one time. Under this drinking behavior, the person normally drinks at least once during the week. It is imperative to note that this type of drinking behavior is highly risky, owing to the fact that it usually culminates into binge drinking pattern. In this regard, risky situation with respect to the consumption of alcohol is attained when the blood alcohol concentration of the drinker ranges from 0.05 gm to 0.08 gm. According to NIAAA, binge drinking behavior is attained when the blood alcohol concentration (BAC) is 0.08 gm or above. Binge drinking is normally brought to the fore when an individual consumes more than five drinks within a time span of less than two hours. If not controlled, binge drinking usually results into one becoming a bender or heavy drinker that it is characterized by an individual drinking heavily for two or more days.

Low-risk drinking pattern, on the other hand, encompasses both abstinence and low frequency of alcohol consumption. In particular, this refers to the instance when one drinks less than half an ounce of alcohol or none at all in the case of an abstainer. With regard to the age, older persons have been shown to require fewer number of drinks in order to reach binge level of drinking thus are usually at high risk. The same applies to women that have been reported to require four or more drinks to reach the said level. On a different note, data from SAMHSA, (1999a), shows that alcohol consumption rates, binge drinking as well as heavy drinking are comparatively high amongst men against women. The scenario is similar in relation to young adults in comparison to older ones. Moreover, this data indicates that young men are normally highly predisposed into turning out to become both binge drinkers and benders in the event that they drink alcohol.

In this study, it was found out that 67 percent of males within this group of age had reported as to being binge drinkers or benders in comparison to less than 50 percent of men and women that were above 26 years. Majority of women that were above 26 years old on the other hand were captured as to being abstainers, although upon opting to consume alcohol, they end up using significantly lesser amounts in comparison to their male counter-parts within the same age group. Additional findings presented by SAMHSA, (2000a), indicate that the risk of alcohol abuse varies subject to ethnic differences despite the fact that it has a positive correlation with age.

Among the young people, there is a high alcohol consumption rate among the whites according to this 2000 alcohol use study.  Asian and black respondents, on the other hand, reported the lowest consumption of alcohol rates. That not withstanding, this survey revealed that there was a high rate of binge drinking amongst American Indian as well as Whites closely followed by the Hispanics. Heavy drinking on the other hand was reported to be highest amongst the Whites and followed by Hispanics and American Indians. With regard to persons of the age of 18 to 25 years, the Asians and Afro-Americans were captured as to having lowest heavy drinking rates. In the overall, this survey found out that the American Indians accounted for the greatest proportion of both binge and heavy drinking. Furthermore, the family stability and the social class certainly play an important role in the drinking behaviors of persons. Individuals growing up or under the care of less stable families are highly predisposed to the risky alcohol consumption. This might be complicated by the high social class status, since one has the access to high amounts of disposable income. Unlike the two, disability tends to reduce this risk since it acts as a limiting factor as far as social interactions is concerned. The risk might be increased in the event that a person consumes alcohol though heshe has a medical condition. Religion, just as disability greatly reduces this risk owing to the fact that consumption of alcohol is usually prohibited in almost all the religions across the globe.

With regard to policy implications and social work subject to the relationship between violence and alcohol, it would be imperative to come up with policies or legislations that restrict the amount of alcohol that is consumed by any one person. This would take the form of the government regulating the alcohol percentage concentration by volume at the point of manufacture. The other feasible policy option would be in terms of restricting the number of drinks that an individual might be allowed to take at any given time or period. These policy implications options stem from the positive relationship between the use of alcohol and violence. Perhaps it is imperative to note that use of alcohol does not only encourage aggressive behavior, but rather victimization could also lead to excessive consumption of alcohol. According to NIAAA, (2000), it is found out that alcohol-related violence is very common within America in comparison to that associated with use of other drugs.

On a positive rejoinder, Roizen (1997), found out that the majority of offenders were usually intoxicated at the time of committing the various crimes. There is a positive correlation between the use of alcohol and domestic violence among intimate partners according to Greenfield and Henneberg, (2001). It is estimated that approximately 45 percent of all domestic violence cases involve men that were drunk at the time of this offence as it has been put forward by Roizen, (1993). Against this backdrop, it would be prudent to come up with a policy of regulating use of alcohol at homes with specific emphasis on young couples to reduce this risk. At the same time, there is need for policy that compels one of the affected partners to report incidences of alcohol-related domestic violence to reduce additional risk at home. The positive correlation between the use of alcohol and accidents also calls for stringent policy measures aimed at restricting consumption of alcohol by the motorist. In this regard, social work efforts should be directed towards sensitizing the wider public on the need to avoid alcohol all together as the surest way of curbing the increasing rates of alcohol-related accidents. With regard to the use of alcohol and health, there is the urgent need to control the amount of alcohol that one can take at any sitting. In the overall, the above policy implications would be complicated by intensified sensitization or awareness on the dangers of alcohol in general across gender, ethnicity and age.

Alcohol and the Family
Social learning constructs with respect to the use of alcohol lay significant emphasis on the cognitive constructs for example self-efficacy, expectancies, as well as attributions as pathway mediation to the use of alcohol from stimuli as response mechanism. Expectancies with regard to positive effects that are derived from alcohol use have been known to develop to become conditioned cognitions. This is normally brought about by operant parings or repeated classical as a result of alcohol use based on positive experience. Self-efficacy on the other hand, entails individual expectations that heshe would successfully be able to perform a given coping behavior subject to certain situation and that such behavior would be reinforced. Against this backdrop, the social learning construct is founded on the premise that alcoholism is brought about due to failure to cope by an individual.

Hence, the self-efficacy is significantly low among individuals that consume alcohol. Faced with this challenge, such persons therefore depending on alcohol due to continued use of the same. In relation to one of the social learning theories by Petraitis (1995), for the adolescent experimentation, it was found that individuals usually have a range of positive expectations from using alcohol. In this regard, several studies under the social learning theories are focused on indentifying the ability of alcohol to actually influence given types of behaviors for example aggression induction, sexual arousal, increase in addition to reduction of tension among others. Of importance to note is the fact that the said laboratory or experimental studies assume cognitive-related influence that is brought about by the use of alcohol. As a result, a number of alcohol use-related expectancies amongst users have been indentified. These are increase in aggression as well as personal power, tension reduction and relaxation, sexual performance enhancement and pleasure and social facilitation. The other expectancy that is usually attached to the consumption of alcohol is the need for a positive outcome in general which might be brought about by drinking.

With this in mind, several instruments have been developed in order to assess such expectancies in the wake of the use of alcohol by someone in the context of its effects. It should be emphasized that these expectancies are not usually limited to an individuals experience with alcohol but rather encompass influence towards them due to the exposure to alcoholic beverages through advertising. In addition, these expectancies might be given the much needed impetus through observation of other people drinking an aspect that can occur both in real life situation and through the media models in this regard. It is possible that this process of modeling can begin during the early stages of an individuals growth (Miller et al. 1990). In one of his study, Miller together with fellow social researchers, found out that positive alcohol use expectancies tended to increase as one becomes old especially amongst children aged between 8 and 10 years. On a positive rejoinder, Stacy (1990) and Christiansen (1989), argue that a number of additional studies have revealed that it is possible to predict to ones initiation into drinking, drinking intention as well as the rate of drinking amongst college and high school students with respect to the effects of alcohol.

Though it was originally believed that these expectancies were directly linked to beliefs and attitudes in relation to the alcohol reinforcing properties, it has emerged that they are in fact closely related to the processes of memory. In this way, positive expectancies are usually brought about due to the usual process of drinking. Furthermore, the said expectancies are easily retrievable from an individuals memory during subsequent alcohol drinking. This is attributed to the fact that such positive expectancies have been found to be closely related to the usual process of drinking. Negative expectancies on the other hand, have been found to be brought about by unpleasant drinking experiences or situations. Therefore, such experiences tend to be less associated with the usual practice of drinking. However, there is a high possibility that they are brought about due to heavy drinking practices. In this respect, light to medium alcohol drinkers are least likely to experience negative alcohol expectancies with regards to the effects of alcohol. At the same time, they might act as inhibiting factors during the usual drinking practices. Based on the social learning theories, it is justifiable to state that a lot of emphasis is usually placed on the sources of modeling with specific reference to the young ones. Also, through alcohol use expectancies, it is possible to determine the drinking practice of an individual and thus be able to come up with an appropriate control as well as a treatment regime.

The family system most certainly plays a very crucial role as far the initiation into alcohol use by other persons within the family is concerned. This can be attributed to the fact that the family system that is founded on alcoholism has the effect of providing a steady supply of alcohol to its members. In this way, it becomes much easier for one member to be initiated into alcoholism owing to the fact that alcohol is used as a means of maintaining the balance within the family. Under such instances, the use of alcohol tends to become a natural practice. Thus, family members grow to accept the fact that the use of alcohol is indeed a natural practice or element of life without however paying attention to the danger of alcoholism. In particular, this is usually given an impetus since the family normally opts to maintain this problem against the expected cost of changing the status quo. The main reason in such instances is usually founded on the assumption that accepting the use of alcohol is relatively less demanding and also enables the family to avoid tackling more disturbing issues.

A family system that is based on abstinence to alcohol or responsible drinking practices tends to offer a very strong resistance and resilience to alcoholism. By limiting the amount of alcohol within the family or restricting the same, family members tend to be less exposed to the risk of alcoholism. Furthermore, such a family system acts as an effective support mechanism to the other family members that might be affected by alcoholism.

Client Case Study

Introduction
Born in a family of four, Martin grew up knowing that alcohol was as natural as any other element of life. Being the youngest, he had seen his father come home drunk every night from work. The mother was no exception to the problem of alcohol abuse as well, although she was a light drinker and thus preferred to have her drinks during the weekends and occasionally after meals during the week. From as early as the age of eight, Martin was forced to accept the fact that alcohol was inseparable to his family. Evidently, his father had gone a step further to ensure that the family shelf was adequately stocked with his favorite whisky brands. As it was expected, the mother also had a similar stock of her spirit and whisky brands an aspect that consumed a significant proportion of the family finances. It was not uncommon for the utility bills to be accumulated at the expense of ensuring a steady supply of alcohol in within the family.

Just as it was the case with his immediate elder brothers, Martin was introduced to drinking by his elder brother. In particular, this was occasioned as a way of enabling them to cope with the constant physical abuse from the father whenever he came home late in the evening. Resigned to the fact that nothing would be remedied, his mother opted to take up drinking to save the family as well as try to get close to their father with the view of keeping peace in the family. She did not have a steady job which further complicated things. In this way, everyone in the family had to contend with the violence from the family head. A couple of years later, the parents were able to undergo the recovery process, albeit with a lot of challenges. One year later, his two brothers followed the parents example, although they had not yet fully recovered from the same problem. With a background of six years in drinking all the way from high school and now in a business school, Martin is in a desperate need for help with regard to quitting alcoholism. Faced with the risk of losing focus in his studies, Martin finally came to the realization that perhaps it was time he quit taking alcohol which had become a part of his life for quite a long time. With the help of his brothers, Martin gathered the courage to come to our centre for assistance out of alcohol addiction.

Theory of Addiction
From the above case study, it is evident that that Martins case best fits within the family system theoretical perspective. The family system model with respect to addiction is founded on the premise that development of alcoholism is greatly dependant on family interaction. This is a socio-cultural model that carries with it an intricate interconnectivity between personal, genetic, environmental as well as other closely related factors. According to Bennett and Wolin (1990), the family system model recognizes the fundamental fact that persons within a given family can best be understood as an integral component of their respective families. In this way, emphasis is usually put on the need to consider individuals to be part of the larger family but not in isolation. In the context of alcohol or substance abuse, this family systems model centers on the way family members behave with regards to drinking.

In this way, the role played by the spouse or origin of the family as it has been put forward by OFarrell and Fals-Stewart (1998). One of the fundamental assumptions of the family system model is that alcohol use normally takes centre-stage within the family. In particular, this is used by the family members as an effective way of promoting relationship amongst members. Therefore, this results to alcohol being elevated into becoming the primary facilitator of interactions within and without the family. Based on this model, the cost benefit analysis in terms of any problem within the family is usually looked at from the standpoint of being too costly or more demanding. Thus, the family becomes resigned to use alcohol as a means of maintaining the status quo within the family as well overcome family problems. A closer look at Martins family reveals that alcohol had become a source of maintaining the equilibrium within the family and thus the cost of addressing the problem of lack of stability and physical abuse to the children was too great to be born.

Martins parents in this regard were of the viewpoint that addressing such challenges would require more effort in comparison to alcohol related problems. Probably this is due to the notion that alcoholism within this family would not be tackled other than through the use of more and more alcohol. By so doing, everyone within this family would be in a comfort zone and thereby being able to avoid facing more disturbing problems facing such family. The other model that describes the above stated case study is the behavioral theory. In principle, this model pays special attention to the behaviors of individual members within a given family, especially the parents. Behaviors of family members are in this regard perceived to be the ones to reinforce and antecedents addiction to alcohol as well as substance abuse by other family members. It is believed that these responses provide the ideal platform and environment towards the development and maintenance of alcoholism within the family. According to Bennett and Wolin, (1990), there is a positive correlation between increase in alcoholism rates among off springs and interaction with their alcoholic parents. From this case study, it is clear that Martins addiction was given the much needed impetus by his parents continued dependency on alcoholism. His brothers on the other hand reinforced this when they attempted to fill the vacuum that had been left by their parents.

One of the tenets of behavioral model with regards to alcoholism is that consumption of alcohol or any other substance is usually learned. Upon learning, it is then maintained through operant or classical conditioning. Classical conditioning in this case is based on the principle that learning or development of the drinking behavior by an individual is subject to repeated pairings. These pairings include conditioned stimulus for instance a given person and unconditioned stimulus, for example a given time or location. The presence of alcohol can not be ignored in this regard. The exposure to repeated pairings usually leads to the development of conditioned stimulus and thereby resulting to the development of drinking behavior. The behavioral model therefore argues that substance abuse by an individual is normally learned.  Secondly, this model advances the view that the use of substances is in fact maintained by conditioning mechanism. The initial development as well as maintenance of alcoholic craving is caused by antecedent stimulus as response mechanism.

From the above case study, it is indeed justifiable to state that alcoholism within this family was initiated and perpetuated by the parents although his older brothers played an important role towards creating antecedent stimulus. Alcoholism within this family was also reinforced by the apparent lack of stability and control from the parents since it they paid attention on meeting the bare minimum requirements in order to keep the family together. This served to provide a reinforcing effect against the antecedent stimulus as every one within this family used alcohol as a means of getting relieved from anger or physical pain. Hence, drinking is most likely to increase due to the perceived hope of getting positive effects of alcohol or lessening negative reinforcing effect of alcohol. According to the behavioral family theory, it is thought that families that engage in rituals for example, celebrating holidays with all members, having dinner together, help to protect their children from being drawn into alcoholism. Of importance to note is the fact that the behavior of family members especially parents or older siblings are very critical towards ensuring that other members who may be alcoholic give serious consideration to changing. The conduct of family members may also help the alcoholic person to act towards change as well as maintain this change or perhaps relapse into drinking. Growing up in an alcoholic family, Martin was in doubt greatly influenced by the family members from the parents all through to his two older brothers.

At the same time, interacting with the same family members that have successfully gone through alcohol recovery program, Martin is definitely motivated to change. The possibility of maintaining the said change is high owing to the fact that all the family members had transformed from being alcoholics despite facing challenges as a result. Therefore the family would act as support mechanism for his successful recovery since he would be able to relate to any one in the event of any challenges thereafter. However, this theoretical perspective does not explain the role that is played by personality as far as alcoholism is concerned. Growing around alcoholic people would not influence any one to be an alcoholic in the event that ones personality did not appreciate consumption of alcohol. Behavioral influence is also dependent on the personality of would- be alcoholic upon which his or her personal ideals are usually founded. Furthermore, this model does not give an explanation of how the father was initiated into alcoholism considering the fact that he was initiated into alcoholism at a much later stage in his life. In this regard, environmental factors are ignored although they have significant influence in the ultimate development of alcoholism. In the overall, the above theoretical perspectives are founded on the social learning constructs since it is facilitated by interaction.

Treatment
Within the medical fraternity, there is the general consensus concerning the fact that there is no known medical cure for alcoholism. Recent developments from the scientific community have only managed to come with medications that serve the purpose of reducing an individuals craving for alcohol. By so doing, they greatly benefit the affected person since they help to reduce the risk of dependency or facilitate alcohol dependency recovery process. From the above case study, it is evident that individuals develop addiction due to social learning. In particular, this is usually facilitated by interaction amongst the family members as well as the expected benefits. In this way, persons become initiated and maintained into alcoholism by repeated pairings and conditioning. From the above case study, the most appropriate method of dealing with Martins problem is through the use stages of development approach. Though it was recently developed, this trans-theoretical approach as it is commonly known emphasizes on the role that is played by a client towards hisher successful recovery.

In a nutshell, it is the clients readiness to change that determines the efficacy of any treatment regimen that might be put in place. Understanding the readiness of an addict to change usually helps treatment providers to be able to overcome any potential or emerging barriers to the success of such treatment plan (Joseph, 2004). Also, it helps the client to anticipate relapse in addition to lowering both provider and client frustration with the overall treatment process. Improvement in the satisfaction by the client is the other benefit of this model of addressing alcohol dependency which in turn leads to a successful recovery program. Social learning and stages of change are interconnected by virtue of the fact that addition is usually as a result of social-cultural factors within the addicts environment. An individual usually considers changing and taking up drinking based on the expectancies that are in fact developed from observing the behavior of other people around him. This, together with personal experience from alcohol usually acts as a motivation towards drinking. It is worth noting that such decision is normally determined by the persons readiness to take up drinking. On the other hand, it is this readiness to change from being dependent on alcohol that forms the basis of recovery process and treatment regimen.

From the above stated case study, it is justifiable to state that the client is at contemplation stage of change. The said stage tends to be characterized by uncertainty, conflicted emotions and ambivalence. Just as it is the case with Martin, persons at this stage of change normally become aware of any risk that might be associated with such alcoholic behavior. This is usually informed on the fact that such persons become more aware of the expected or potential benefits of making such change in the first place (Joseph, 2004). Though Martin is desperate for change away from alcohol dependency, there is a high possibility that he is ambivalent about making this change since it shall amount to giving up his most enjoyed behavior. The mere prospect of giving such behavior creates a sense of feeling lost despite their awareness of the possible benefits of making such change in their drinking behavior. Addicts who are at this stage are also known to have difficulties in appreciating the perceived obstacles to the recovery and treatment for example, fear, hassle, time or expense.

Clients who are at this stage are able to benefit from the much needed professional help with respect to weighing merits and demerits of their behavioral change. Receiving the encouragement towards developing their confidence regarding them being able to change is the other help that individuals at this stage receive. Thirdly, addicts are able to get help towards the determination of the best way of overcoming any potential barriers or challenges towards their treatment and recovery. The fundamental questions that addicts at this stage are usually faced with are what is the primary reason for the change in the first place Are there challenges that would hinder this change process The third most important issue of concern is the identification of other things that would be of help towards making this change. Before an individual moves to this stage, they are usually under the pre-contemplation stage.

This stage of recovery is largely characterized by ignorance as well as denial of the problem by the addict. People who are at this stage do not even think about the need for them to change in the first place. To them, changing does not seem to be a feasible or palatable option as far as their behavior is concerned. Clients at this stage usually stand to benefit in terms of getting encouragement to take a critical look into their behaviors with the view of changing. Furthermore, clients are educated regarding the potential long and short term repercussions as well as risk that are associated with their behavior. Such addicts also get additional help towards enabling them to conduct self analysis with regard to development or addiction to alcoholism.

The different theories that concern human psychology try to explain the logic behind human behavior in relation to what goes on in his mind and what influences him to do so. Most of the time, our thoughts and behavior are highly connected to the activities that go on around us be it in the environment or within our physiological systems. Therefore, it is good to observe human nature as one that is highly influenced by its surroundings. The human mind is complex and the explanations as to how it reacts are highly given by the perspectives of psychology. The perspectives assess, analyze and give an explanation as to why we react the way we do. Different perspectives explain the different reactions to different situations. We examine the different perspectives. There are seven critical perspectives of psychology. They are as follows the evolutionary perspective, behavioral perspective, neuroscience or the humanistic perspective, the socio-cultural perspective, the psychodynamic or psychoanalytic perspective, the cognitive perspective and the biological or behavior genetics perspective (Nemec, 2010).

The evolutionary perspective is largely based on Charles Darwins theory of Survival for the fittest. This perspective tries to explain how nature influences ones genes. It further suggests that behavior and the thought process are inherited from a lineage. The traits that one inherits are as such contained in the DNA of his or her parents. They are then passed on at birth to the child. The behavioral perspective suggests that our behavior is molded around what we see in our environment. The experiences one undergoes also serve to influence his behavior. For instance, a baby would normally observe how the people around it behave. It would then copy what it has seen or simply emulate the adults around it. The humanistic or neuroscience perspective features the way the human mind responds to happenings in the world around it. This would most likely be happenings like ones that solicit emotions o sympathy and empathy. A person would always feel the need to help others who are in certain situations. Therefore, this perspective tries to show how our brain comes up with emotions. It shows that to a big degree, we are all capable of being good.

The socio-cultural perspective is a perspective that looks at how the different cultures, social classes, our gender, ethnicity and other factors influence us. The way we carry ourselves out varies in all the cultures. People in the high class are bound to be of different thought and behavior. Suffice to say that we behave according to the dictates of our cultural and ethnic background. The psychodynamic or psychoanalytic perspective largely looks into how behavior is rooted in conflicts within the mind. Sigmund Freud explained that we unconsciously suppress our feelings and release the emotions that build up within through other means. For instance, when we are tense, we normally find something to do so that we can release the tension. Some of us listen to music or even go and engage in sports. We do this instead of venting our anger on other people or objects. The cognitive perspective deals with how we receive and process information and later react. Our thinking influences our behavior.

Therefore, it goes a long way in influencing us to choose what we think is the best way to react to a situation. For instance, when a person finds that playing basketball is more fun than listening to music, he will always choose basketball over music. Lastly, the behavior genetics perspectives, also referred to as the biological perspective, generally emphasizes that our genes and the environment have a large influence on individual differences. We respond differently to different stimuli. Most people like music but it seems to elicit different emotions in us. For instance, whereas some would always respond to good music by dancing and being happy, others would be happy to the point of shedding tears. Another aspect of this perspective is that different parts of the brain are responsible for different reactions. The part of the brain that responds to pain is different to the one that responds to happiness. Therefore, different parts of the brain process how we feel about pleasant and unpleasant stimuli (Oak, 2008).

Human beings are social in nature and as such they are bound to interact or engage in activities that bring them closer to each other. The reasons for such interactions are vast and varied and can only be determined when we consider an exact situation. Some of the reasons why most people interact are sharing of ideas, finding companionship, understanding other peoples perspectives, among very many other reasons. Each one of us has his own peculiar habits. Everybody engages in some antisocial behavior that tends to make them happy in their private lives. While these behaviors make them happy, they would not be happy to be identified with such kind of behavior because of the manner in which their societies perceive such acts (Westen  Kowalski, 2006).

Nobody likes to be thought of as an outcast. Nobody likes being left out by their peers. People are able to sacrifice what they like, or engage in what they do not enjoy just to have the perception of being together with the people. Human beings are able to acquire the nature of chameleon this is in the sense that they are able to change some of their behaviors to adapt in a given kind of environment. They want to have a feeling of belonging to the crowd. Their behaviors are always geared towards fitting into their social situations and as such their real behaviors can be known only with time (Merton, 1957).

When men go out with their male friends during night outs, they are able to engage in certain activities that they would not contemplate engaging in if they are in the company of their wives. Very polite men who are otherwise polite and always respectful are able to engage in disrespectful acts when he is with some of his friends. A gentleman who is associated with polite gestures towards women is able to take a completely different turn of being particularly arrogant to women. Men are always trying to show their might in such occasions and are such more likely to do anything that portray the same. They want to show that they know more than their peers in the course of their conversations. They want to drink more than their friends to show that they are able to withstand alcohol than most of their friends. They want to outdo each other in terms of tuning women. They raise their voices in the course of their talking. The situation would be completely different when they are in the company of their spouses. They would lower their voices they would be particularly gentle and would not engage in any disrespectful act. A frequenter of the stripping club would act as if he does not know any of these clubs when they are in the company of their wives (Westen  Kowalski, 2006).

The driving force behind such actions by men may be the cheer and being highly regarded in these groups. When they compete in drinking alcohol, their friends cheer as if they were in a kind of competition. They have to demonstrate that they are manly in such company. The influence of the group is demonstrated on the individual members. The individuals would do many things including those that they do not really enjoy in order to conform. They would also change the types of clothes they wear to reflect fashion even when they do not like some of those items (Gray, 2006).
Many people enjoy ghost hunting and ghost tours in the Halloween spirit. The members of such expeditions always adjust their behavior to fit their company. They visit haunted places under the instruction of a guide who gives them all the details pertaining to the place in question. Individuals in such kind of tours supposedly experience supernatural occurrences. They can claim to be seeing a shadow which may not be present in real sense. When a person says this to members of the group, some may genuinely see this non-existent shadow. However, some or even all the people in the group may just pretend to be seeing these things to ensure that they are part of the group. They then feel that they have had a ghost experience while some of their members did not even catch a glimpse of this experience. Others may just base their experience on what the tour guide told them about the ghosts at that site. The impression is able to make some of these people have a real experience of seeing some of these things. People in a cemetery can just point in a given direction and claim they are seeing something (Merton, 1957).

Bibb Latane developed a theory, The Social Impact Theory, which tries to explain such social pressures. He argued that if more people are pushing you towards a given direction or action, then you are more likely to conform. If the source of a given opinion is a source you value so much then you are more like to follow that direction. A source you see more often can easily influence you than distant sources. A source of information particular to you is more likely to influence you than that which is aimed to advice many people. These men are normally pushed to engage in some of these activities because of their audience and they would most likely not do these things alone. It is thought that audience arouses an individual. These men are out to impress (Gray, 2006).

The concept of group polarization also comes into play. This concept is based on the idea and belief that each member of a given group is always in a competition with the rest of the members to achieve the support of the majority. The way in which a group is divided on a given opinion matters a lot to the common stand or state of compromise the group is like to settle for. Individuals are usually in a dilemma on whether to compete with each other or to cooperate. When one member gives an opinion that differs from the other, it is a bit difficult to settle for a solution without a compromise on the side of one or both the individuals. A person may feel shortchanged when his ideas are not taken into serious consideration. Nobody likes to be the inferior member of his group (Gray, 2006).

The examples we have considered are never permanent and only occur in certain occasions. These behavioral changes are inconsistent and do not appear to happen to these individuals out of the necessary settings. They are able to control them and hence no therapeutic intervention may be required. The people are to adjust to their normal behaviors. Medical intervention would be recommended in the event that these people did the same thing with both the men and the women. Since human beings are social, they have to be together. Each and every one of us is unique and hence we are bound to be different from each other and as such some behavioral adjustments may be necessary to fit into different groups.

There is no doubt that leadership qualities are mostly inborn rather than learned where as, management qualities are learned. We have read about many leaders who  through their immense leadership qualities  emerged as a source of change or revolution in their times. Some great leaders of the past include Napoleon, Gandhi, and Quaid-e-Azam, who at their times brought about significant changes in their circumstances, led the people or followers, and influenced them in such a way that their actions became inline with the desired purpose. Of course, the role of time and place played a significant role in their leading and influencing the people.

In this paper, we would talk about a great iconic personality who  with some vision, hope, and rigidness  changed the course of his life and emerged from nowhere as a leader and a great influencer, who is acknowledged as a great cyclist and leader. And that great personality is of Lance Armstrong, who was at the peak of his success and achievement when he was just 25 during the period of 1995. Then he had testicular cancer which is the most common cancer in men who age from 15 to 35 years (Rodriguez, 2002). Though he got late in diagnosing the disease due to which he had little chances to live nevertheless, he kept his spirits on and affirmed himself as a cancer survivor, not a cancer victim.

As far as the influences of heredity and environment are concerned over Armstrongs life and his psychological development, both played equal role. The area that was most influenced in his psychological development was the moral part. Since the leadership qualities and sheer determination to achieve something was inborn in him, hence his morality and dignity was even more influenced and developed. Heredity also played a great role in his psychological development, building up his morality, determination, leadership qualities, and the sheer quality of not giving up because the qualities were inborn.

Answer  2 - He was a great cyclist before, he never thought of founding such an organization that would be very fruitful for the cancer patients. After his successful treatment, he decided to come back in action (cycling) with full confidence and hope, and therefore won three consecutive Tour de France titles. What made him hopeful and confident, was the crucial time and situation when he became a cancer patient. He never gave in and decisively kept on believing more in God, hope, and optimism. He  by his courage, bravery, and hopefulness  motivated and influenced many people including his cycling competitors, who gained the lesson of not to give up and continue on with the hard work and full concentration.

He believed in God, surgery, and doctors, and was hopeful that one he would be fine and would return to compete and win more cycling titles, and thats what he did. Before having a complete and successful surgery, he founded Lance Armstrong Foundation with a vision that he had in his mind and that vision most probably was the result of the time and circumstances that he was facing.

He used to communicate to others and always asked others to be hopeful, brave, and optimistic in addition, he used to model that vision and advice so that others get inspired from him and strive for the same strategy or vision. By forming the organization, he really changed the patients mentality, the way of thinking, and filled them with the hope to be cured and all right in the future. Therefore, we can say that there were the social support systems that played somewhat role in shaping the developmental growth and adjustment of Armstrong.

Answer  3  two different theories of personality are Type a personality, and Type B personality. People who possess type a personality normally possess the following qualities and traits. First, high sense of time urgency impatience. They normally get frustrated and are very conscious of time that whether it is being utilized properly or not. Secondly, these people are aggressive in nature and become hostile and rude at times. In other words, they are competitive possess strong need for achievement and certain traits that result from stress.

Type B personality people are a bit relaxed and calm by nature and have low sense of urgency for time. They can sit without doing anything with any guilt or shame whatsoever. Third, they have the tendency to prolong or delay their work that they have to perform in a given amount of time and they dont get stressed out easily.

Applying these theories over Lance Armstrong would not be an easier task. It is because he possesses the mixture of both types of personality traits. From type a personality, he is competitive, has high need for achievement whereas from type B personality traits, he is calm, cool, determined, and dont get stressed out or demotivated easily.

Answer  4  As far as other leadership theories are concerned, leadership perspective that can be applied to him is the Charismatic leadership that is having interpersonal attraction, whereby followers develop a respect for, and trust in, the charismatic individual (McShane and Travaglione, 2003). His cycling competitors learned a lot from him and tried to adapt to his leadership, constant improvement skills, and his personal traits. Some of his skills include, the nurturing of his nature, improving the way of performing tasks, and overcoming the weaknesses second, focus similar to a laser and keeping the vision or aim in mind abreast third, commemorating the individual or a team on success and fourth, maintaining of lucid and elastic roles without any ambiguity or confusion (Jensen, 2005).

Lance Armstrong possessed many leadership and achievement related skills, capabilities, attitude, motivation, abilities, and values. Or in other words, he had all vibrant qualities that a competent leader possesses  qualities that come under the leadership contingency. First, he owned the quality of Drive, which is the inner motivation to pursue goals. As we discussed earlier, he never thought of giving up even when he was entangled by testicular cancer in fact, he became more eager, willing, and excited to compete and win the titles after the recovery. Second, he had self-confidence in himself, and was quite determined and focused to put great effort towards his objectives (Cordair, 2004) he kept himself focused and on the path to success and always worked hard and differently from others.

Another theory that shows this need for achievement is Maslows hierarchy of needs. This theory consists of five stages psychological, safety, belongingness, esteem, and self-actualization. Armstrongs need for self-actualization seemed to be pretty high as compared to other needs the need to prosper, flourishes, and achieve. His aim was to be the best among the other cyclists, win more titles, and even to support other team members to win (Jensen, 2005). The act of supporting and helping out his partners and competitors is one of the key leadership qualities that must be there in order to reconcile the differences among people with himself and to guide and lead others in the way we want and what others think is suitable for them.

After all the discussion, we come to know that whether the person is short in size, weight, or have any other flaw, he or she can become an outstanding leader by appropriately using the skills and abilities, learning from the time, place, and situation, and creating vision, communicating it, and modeling it then. Lance Armstrong was just a cyclist, but due to his immense hard work, focus, determinacy, courage, optimism, hopefulness, and the firm belief in success and achievement, he became the best cyclist of his time. Later, he also managed to fight with the disease that was severe and spread to his brain too. He continued the hope to be cured, and even he opened his own organization, along with the development of thoughts regarding to the future cycling career.

In our lives, we go through various developments which involve an obvious element which is change. This development involves the change or movement from one state to another. A development interest results to ones concern for transitions. With the development change, there is permanent or a lasting impact on the person who undergoes the transition. This is why it is referred to us the growth to a progression through certain stages.

In efforts to compare the early adulthood and Middle adulthood, the first thing about the two is that they occur at different intervals of the human life. The early adulthood take place form the age of eighteen after the adolescent stage to the age of thirty-five. While on the other hand, the middle adulthood falls under the age of 35-65 years of age. The two development stages are characterized by various elements that are unique in both. In the early adulthood, the ego development outcome in this stage is intimacy and solidarity while at some point if these two elements do not occur, a person may develop isolation. As this is the initial stage of one being an adult, human tend to seek one or even more companions and even Love. In this stage, people tend to look for satisfying relationship. The basic strengths that are found at this development stage are affiliation and love.

On the other hand, the middle adulthood is characterized by generativity but if this fails, one may experience self absorption or stagnation. At this stage, the important task the people take on is to perpetuate culture while at this level transmitting values of that particular culture t the family. Establishing a stable environment for the family is also part of the development changes. The basic strengths in this development is found in the production and care.

Healthy People 2010 postulates that social determinants are critical to understanding and eliminating health disparities and inequities. Social determinants include differential access to and distribution of resources, services, and structures. As noted previously, when access and distribution to resources, services, and structures is limited health inequities ensue.

The resources, services and structures that comprise the social determinants are not solely medical or behavioral, therefore Healthy People 2010 suggests that the traditional focus of health education as practiced in the United States is too narrow. Instead, they call for more equitable access to and distribution of factors including education, housing, labor, justice, transportation, agriculture and the environment, a few of the factors categorized in the literature as social determinants of health (Baker et al, 2005 Marmot  Wilkinson, 1999 Schulz  Northridge, 2004). To some this shift of focus may seem novel. However, since the early 19 century people have understood that ones social position and living conditions influence their health (Kelly, Bonnefoy,Morgan,  Florenzano, 2006). Many of the strategies employed to eliminate the spread of infectious disease had little to do with medicine and more to do with changing the environments in which people lived and worked and increasing access to nutritious food (Kelly et al., 2006).

Social determinants of health are the social, political and economic resources, services and structures that shape our living and working circumstances and ultimately influence the health of communities and individuals alike (Baker et al., 2005 Graham, 2004 Marmot  Wilkinson, 1999 Picket  Pearl, 2001 Smith, Hart, Watt, Hole,  Hawthorne, 1998). Typically, policies and practices are the mechanism through which this influence is exerted because they regulate access to and distribution of resources like money, power and social support (i.e., social determinants) across individuals and communities (Graham Schulz et al., 2005). Characteristically, the inequality in access to and distribution of these resources creates health inequities. For example, an economic policy that creates tax incentives for the creation of grocery stores in underserved areas provides access to nutritious foods. In the absence of a grocery store, many communities lack access to nutritious food options completely. Therefore, individuals living in communities with limited access are more likely to develop certain diseases (e.g., cardiovascular disease) than those that have access.

The demographic makeup of the Canada like that of the U.S. has changed dramatically in recent decades families are shrinking, highlighted by decreasing birth rates in the past generation. Death rates have also declined for quite some time (Preston 1977), creating a large cohort of individuals who live well into retirement and old age (Waite 2004). In fact, people aged 65 and older in the U.S. make up approximately 13 of the population, and this proportion is growing (Waite 2004). With a growing older population come implications of a changing demographic makeup. The increase in life expectancy may add to the number of years in which people live with illnesses and disabilities (House, Kessler and Herzog 1990 Manton 1982). Other elderly people will live better quality lives in accordance with their increased life expectancy as a resulteither way, the government is burdened with increasing medical expenses from the fastest growing segment of the countrys population, the elderly (Waite 2004).

In recent decades, the Canadian government has instituted social policies with the intent of increasing the quality of life among the elderly from an economic and health standpoint. While this intended effect has been successful in many cases, these policies have the latent effect of decreasing the amount of inequality experienced by this growing segment of the Canadian population. Specifically, Social Security and Medicare are designed to help the elderly. Social Security is structured such that the current working populations income benefits the current 65 population. Similarly, Medicare is the health insurance coverage issued by the federal government to all individuals aged 65 and above in Canada. Additionally, Medicaid provides long-term care coverage, which is an increasing proportion of states budgets (Waite 2004).

These programs specifically provide benefits to the elderly, enabling the convergence of health inequalities in old age. Using social policies to explain converging health inequalities over the life course is a macro-level explanation of the SES-health gradient. Typically, explanations of the gradient are micro-level in nature, associated with personal factors such as education, income, job status, stress, and lifestyle behaviors. Ecological explanations are less common, but not less important. Blane (1999) argues that social policies take account of life course influences. For instance, critical social transitionssuch as entering the age group of 65 and aboveidentify at-risk individuals who are likely to require frequent welfare, health, and social support. Effective policy interventions are able to prevent the accumulation of further disadvantage from past damage, and set people on a more advantaged life trajectory (Blane 1999 77). So, disadvantaged people may finally gain some advantages in old age through social policy, which has the potential to affect the trajectory of health advantages and disadvantages.

Blane (1999) also indicates that the most crucial stages of life in which social policies effect people are late middle and early old age, simply because of their impact on health and welfare expenditures. In sum, social policies serve an important role in the convergence-divergence debate over SES and health inequalities. Most likely policies, such as Social Security, Medicaid, and Medicare, have important life course effects on the health-education relationship more so in the U.S. than in Europe, where health insurance is available throughout the life course. Low socioeconomic groups have higher mortality (Hummer, Rogers, and Eberstein 1998), morbidity (Link and Phelan 1995), and disability (Molla, Madans, and Wagener 2004) than high socioeconomic groups (House, Kessler, and Herzog 1990 Kitagawa and Hauser 1973) due to unhealthy lifestyle choices such as alcohol use and smoking, unstable working conditions characterized by high stress levels and job insecurity, low levels of social support and networks, little sense of control, and exposure to physical and environmental hazards (Mirowsky and Ross 1989 Mirowsky 1999 Rogers, Hummer and Nam 2000 Mirowsky and Ross 2003).

Interestingly, little literature exists on how exposure to these risk factors affects individuals as they age. That is, at what point do health inequalities associated with risk factors between socioeconomic groups peak Do socioeconomic-based health inequalities rooted in health behaviors converge or diverge in old age House, Kessler, and Herzog (1990) investigate the issue of convergencedivergence of socioeconomic-based health inequalities and risk factors, arguing  INCLUDEPICTURE httpsapi.turnitin.comimagesspacer.gif  MERGEFORMATINET  HYPERLINK javascriptvoid(0) that the impact of risk factors on health INCLUDEPICTURE httpsapi.turnitin.comimagesspacer.gif  MERGEFORMATINET  should be the greatest in middle and early ages. These risks are greatest during middle and early old age because smoking, drinking, exposure to harmful conditions, and other factors have had years to take effect on an individual and manifest their harmful consequences at this later stage in life. While this maximum level of inequality is likely to exist between the ages of 35 and 65, it reduces after age 65 due to U.S. government assistance and a reduction of harmful exposures at this stage in life (House, Kessler and Herzog 1990). It is less common for elderly people to drink, smoke, or engage in risky behaviors as younger people do also, harmful work conditions are no longer in effect due to retirement in old age (House, Kessler and Herzog 1990). Eliminating exposures in old age may also have an additive positive effect on health. That is, reducing exposure to risk factors in old age benefits health because the elderly are more susceptible to these things in old age (House et al. 1994). By eliminating dangerous risk factors, the health status of the elderly can potentially get much better.

Education and income are closely related to the amount of exposure one has to social, psychological, and physical risk factors. Less-educated people have a greater propensity to work in an environment characterized by more demanding physical labor, greater stress due to lower job security, unsafe working conditions, longer hours, and a variety of other taxing conditions (Ross and Mirowsky 1999). The accumulation of these factors leads to heightened levels of health inequality between members of different socioeconomic groups (Molla, Madans, and Wagener 2004). Where these levels of inequality are smallest and where they are greatest is yet to be determined, although evidence exists that they do not continue throughout the entire life span (Johnson 2000).

Theories of converging inequality take four different approaches selective survival, social policy, proximity to education, and exposure to risk factors. Each of these four areas has been used as an approach in current literature to explain unique and specific ways in which the socioeconomic gradient in health is minimized in time. The selective survival (Beckett 2000 Johnson 2000 Elo and Preston 1994) and social policy (Waite 2004 Blane 1999 House, Kessler, and Herzog 1990) explanations are more recent explications. The selective survival explanation is also commonly used in literature on the racial mortality crossover in the U.S. (Johnson 2000 Preston et al. 1996 Mutchler and Burr 1991).

Alternatively, at least one theory of diverging inequality has also recently received a great deal of attention in the literature.