Family assessment and family interventions — formative SAQs

SAQ 1 — Assessment, mechanism and choosing the rung (10 marks)

An 8-year-old boy with established ADHD continues to display escalating aggression at home despite an optimised stimulant. His mother, raising him alone after a recent separation, is exhausted and reports that nothing she tries works for more than a few days. The school reports worsening playground conflict. There is no disclosure of violence or maltreatment. ^{[6] [12]}

Questions

1. Outline the components of a systematic, non-blaming family assessment in this case, including the genogram and a validated family-functioning approach. (3 marks) ^[10]
2. Name the family-level mechanism most likely maintaining the behaviour and explain how it works. (3 marks) ^[6]
3. State the first-line family intervention for this presentation, justify why it precedes family therapy, and cite the evidence. (4 marks) ^{[4] [7]}

Model answer

Assessment (3). A three-generation genogram, drawn with the mother, maps structure, the recent separation, losses and any repeating patterns of conflict. Add a validated family-functioning measure — the McMaster Family Assessment Device dimensions (problem-solving, communication, roles, affective responsiveness and involvement, behaviour control) or the Family APGAR — and observe the mother-child relationship in a naturalistic moment. Gather the school's view alongside the mother's and build a shared, non-blaming formulation that names the problem to work on together. The framing is critical: the mother is not failing, the interaction is being shaped by its consequences. ^[10]

Mechanism (3). The coercive cycle, described by Patterson, is most likely. The child behaves aversively — demanding, hitting, refusing — and the mother, exhausted, reacts harshly or gives in. Either reaction ends the aversiveness in the short term, which negatively reinforces the behaviour, so it escalates over months. Single parenthood and recent separation are not the cause; the coerced interaction loop is. ^[6]

First-line intervention (4). Behavioural parent training is first-line — not family therapy — because it targets the coercive cycle directly by changing what the parent does. Named options include parent management training (Kazdin), the higher levels of Triple P, the Incredible Years, and Parent-Child Interaction Therapy, whose meta-analysis shows large effects on child behaviour and parenting. Escalation to Functional Family Therapy or Multisystemic Therapy is reserved for persistent or severe cases, because jumping straight to family therapy overshoots, drops out, and wastes resources. The family intervention is adjunctive to continuing the child's ADHD treatment on its own merits. ^{[4] [6] [7]}