Clinically Referred ODD Children with or without CD and Healthy Controls: Comparisons Across Contextual Domains

This study compares 6–11-year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder, either with (ODD + CD, n = 40) or without Conduct Disorder (ODD only; n = 136), to a matched sample of healthy control children (HC; n = 69). Multiple informants completed intake diagnostic interviews and self-reports to evaluate constructs examining the child’s functioning and contextual influences on functioning (e.g., parent, family, peer, community). ODD + CD and ODD only children were each distinguished from HCs by greater exposure to delinquent peers and lowered parental self-efficacy. In further comparisons to the HC group, ODD only status was associated with parental use of psychological aggression and more stressful life events, whereas ODD + CD status was associated with greater parental hostility. Relative to ODD alone status, ODD + CD status was comparable on all but one variable (greater parental hostility). Similar findings were reported using a subset of girls only. The characteristics that distinguish children with DBDs from controls and, in particular, ODD + CD from ODD only, bear implications for understanding and treating both CD and ODD.

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Community vs. Clinic-Based Modular Treatment of Children with Early-Onset ODD or CD: A Clinical Trial with 3-Year Follow-Up

This study examines the treatment outcomes of 139, 6–11 year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) who were randomly assigned to a modular-based treatment protocol that was applied by research study clinicians either in the community (COMM) or a clinic office (CLINIC). To examine normative comparisons, a matched sample of 69 healthy control children was included. Multiple informants completed diagnostic interviews and self-reports at six assessment timepoints (pretreatment to 3-year follow-up) to evaluate changes in the child’s behavioral and emotional problems, psychopathic features, functional impairment, diagnostic status, and service involvement. Using HLM and logistic regression models, COMM and CLINIC showed significant and comparable improvements on all outcomes. By 3-year follow-up, 36% of COMM and 47% of CLINIC patients no longer met criteria for either ODD or CD, and 48% and 57% of the children in these two respective conditions had levels of parent-rated externalizing behavior problems in the normal range. We discuss the nature and implications of these novel findings regarding the role of treatment context or setting for the treatment and long-term outcome of behavior disorders. This study was supported by grants to the first author from the National Institute of Mental Health (MH 57727) and to the second author by the National Institute of Nursing Research (NR 07615). The fourth author was supported by grant K01 MH078039 from the National Institute of Mental Health. The authors acknowledge the research and clinical staff of the Resources to Enhance the Adjustment of Children (REACH) program, and Drs. David Brent, Tammy Chung, William Gardner, John Lochman, and Wayne Osgood. Reprints may be obtained from Dr. Kolko, WPIC, 3811 O’Hara St., Pittsburgh, PA 15213.     

Coping, competence, and aggression prevention: Part 1. Developmental model

According to coping-competence theory, current challenge encounters determine future life outcomes and competence. This theory provides a testable causal model of the development of persistent aggression. The model suggests that protective circumstances enable resilient youth to cope prosocially (helping self without harming others) even with uncontrollable challenges. Unprepared for language-based prosocial coping, high-risk youths' antisocial coping yields adverse life outcomes (e.g., school expulsion, teen pregnancy, police arrest). Each adverse outcome increases future antisocial coping, threatens future competence (i.e., self-definition, social reputation, dominant coping strategy), and aggravates status on risk-protection variables (i.e., parent warmth and skill, child temperament and intelligence). The same structural model may apply across the lifespan with changes in indicators and weighting of constructs during key developmental transitions. Part 2 presents the model's prevention implications.     

Reciprocal Relationships Between Parenting Behavior and Disruptive Psychopathology from Childhood Through Adolescence

Theoretical models suggest that child behaviors influence parenting behaviors, and specifically that unpleasant child behaviors coerce parents to discontinue engaging in appropriate discipline. This study examined reciprocal relationships between parenting behaviors (supervision, communication, involvement, timid discipline and harsh punishment) and child disruptive disorder symptoms (ADHD, ODD and CD) in a clinic-referred sample of 177 boys. Annual measures, including structured clinical interviews, were obtained from the beginning of the study (when boys were between the ages of 7 to 12) to age 17. Specific reciprocal influence was observed; only timid discipline predicted worsening behavior, namely ODD symptoms, and ODD symptoms predicted increases in timid discipline. Greater influence from child behaviors to parenting practices was found: ODD also predicted poorer communication and decreased involvement, and CD predicted poorer supervision. ADHD was neither predictive of, nor predicted by, parenting behaviors. The results are specifically supportive of a coercive process between child behaviors and parenting behaviors, and generally suggestive of greater influence of child behaviors on parenting behaviors than of parenting behaviors on child behaviors.     

Brief Behavioral Intervention for Young Children with Disruptive Behaviors

Parent reported behavioral difficulties in young children are relatively common. Without adequate intervention, some children will later present with more severe problem behaviors. Parent management training is one of the best methods of treatment for behavior problems; however, existing treatments can be lengthy and difficult to conduct outside of a research setting. The Brief Behavioral Intervention was designed as a briefer version of a manualized parent management training treatment package. Thirty-one parents of children aged 2–6.5 presenting with behavior problems were included in this initial study of treatment effectiveness. Based on parent and teacher report, treatment was effective in a mean of 7.2 sessions.     

Relation of Age of Onset to the Type and Severity of Child and Adolescent Conduct Problems

In a cross-sectional household sample of 9-through 17-year-old youths from 4 U.S. communities, youths with earlier ages of onset of conduct problems engaged in more conduct problems than youths with later ages of onset when current age and gender were controlled. Specifically, youths with earlier ages of onset were more likely to engage in several types of physical aggression, frequent lying, theft, and vandalism and were less likely to engage in only truancy. There also was an inverse relation between age of onset and level of functional impairment, mental health service use, and meeting diagnostic criteria for conduct disorder, attention-deficit hyperactivity disorder, and oppositional defiant disorder. Within the limits of cross-sectional data, these results support the hypothesis that key aspects of the heterogeneity of conduct problems among youths are related to the age of onset of conduct problems.     

Description and Immediate Impacts of a Preventive Intervention for Conduct Problems

A population-based randomized intervention trial for the prevention of conduct problems (i.e., oppositional defiant disorder and conduct disorder) is described. The LIFT (Linking the Interests of Families and Teachers) intervention was designed for all first- and fifth-grade elementary school boys and girls and their families living in at-risk neighborhoods characterized by high rates of juvenile delinquency. The 10-week intervention strategy was carefully targeted at proximal and malleable antecedents in three social domains that were identified by a developmental model of conduct problems. From 12 elementary schools, 671 first and fifth graders and their families participated either in the theory-based universal preventive intervention or in a control condition. The intervention consisted of parent training, a classroom-based social skills program, a playground behavioral program, and systematic communication between teachers and parents. A multiple measure assessment strategy was used to evaluate participant satisfaction and participation, fidelity of implementation, and the immediate impacts of the program on targeted antecedents.     

External Validity of Conduct and Oppositional Defiant Disorders Determined by the NIMH Diagnostic Interview Schedule for Children

We administered the Diagnostic Interview Schedule for Children (DISC) two times to a group of youth (222 boys, 147 girls) entering residential care, once at their time of entry and once 1 year later. We then compared their DISC outcomes on Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD) against changes in independent direct observations of diagnostically relevant behavior obtained over the course of that year. Results from hierarchical linear modeling analyses showed significant discriminative relationships between results from the DISC and the independent observations. Specifically, observations of symptomatic behaviors (CD or ODD) decreased for youth who met diagnostic criteria at the first administration of the DISC but not at the second, increased for youth who did not meet criteria at the first administration but did at the second, and did not change for youth who met criteria at both administrations. These results extend the data on the validity of the DISC and support continued research efforts to determine its clinical utility.     

Toward a Transactional Conceptualization of Oppositional Defiant Disorder: Implications for Assessment and Treatment

The conceptualization and treatment of oppositional defiant disorder (ODD) has been characterized by surprising homogeneity. In this paper evidence is presented to underscore the heterogeneity within ODD, including research demonstrating (a) the distinction between reactive and proactive forms of aggression; (b) the importance of affective modulation and self-regulation, and associated cognitive skills, in the development of the skill of compliance; and (c) high levels of comorbidity between ODD and other disorders. The disparate pathways that give rise to oppositional behavior suggest that different children with ODD may require different forms of intervention. The necessity of a transactional conceptualization, of achieving a comprehensive understanding of the factors underlying the difficulties of individual children with ODD, and of matching intervention ingredients to the specific needs of different children and families is discussed.Ross W. Greene     

Counseling Outcomes for Youth With Oppositional Behavior: A Meta‐Analysis

This meta‐analysis of clinical trials explored the effectiveness of treatments targeted at changing oppositional behavior. The meta‐analysis included 31 peer‐reviewed treatment studies with school‐age youth ages 6–17 years identified as having oppositional defiant disorder. Results were synthesized using a random effects model for mean difference and mean gain effect size estimates. Findings suggest that counseling/psychotherapy is effective in treating oppositional behavior in school‐age youth at termination, but the long‐term efficacy of such treatment is less stable.     

A modified DBT skills training program for oppositional defiant adolescents: promising preliminary findings

A modified skills training component of dialectical behavior therapy (DBT) was implemented in a group therapy format for non-suicidal outpatient young adolescents who met criteria for oppositional defiant disorder (ODD). Thirty-two youths completed the 16-week program, as well as pre- and post-treatment measures. The treatment was effective not only in decreasing negative behaviors, but also in increasing positive behaviors, per caregiver report. The youths reported a significant reduction in externalizing and internalizing symptoms and in depression. Reliable change indices indicated that far more participants were in the improved category than in the deteriorated category on the measures of interest. Despite the absence of control groups but consistent with the treatment outcome research literature for DBT-based treatments for other disorders, this study demonstrated that DBT skills training is feasible and shows promise in improving the behavior of ODD young adolescents.     

Coping, competence, and aggression prevention: Part 2. Universal school-based prevention

Coping—competence theory yields a structural model of the development of persistent aggression in which current challenge encounters determine future life outcomes and competence. Driven by this model, universal, school-based prevention programs would aim in multiple ways to promote prosocial coping among high-risk, resilient, and advantaged youth from kindergarten through high school. Expected benefits of prosocial coping would include: less aggressive behavior, fewer adverse life outcomes (e.g., school dropout, police arrest, teen pregnancy, conduct, mood, and substance-use disorders), and a more competent self-definition and social reputation. Five stages are described that may prove useful in creating prosocial schools and neighborhoods supportive of youth in transition away from antisocial coping and deviant peers.     

Maintenance of Treatment Gains: A Comparison of Enhanced,Standard, and Self-directed Triple P-Positive Parenting Program

This report describes the 3 year outcomes of three different variants of the Triple P-Positive Parenting Program, a behavioural family intervention. Families were randomly assigned to one of three intervention conditions or to a waitlist condition. At 1 year follow-up there were similar improvements on observational and self-report measures of preschooler disruptive behaviour for Enhanced, Standard and Self Directed variants of Triple P. At 3 year follow-up (completed by 139 families), each condition showed a similar level of maintenance of intervention effects. Approximately 2/3 of preschoolers who were clinically elevated on measures of disruptive behaviour at pre-intervention moved from the clinical to the non-clinical range. Across conditions, there was a comparable preventive effect for each intervention for these high risk children. The implications of the findings for the development of brief, cost effective parenting interventions within a public health framework are discussed.     

Parent management training for reducing oppositional and aggressive behavior in preschoolers

This article provides an overview of parent management training (PMT) for preschool-age children with aggressive and oppositional behaviors. Assessment strategies and basic concepts of PMT are provided. Theoretical underpinnings and research outcomes are highlighted for some variations of PMT programs that have strong empirical support. These programs include Helping the Noncompliant Child, Parent–Child Interaction Therapy, Incredible Years Training Series, Triple P-Positive Parenting Program, and Oregon Early Intervention Foster Care.     

Screening for Behavioral Disorders With the Dyadic Parent-Child Interaction Coding System: Sensitivity,Specificity, and Core Discriminative Components

We assessed the ability of the Dyadic Parent-Child Coding System to discriminate between Norwegian children with Oppositional Defiant Disorder and/or Conduct Disorder (n = 36) and community controls with no diagnosis (n = 122). All children were diagnosed by the Preschool Age Psychiatric Assessment. Results showed that a composite score of three negative parent codes—Negative Talk, Indirect Commands with No Opportunity for Compliance, and Direct Command with Compliance—as well as one child code, Command, evidenced excellent screening efficiency. Results are discussed in light of possible cultural differences in parent-child interaction and revisions of the coding system.     

Early Parenting Intervention: Family Risk and First-time Parenting Related to Intervention Effectiveness

The effects of cumulative risk and parity on the effectiveness of a home based parenting intervention were tested in a randomized controlled trial with 237 families with 1- to 3-year-old children screened for high levels of externalizing behavior. The intervention was aimed at enhancing positive parenting and decreasing externalizing behaviors. The results showed that cumulative risk was not associated with either change in child externalizing behaviors or change in positive parenting. When intervention effectiveness was compared for primiparas (i.e., first-time mothers) versus multiparas (i.e., mothers with more than one child), we found that intervention mothers of first-born children displayed an increase in their use of positive discipline strategies as compared to first-time mothers in the control group, whereas a similar effect for multiparas was absent. Among multiparas we found an intervention effect on sensitivity, with control group mothers showing an increase in sensitivity, whereas the intervention group showed a constant level of sensitivity over time. These results suggest that parity may be a moderator of intervention effectiveness. Implications for investigating moderators of intervention effectiveness are discussed.     

Bidirectional Influences of Violence Exposure and Adjustment in Early Adolescence: Externalizing Behaviors and School Connectedness

This study utilized cross-lagged longitudinal models to examine prospective, bidirectional relationships between witnessing violence and victimization and three adjustment variables—delinquency, conduct problems, and school connectedness. Participants included 603 early adolescent boys and girls (78% African American, 20% Caucasian). Witnessing violence was related to subsequent lower levels of school connectedness and more conduct problems. For Caucasian but not African American adolescents, witnessing violence also predicted later delinquency. Victimization was linked with lower school connectedness over time, and for boys but not girls also with more conduct problems. Only adolescent delinquency was associated with subsequent witnessing violence and victimization. This research was partially supported by the Centers for Disease Control and Prevention Grant No. R49–CCR418569.     

Parent training for young Norwegian children with ODD and CD problems: Predictors and mediators of treatment outcome

Participants were 121 children, aged 4–8 years referred for conduct problems, and their mothers. A parent training intervention was implemented in two outpatient clinics in Norway. Treatment responders were defined as children scoring below a cut-off on the Eyberg Child Behavior Inventory, a score below an optimal cut-off for children in day-care and school as reported by teachers, in addition to a 30% reduction or greater in observed negative parenting. Self-reported parenting practices were explored as potential mediators. The results of logistic regression analyses showed that high levels of maternal stress, clinical levels of ADHD, and being a girl predicted a poorer outcome in conduct problems at home, while pretreatment clinical levels of ADHD predicted a poorer outcome as perceived by the teachers. Harsh and inconsistent parental disciplining emerged as significant partial mediators of changes in conduct problems, highlighting the importance of altering parenting practices to modify young children's conduct problems.     

Preschoolers at risk for attention-deficit hyperactivity disorder and oppositional defiant disorder: family,parenting, and behavioral correlates

This community study assigned 129 4-year-olds to groups at risk for attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), both ADHD and ODD, or no problems. Mothers of children at risk for ODD reported more family dysfunction, felt less competent as parents, suggested fewer solutions to child behavior problems, demonstrated a less assertive approach to child management, and reported more child internalizing problems than did mothers of children not elevated on ODD symptoms. Mothers of children at risk for ADHD reported higher personal depression scores than did those of the non-ADHD subgroup. Children at risk for ADHD evidenced the most difficulties in school where teachers reported more social behavior, classroom management, and internalizing problems relative to other children not at risk for ADHD. When solving child management problems, mothers of children in all groups suggested twice as many controlling/negative management strategies as positive/preventive strategies. In addition, faced with oppositional and conduct problems, mothers of children in all groups increased controlling/negative suggestions and decreased positive/preventive suggestions. Mothers of girls at risk for ADHD, ODD, and ADHD/ODD gave more rewards per positive behavior than did mothers of boys.