Child Oppositional Behavior Research Articles

The Impact of Cognitive-Behavioral Counseling Program on Improving Academic Achievement in Children with Oppositional Defiant Disorder: A Case Study

The aim of this study was to enhance the academic achievement of a child with Oppositional Defiant Disorder (ODD) through a cognitive-behavioral counseling program. The program was implemented on a single case, a 9-year-old school child with low academic achievement diagnosed with Oppositional Defiant Disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To achieve this goal, a clinical case study approach was utilized, employing observation, clinical interviews, and three measurements of the child's oppositional behavior using pre-test, post-test, and follow-up measurements. The study results confirmed a positive impact of the cognitive-behavioral counseling program on the academic achievement of the child with Oppositional Defiant Disorder. The quarterly average increased from 4.57 to 6.38 in the second quarter, and further to 7.42 in the third quarter of the academic year 2022-2023. Additionally, the child's level of oppositional behavior decreased from high to low.

ADHD Symptoms in Middle Childhood: The Role of Child Attachment and Maternal Emotional Availability in an Inpatient Clinical Sample.

Child ADHD symptoms are highly prevalent in middle childhood, alongside impairment in social functioning. The parent-child relationship has been shown to play an important role; however, studies investigating specific facets of the parent-child relationship in ADHD symptomatology in middle childhood have been neglected. We assumed that higher ADHD symptoms were associated with both (1) lower maternal emotional availability (EA) and (2) lower child attachment security. Moreover, (3) we aimed to explore which specific EA dimensions were associated with ADHD symptoms. In a socio-pediatric clinic in Germany, 71 inpatient mother-child dyads (child age: M = 7.70, SD = 1.06; n = 54 boys) were assessed. Clinical data about child ADHD symptoms (Child Behavior Checklist 6-18 subscale "attention deficit/hyperactivity problems"), maternal EA (free play), and child attachment representation (Attachment Story Completion Task, GEV-B) were analyzed cross-sectionally. Controlling for child oppositional behavior and sex, child ADHD symptoms were associated with overall maternal EA, and more specifically non-hostility, but not with child attachment representation. Our results imply that the role of parent-child interaction quality should be considered in the treatment of ADHD. Bidirectional effects cannot be ruled out.

Children's opposition, marital and life satisfaction: the mediating role of parenting stress

AbstractObjectiveThe present study examines the association of children's oppositional behavior with marital and life satisfaction by examining the mediating role of parenting stress.BackgroundPrevious research indicates that parents of children who exhibit behavioral problems often experience parenting stress and lower marital and life satisfaction. However, few studies have addressed the underlying mechanisms, and even fewer have focused on the effects of children's nonclinical oppositional behaviors while obtaining data from both parents.MethodParticipants were 211 parent dyads (N = 422) of typically developing preschool children. Data on child's oppositional behavior, parenting stress, and marital and life satisfaction were obtained from both parents simultaneously and analyzed using the common fate mediation model.ResultsParenting stress was found to fully mediate the associations between children's oppositional behavior and marital and life satisfaction, whereas marital satisfaction was found to partially mediate the association between parenting stress and life satisfaction.ConclusionsChildren's oppositional behaviors lead to lower marital and life satisfaction through a mechanism of parenting stress, and parenting stress negatively affects life satisfaction, both directly and indirectly, through marital satisfaction.ImplicationsTherapeutic interventions for treating children's oppositional behaviors can usefully include a direct focus on reducing parenting stress and enhancing parents’ ability to cope with child‐related stress as a couple, thus improving parents’ satisfaction with their marital relationship and with life in general.

Child-based treatment of oppositional defiant disorder: mediating effects on parental depression, anxiety and stress.

Previous research has shown that child-oppositional defiant disorder (ODD) and conduct disorders (CD) are associated with parental symptoms of depression, anxiety and/or stress, probably in a bidirectional relationship with mutual influences. It is, therefore, reasonable to assume that in child-centered treatment, a decrease in child-oppositional behavior problems constitutes (at least in part) a mechanism of change for a subsequent reduction in parental psychopathology. The aim of the present study (Clinical trials.gov Identifier: NCT01406067) was to examine whether the reduction in ODD symptoms due to child-based cognitive behavioral treatment (CBT) led to a reduction in parental depression, anxiety and stress. Eighty-one boys (age 6-12years) with a diagnosis of ODD/CD were randomized either to a cognitive behavioral intervention group or an educational play group (acting as control group). Mediation analyses were conducted using path analysis. The stronger reduction in child ODD symptoms in the CBT group compared to the control group led to a decrease in parental depression and stress, as indicated by significant indirect effects (ab = 0.07 and ab = 0.08, p < 0.05). The proposed model for mechanisms of change was, therefore, confirmed for two of the three outcome parameters. Parental psychopathology and stress can be modified by child-centered CBT. The preceding reduction in ODD symptoms acts as a mediator for at least some of the changes in parental depression and stress. However, due to some limitations of the study, other possible explanations for the results found cannot be completely ruled out and are, therefore, discussed.

Early Childhood Predictors of Severe Youth Violence in Low-Income Male Adolescents.

Using a cohort of 310 low-income male adolescents living in an urban community and followed prospectively from 18months through adolescence (ages 15-18years), the current study examined whether individual, family, and community risk factors from ages 18 to 42months were associated with adolescents' violent behavior, as indexed by juvenile petitions. Results of multivariate analyses indicated that although family income was the only factor to discriminate those with no arrest record from those with nonviolent arrests, rejecting parenting, child oppositional behavior, emotion regulation, and minority status during the toddler period contributed unique variance in distinguishing male adolescents arrested for violent behavior compared to those never arrested and those arrested for nonviolent behavior. Implications for prevention efforts are discussed.

The impact of caregiver treatment satisfaction upon child and parent outcomes.

Parental perceptions about treatment influence their child's engagement in and ongoing utilization of mental health services, but less is known about the association between caregiver expectancies and family outcomes. The literature is particularly lacking with families of color, who are at high risk for the onset and perpetuation of disruptive behaviors. The purpose of this study was to examine caregiver treatment satisfaction amongst 320 youth of color aged 7 to 11 and their families who were assigned to either a Multiple Family Group intervention or services as usual condition. Caregiver stress was measured by the Parenting Stress Index Short-Form full scale and child oppositional defiant behaviors were measured using the Iowa Connors Rating Scale-Oppositional/Defiant subscale both at baseline and post-test. Satisfaction with treatment was measured using the Metropolitan Area Child Study process measures program satisfaction subscale at post-test. The two main effects models that focused on satisfaction with treatment was predictive of parental stress and child oppositional defiant behaviors independently. Satisfaction with treatment accounted for 31% of the variance in child oppositional behavior and 24% of parental stress improvements across time holding all covariates constant. Our findings support previous research that shows parental expectancies, including treatment satisfaction, are powerful mechanisms of treatment outcomes for children with DBDs as well as parental emotional health. Further, parental expectancies may be enhanced by the involvement of families in the development of treatment approaches for children and a greater focus on caregiver emotional health for the benefit of the family as a whole.

Early family regularity protects against later disruptive behavior.

Infants’ temperamental anger or frustration reactions are highly stable, but are also influenced by maturation and experience. It is yet unclear why some infants high in anger or frustration reactions develop disruptive behavior problems whereas others do not. We examined family regularity, conceptualized as the consistency of mealtime and bedtime routines, as a protective factor against the development of oppositional and aggressive behavior. This study used prospectively collected data from 3136 families participating in the Generation R Study. Infant anger or frustration reactions and family regularity were reported by mothers when children were ages 6 months and 2–4 years, respectively. Multiple informants (parents, teachers, and children) and methods (questionnaire and interview) were used in the assessment of children’s oppositional and aggressive behavior at age 6. Higher levels of family regularity were associated with lower levels of child aggression independent of temperamental anger or frustration reactions (β = −0.05, p = 0.003). The association between child oppositional behavior and temperamental anger or frustration reactions was moderated by family regularity and child gender (β = 0.11, p = 0.046): family regularity reduced the risk for oppositional behavior among those boys who showed anger or frustration reactions in infancy. In conclusion, family regularity reduced the risk for child aggression and showed a gender-specific protective effect against child oppositional behavior associated with anger or frustration reactions. Families that ensured regularity of mealtime and bedtime routines buffered their infant sons high in anger or frustration reactions from developing oppositional behavior.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-015-0797-y) contains supplementary material, which is available to authorized users.

Inhibitory control as a mediator of bidirectional effects between early oppositional behavior and maternal depression.

Maternal depression is an established risk factor for child conduct problems, but relatively few studies have tested whether children's behavioral problems exacerbate mothers' depression or whether other child behavioral characteristics (e.g., self-regulation) may mediate bidirectional effects between maternal depression and child disruptive behavior. This longitudinal study examined the parallel growth of maternal depressive symptoms and child oppositional behavior from ages 2 to 5; the magnitude and timing of their bidirectional effects; and whether child inhibitory control, a temperament-based self-regulatory mechanism, mediated effects between maternal depression and child oppositionality. A randomized control trial of 731 at-risk families assessed children annually from ages 2 to 5. Transactional models demonstrated positive and bidirectional associations between mothers' depressive symptoms and children's oppositional behavior from ages 2 to 3, with a less consistent pattern of reciprocal relations up to age 5. Mediation of indirect mother-child effects and child evocative effects depended on the rater of children's inhibitory control. Findings are discussed in regard to how child evocative effects and self-regulatory mechanisms may clarify the transmission of psychopathology within families.

Multiple Family Group Service Model for Children With Disruptive Behavior Disorders: Child Outcomes at Post-Treatment.

The purpose of this study was to determine the benefits of a multiple family group (MFG) service delivery model compared with services as usual (SAU) in improving the functioning of youth with oppositional defiant/conduct disorder in families residing in socioeconomically disadvantaged communities. Participants included 320 youth aged 7 to 11 and their families who were referred to participating outpatient clinics. Participants were assigned to the MFG or the SAU condition, with parent report of child oppositional behavior, social competence, and level of youth impairment as primary outcomes at post-treatment. Family engagement to MFG was measured by attendance to each group session. Caregivers of youth in the MFG service delivery model condition reported significant improvement in youth oppositional behavior and social competence compared with youth in the SAU condition. Impairment improved over time for both groups with no difference between treatment conditions. The MFG led to greater percentage of youth with clinically significant improvements in oppositional behavior. Attendance to the MFG was high, given the high-risk nature of the study population. The MFG service delivery model offers an efficient and engaging format to implement evidence-based approaches to improving functioning of youth with oppositional defiant and/or conduct disorder in families from socioeconomically disadvantaged communities.

Coercive family process and early-onset conduct problems from age 2 to school entry

The emergence and persistence of conduct problems (CPs) during early childhood is a robust predictor of behavior problems in school and of future maladaptation. In this study we examined the reciprocal influences between observed coercive interactions between children and caregivers, oppositional and aggressive behavior, and growth in parent report of early childhood (ages 2-5) and school-age CPs (ages 7.5 and 8.5). Participants were drawn from the Early Steps multisite randomized prevention trial that includes an ethnically diverse sample of male and female children and their families (N = 731). A parallel-process growth model combining latent trajectory and cross-lagged approaches revealed the amplifying effect of observed coercive caregiver-child interactions on children's noncompliance, whereas child oppositional and aggressive behaviors did not consistently predict increased coercion. The slope and initial levels of child oppositional and aggressive behaviors and the stability of caregiver-child coercion were predictive of teacher-reported oppositional behavior at school age. Families assigned to the Family Check-Up condition had significantly steeper declines in child oppositional and aggressive behavior and moderate reductions in oppositional behavior in school and in coercion at age 3. Results were not moderated by child gender, race/ethnicity, or assignment to the intervention condition. The implications of these findings are discussed with respect to understanding the early development of CPs and to designing optimal strategies for reducing problem behavior in early childhood with families most in need.

A Collaboratively Designed Child Mental Health Service Model

This paper presents preliminary outcomes associated with an experimental, longitudinal study of a Multiple Family Group (MFG) service delivery approach set within thirteen urban outpatient clinics serving children and their families living in inner-city, primarily African American and Latino communities. Specifically, this paper focuses on parent reports of child oppositional behavior and parenting stress over time. MFG is a flexible, protocol-driven approach designed to address the most common reason for referral to outpatient child mental health clinics, childhood behavioral difficulties. The MFG also aims to enhance family-level engagement and retention in ongoing care. Further, the service delivery model was collaboratively developed with intensive input from parents rearing children with conduct difficulties, parent advocates, community-based child mental health providers and services research staff in order to ultimately expand the number of effective service models that can be situated within "real world," urban child mental health settings.

The Effect of Child Gender on Teachers' Responses to Oppositional Defiant Disorder

This study investigated whether child gender influences teachers' responses to oppositional defiant disorder (ODD). Teachers (N = 145) read a vignette describing a fictional child's oppositional behavior. Two forms of the vignette were administered, identical with the exception of child gender, and included ODD symptoms descriptive of both boys and girls. Child gender did not affect teachers' ratings of disruptiveness or severity, or most responses to oppositional behavior. Teachers were more likely to have had actual oppositional boys than girls in their classes, and were more likely to refer the vignette student if they had referred a similar student in the past. The potential roles of gendered symptom expression, comorbidity, and recent changes in school referral procedures are discussed.

Does the cortisol response to stress mediate the link between expressed emotion and oppositional behavior in Attention-Deficit/Hyperactivity-Disorder (ADHD)?

BackgroundExpressed Emotions (EE) are associated with oppositional behavior (OPB) in children with Attention Deficit/Hyperactivity Disorder (ADHD). EE has been linked to altered stress responses in some disorders, but ADHD has not been studied. We test the hypothesis that OPB in ADHD is mediated by altered stress-related cortisol reactivity to EE.MethodsTwo groups of children (with/without ADHD) and their respective parents were randomly assigned to two different conditions with/without negative emotion and participated in an emotion provocation task. Parents' EE, their ratings of their children's OPB and their children's salivary cortisol levels were measured.ResultsLow parental warmth was associated with OPB in ADHD. High levels of parental EE elicited a larger cortisol response. Stress-related cortisol reactivity mediated the EE-OPB link for all children. This highlights the general importance of parent-child interactions on externalizing behavior problems.ConclusionHigh EE is a salient stressor for ADHD children that leads to increased levels of cortisol and OPB. The development of OPB might be mediated by the stress-response to high EE.

Can Emotional Language Skills be Taught During Parent Training for Conduct Problem Children?

To assess the effectiveness of providing training in elaborative, emotion rich reminiscing (emotional reminiscing, ER) as an adjunct to Parent Management Training (PMT) for parents of children (N = 38, M age = 56.9, SD = 15.8 months) with oppositional behaviors. Control parents received PMT and non-language adjunct intervention, child-directed play. All components of the intervention were manualized. Parents in both conditions received training in an abbreviated course of PMT. Parents in the ER condition additionally received brief training in discussing everyday past events with their child incorporating emotion labels and causes, "wh" questions, and detailed descriptive information. Parents in the control condition received training in allowing their child to lead during play sessions. Across both conditions, children's oppositional behaviors decreased between the beginning and end of training. Providing parents with training parents in an elaborative, emotion-rich reminiscing style resulted in greater parent and child use of elaborations and emotion references during shared conversations. Given findings in the literature of an association between parental emotion talk and children's emotional competence, developmental skills that are frequently compromised in oppositional children, the current pilot study has implications for interventions that broaden the focus of PMT.

Maternal attributions and child oppositional behavior: A longitudinal study of boys with and without attention-deficit/hyperactivity disorder.

The authors examined changes over a 1-year period in mothers' attributions for child behavior and child oppositional behavior among 53 mothers and nonproblem sons and 44 mothers and sons with attention-deficit/hyperactivity disorder (ADHD). Boys averaged 8 years of age (SD = 11 months) at Time 1. Families were primarily of European Canadian cultural background and most were middle to upper middle class. Initial levels of child oppositionality did not predict changes in mothers' attributions over time. However, initial levels of mothers' attributions of oppositional child behavior to internal, stable, and global causes positively predicted child oppositional behavior, controlling for ADHD versus nonproblem status and the child's initial level of oppositional behavior. Although initial levels of overreactive and nonresponsive parenting also positively predicted child oppositional behavior, the contribution of mothers' attributions remained significant even with parenting variables controlled. Results suggest that mothers' attributions of child oppositional behavior to internal, stable, and global causes may contribute to maintenance of child problems over time and that these parenting cognitions have importance as intervention targets.

Patterns of Conflict Interaction in Mother–Toddler Dyads: Differences Between Depressed and Non-depressed Mothers

We examined the differences in conflict interaction between depressed mothers and their toddler and non-depressed dyads and whether these differences mediated the association of maternal depression with compromised child socioemotional development. Mother/ child interaction was videotaped during a teaching task and during a free play task as part of a home visit when the target child was between 16 and 18 months old. Each turn of every conflict was coded for behavior and affect of each member of the dyad. Interaction data were summarized to calculate the number of conflict turns, the rate of conflict, and the proportion of mother-initiated versus child-initiated conflicts per dyad. Sequential analysis was used to estimate the probability of specific maternal responses to specific child behaviors. Bivariate comparisons indicated that depressed dyads experienced higher rates of conflict, especially during the teaching task, and that depressed mothers were more likely to respond destructively to child oppositional behavior. Results of multivariate linear regression indicated that the higher probability of destructive response mediated the association of maternal depression with lower quality of mother-child attachment. These findings have implications for the development of interventions to support mothers in dealing with the conflicts that are so common during the second year of a child's life.

Teenage mothers’ anger over twelve years: partner conflict, partner transitions and children's anger

This study examined the effects of maternal anger, partner transitions and partner conflict on later oppositional and angry behavior of the children of teenage mothers. One hundred and twenty-one teenage women were interviewed prior to the birth of the baby and at 3 points subsequently, when children were newborn, 7 years old and 12 years old. Child and teacher reports of children's oppositional behavior were obtained. Women who showed higher levels of anger at Time 1 experienced more conflict with partners and more partner transitions over the next 12 years than women with lower levels of anger. Partner conflict was a stronger predictor of children's oppositional and angry behavior than partner transitions. Maternal anger at Time 1 was associated with maternal anger at Time 4 but neither predicted children's oppositional behavior at Time 4. There was support for the theoretical model that suggested that the personality characteristics of teenaged mothers confer some of their risk to children through children's exposure to the mothers' problematic partner relationships.

Parenting in mothers with and without attention-deficit/ hyperactivity disorder.

The authors examined the impact of maternal attention-deficit/hyperactivity disorder (ADHD) on parenting behaviors. Sixty mothers between the ages of 31 and 50 with (n = 30) and without (n = 30) ADHD and their 8- to 14-year-old children with ADHD completed self-report and laboratory measures of monitoring of child behavior, consistency in parenting, and parenting problem-solving abilities. These parenting behaviors were selected because of their established links to the development of child behavior problems. As predicted, mothers with ADHD were found to be poorer at monitoring child behavior and less consistent disciplinarians compared with mothers without ADHD. There was some evidence to support the prediction that mothers with ADHD were less effective at problem solving about childrearing issues than control mothers. The differences between the 2 groups of mothers persisted after child oppositional and conduct-disordered behavior were controlled. These results indicate that parenting is an area of functioning that requires more attention in adult ADHD research.

A transactional model of oppositional behavior: Underpinnings of the Collaborative Problem Solving approach

Oppositional defiant disorder (ODD) refers to a recurrent pattern of developmentally inappropriate levels of negativistic, defiant, disobedient, and hostile behavior toward authority figures. ODD is one of the most common (and debilitating) comorbid disorders within Tourette's disorder (TD). Diverse psychosocial treatment approaches have been applied to children's ODD-related behaviors. In this paper, the authors articulate a transactional developmental conceptualization of oppositional behavior and describe a cognitive-behavioral model of intervention—called collaborative problem solving (CPS)—emanating from this conceptualization. The specific goals of the CPS approach are to help adults (1) understand the specific adult and child characteristics contributing to the development of a child's oppositional behavior; (2) become cognizant of three basic strategies for handling unmet expectations, including (a) imposition of adult will, (b) CPS, and (c) removing the expectation; (3) recognize the impact of each of these three approaches on parent–child interactions; and (4) become proficient, along with their children, at CPS as a means of resolving disagreements and defusing potentially conflictual situations so as to reduce oppositional episodes and improve parent–child compatibility. Summary data from an initial study documenting the effectiveness of the CPS approach (in comparison to the standard of care) are also presented.

Coercion: The link between treatment mechanisms in behavioral parent training and risk reduction in child antisocial behavior

Coercive parent-child interaction, child oppositional behavior, and parental reinforcement contingencies for child misbehavior were observed before and after treatment in the families of 46 boys referred for serious conduct problems. Reliable pre- to posttreatment reductions in coercive interaction and child noncompliance, and reliable increases in parental reinforcement of constructive child behavior, were found. Posttreatment parental contingencies for coercive child behavior predicted child arrests over the subsequent 2 years. Children from families whose observed posttreatment coercive interaction, parental contingencies, and child compliance failed to reach levels observed in nonreferred, normative families were more likely to evidence arrests and out-of-home placement during the 2 years after treatment. The implications of using observational data to identify critical mechanisms that mediate change in child antisocial behavior as a result of behavioral parent training are described in terms of developmental theory, the dosage of intervention, and the development of more powerful interventions for child conduct problems.