Treatment Of Oppositional Defiant Disorder Research Articles

Atomoxetine for the Treatment of Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder

In this study we examined the effectiveness of atomoxetine for the treatment of oppositional defiant disorder comorbid with attention-deficit/hyperactivity disorder. Patients were aged 6 to 12 years and met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for attention-deficit/hyperactivity disorder with a Swanson, Nolan, and Pelham Rating Scale-Revised attention-deficit/hyperactivity disorder subscale score above age and gender norms; Clinical Global Impressions-Severity Scale score of > or = 4; and Swanson, Nolan, and Pelham Rating Scale-Revised oppositional defiant disorder subscale score of > or = 15. Patients were randomly assigned in a 2:1 ratio to receive 1.2 mg/kg per day of atomoxetine (n = 156) or placebo (n = 70) for 8 weeks. Treatment effect on oppositional defiant disorder and attention-deficit/hyperactivity disorder symptoms was measured by using the investigator-rated Swanson, Nolan, and Pelham Rating Scale-Revised. Repeated-measures analysis demonstrated a statistically significant difference favoring atomoxetine over placebo in the reduction of Swanson, Nolan, and Pelham Rating Scale-Revised oppositional defiant disorder total scores. There were significant pairwise treatment differences at weeks 2 and 5 but not at week 8 postbaseline. A last-observation-carried-forward analysis showed Swanson, Nolan, and Pelham Rating Scale-Revised scores at endpoint for the atomoxetine and placebo groups were significantly different for attention-deficit/hyperactivity disorder symptoms but not for oppositional defiant disorder symptoms. Atomoxetine was superior to placebo in a last-observation-carried-forward analysis of Clinical Global Impression-Improvement and Clinical Global Impression-Severity scores. This study confirms previous findings that patients with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder show statistically and clinically significant improvement in attention-deficit/hyperactivity disorder symptoms and global clinical functioning when treated with atomoxetine. It remains uncertain, however, whether atomoxetine exerts a specific and enduring effect on oppositional defiant disorder symptoms.

Predictor and Moderator Effects in the Treatment of Oppositional Defiant Disorder in Pediatric Primary Care

To examine predictors and moderators of parent-training outcomes for treatment of Oppositional Defiant Disorder (ODD) in pediatric primary care. Parents of 117 children with ODD, ages 3-6 years, seen in primary care received either a minimal intervention bibliotherapy treatment (MIT), or a 12-session parenting program led by a nurse or psychologist. More initial total life stress, parenting distress, internalizing problems, functional impairment, and difficult temperament were associated with more improvement, but families scoring lower on those variables had fewer behavior problems at posttreatment and follow-up. Gender was a significant moderator, with more improvement for girls than boys in the nurse-led group but more improvement for boys than girls in the MIT group. Less well-educated mothers treated by psychologists showed the greatest change. Predictors and moderators may play a role in deciding, which families receive a particular form of treatment for ODD in primary care.

Pharmacological Treatment of ODD Symptoms in ADHD Children: A Brief Review

Over the past several years there has occurred renewed psychiatric interest in studying the characteristics, validity, prognosis, and treatment of Oppositional Defiant Disorder (ODD). Results have supported the validity of ODD as a meaningful clinical entity independent of conduct disorder (Greene et al., 2002). ODD frequently co–exists with other psychiatric disorders such as ADHD (Kuhne, Schachar, & Tannock, 1997). Because of a high association with ADHD, recent pharmacological research has begun to examine whether medications effective for ADHD will also be effective in diminishing symptoms of ODD when this disorder co–occurs with ADHD. This report discusses the characteristics of ODD and then summarizes recent pediatric psychopharmacological studies investigating medication response in ODD with comorbid ADHD.

Improving treatment outcome for oppositional defiant disorder in young children.

Abstract Oppositional Defiant Disorder (ODD) is relatively common among 3-8 year-old children and its presence puts children at risk for more serious and stable problems. Behavioral Parent Training (BPT) as the most empirical support as a treatment for children with ODD as well as for children with clinically significant problems. The purpose of this paper is to review research on modifications to the BPT treatment model that have improved its efficacy as well as its use by a wider range of families. Keywords: Behavioral Parent Training; Treatment Outcome; Oppositional Defiant Disorder; early childhood; school-aged children; Behavioral Treatments. *********** Oppositional Defiant Disorder Oppositional Defiant Disorder (ODD) is characterized by a pattern of noncompliant, argumentative, angry, hostile and defiant behavior, which have persisted for at least six months. These difficulties cause impairments in social relationships with both adults and peers (American Psychiatric Association, 2000). Angry and hostile commonly take both verbally and physically aggressive forms, although the presence of significantly elevated levels of physical aggression is not required for the diagnosis (Loeber, Burke, Lahey, Winters, & Zerba, 2000). The average age of onset for ODD is age 6 years and most children receive the diagnosis prior to adolescence (Hinshaw & Anderson, 1996). The evidence on gender differences in ODD prevalence is somewhat mixed. A review of the literature suggests equivalent rates of ODD in boys and girls prior to age six and equivalent or slightly higher prevalence among males during middle childhood (Loeber et al., 2000). Two debated issues in the child psychopathology arena are: (a) whether ODD is a developmental precursor to Conduct Disorder and (b) whether conceptualization of ODD as a categorical diagnosis, rather than a pattern of and emotional adjustment is appropriate. The first issue is beyond the scope of the present article and interested readers are encouraged to read other work such as that by Loeber and colleagues (2000). The taxonomic issue regarding the appropriate conceptualization of ODD is pertinent to this article because effective treatments for ODD are often employed with young children with clinically significant conduct problems or behavior problems, as assessed with questionnaires with continuous, rather than categorical scaling (e.g., Achenbach & Rescorla, 2000; Eyberg & Pincus, 1999), as well as with observations, rather than with diagnostic interview techniques. The behaviors that comprise ODD are present in most children during development; unlike many other categorical diagnoses. The critical variable is that children with ODD differ from others in the intensity, frequency, and duration of these behaviors. These behaviors are significantly greater than would be expected developmentally. Thus, for the purpose of this article, treatment research that uses either dimensional or categorical assessment in defining a clinical sample is included. BPT is a family-based intervention strategy and it is a scientifically validated treatment for Oppositional Defiant Disorder in 3-8 year-old children (Chambless et al., 1998). There are many effective BPT programs (e.g., Eyberg & Boggs, 1998; Forehand & McMahon, 1981; Patterson, Reid, Jones, & Conger, 1975; Webster-Stratton et al., 2001b). Programs differ somewhat in format (e.g., group vs. individually administered), treatment setting (e.g., clinic vs. community), and instructional techniques (e.g. differential emphasis on coaching, modeling, role play, and didactic techniques). BPT programs are also referred to using alternative terms such as parent management training (e.g., Kazdin, 1997), behavioral family therapy (McMahon & Forehand, 2003), parent training (see McMahon & Forehand, 1984), and parent-child interaction therapy (Eyberg & Boggs, 1998). …

Similar Presentations of Disparate Etiologies: A New Perspective on Oppositional Defiant Disorder

ABSTRACT Oppositional defiant disorder is an individual diagnosis given commonly to children and adolescents who exhibit a pattern of noncompliant and defiant behaviors. Some children's temperament, behaviors, and interpersonal style merit this diagnosis. Other children, however, exhibit behaviors consistent with this diagnosis within the context of their family system. Certainly, the relationship between children's defiant behaviors and problematic circumstances in the family is best evidenced in the most popular treatments for oppositional defiant disorder, which involve working with parents as much as the children. In fact, some treatments of this disorder focus solely on educating the parent about consistency and immediacy in reinforcing positive behavior and ignoring or using time out for negative behavior. The purpose of this paper is to emphasize a different perspective of oppositional defiant disorder, one in which some children experience oppositional behaviors regardless of the parenting they receive and other children exhibit these same behaviors within an inconsistent family context.

Transtorno desafiador de oposição: uma revisão de correlatos neurobiológicos e ambientais, comorbidades, tratamento e prognóstico

Oppositional defiant disorder (ODD) is an independent diagnostic entity but it is frequently studied in conjunction with Attention-Deficit Hyperactivity Disorder (ADHD) or Conduct Disorder (CD). The purpose of this paper is to review the extant evidence, through the PubMed database, on the neurobiological correlates of oppositional defiant disorder and also describe the familiar and school functioning, comorbidities, prognosis and therapeutic options for oppositional defiant disorder. Evidence of hormonal, genetic and neuro-functional findings in oppositional defiant disorder, correlation with the family, school relations and performance, and the association with mood and anxiety and disruptive disorders are described. The risk of an evolution to conduct disorder and of persistence of the oppositional defiant disorder symptoms is depicted. A review of the effect of Cognitive-Behavioral Therapy and medication is presented. Analysis of the available evidence shows that the impact of oppositional defiant disorder should not be ignored and it should be properly addressed. The effect of treatment for oppositional defiant disorder on the long-term outcome of patients still needs to be addressed.

Predicting Outcome in Behavioral Parent Training: Expected and Unexpected Results

ABSTRACT This study examined the relationships among clinical utility and treatment outcome variables in Behavioral Parent Training (BPT). The sample included 21 mothers with 3–8 year-old children with significant externalizing behavior problems who received treatment for Oppositional Defiant Disorder. The primary aim was to relate two treatment feasibility variables, client resistance and treatment acceptability, to maternal ratings of child improvement. We also examined the relationship between treatment feasibility variables and parent and family risk factors that appear to mitigate the effectiveness of BPT such as low SES, single-parent status, and maternal depression. Outside observers coded videotapes for maternal resistance exhibited in treatment sessions during which discipline techniques were discussed. Mother reports were used to measure treatment outcome (child improvement) and treatment acceptability. Effect size calculations yielded large pre-post improvements in children's externalizing behavior. Results of correlation analyses revealed the following pattern of significant findings: (1) a positive relationship between treatment acceptability and child improvement, (2) a negative relationship between maternal resistance and the risk factors, low SES and single-parent status, and (3) a negative association between SES and child improvement. The first finding was expected but the latter two were not. Although this was a small study with many limitations, the pattern of findings raises intriguing issues for further study. The need for empirically tested models of BPT that incorporate service utilization, risk and protective factors, and implementation is discussed.

Family Treatment of Oppositional Defiant Disorder: Changing Views and Strength-Based Approaches

Oppositional Defiant Disorder (ODD) affects and is affected by the families, school systems, social services systems, medical systems, lawenforcement, communities, and those individuals exhibiting and classified as having this problem. The treatments of ODD are many and varied, leaving one wondering at the cause and treatment options. The prevalence of ODD is examined in this article, the various models of treatment are reviewed, and an integrated family systems strength-based model is presented. In keeping with suggestions for family systems meta research, the model’s parts have proven track records of producing positive outcomes with ODD children and their families. It is postulated that the effect of placing these parts together will have a synergistic and cumulative effect of treatment, increasing positive outcome with this population.

Disruptive Behavior Disorders in Children and Adolescents: How Do Girls Differ From Boys?

Disruptive behavior disorders in children and adolescents can lead to a lifetime of problems. The 2 disruptive behavior disorders identified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV; American Psychiatric Association, 1994) are oppositional defiant disorder and conduct disorder. Although much research has been conducted to learn more about these 2 disorders, little is known about gender differences in the disorders. There is a dearth of specific information regarding girls with disruptive behavior disorders. This article discusses the diagnosis, risk factors, and treatment of oppositional defiant disorder and conduct disorder while incorporating information specific to girls to investigate how disruptive behavior disorders differ for girls.

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.