Treatment Of Oppositional Defiant Disorder Research Articles

Oppositional defiant disorder.

Oppositional defiant disorder (ODD) is a disruptive behaviour disorder involving an ongoing pattern of angry/irritable mood, argumentative/defiant behaviour and vindictiveness. Onset is typically before 8 years of age, although ODD can be diagnosed in both children and adults. This disorder is associated with substantial social and economic burden, and childhood ODD is one of the most common precursors of other mental health problems that can arise across the lifespan. The population prevalence of ODD is ~3 to 5%. A higher prevalence in males than females has been reported, particularly before adolescence. No single risk factor accounts for ODD. The development of this disorder seems to arise from the interaction of genetic and environmental factors, and mechanisms embedded in social relationships are understood to contribute to its maintenance. The treatment of ODD is often successful, and relatively brief parenting interventions produce large sized treatment effects in early childhood. Accordingly, ODD represents an important focus for research, practice and policy concerning early intervention and prevention in mental health.

Parent Child Interaction Training (PCIT) in Zurich, Switzerland - Experiences and Results of the first two years

IntroductionParent Child Interaction Training PCIT (Zisser & Eyberg, 2010; Briegel, 2016) is an evidence-based treatment of oppositional defiant disorder in preschool children. However, it is implemented in few institutions in Europe. The advantage of PCIT is the involvement of both child and parents with direct coaching of the parents.ObjectivesWe will give an overview of 20 treatment courses we have conducted since the introduction of PCIT at the Zurich University Hospital for Child and Adolescent Psychiatry. First, a descriptive analysis of our sample will be conducted. The influence of sample characteristics and intensity of training on the reduction of behavioral problems will be analyzed.MethodsParents attend the training for at least 6 months with regular sessions. The transfer into everyday life is achieved by daily homework. We use the Eyberg Child Problem Behavior Inventory as pre-post measurements. The ECBI is filled out by the parents before each session and also enables a progress analysis.ResultsThree times more boys participated than girls. Problem behavior was significantly reduced after the play training phase. There was also a significant overall pre-post effect. The effect seemed to be independent of the parental problem score before training and of the number of play-training sessions.ConclusionsParents and children clearly benefit from the play training. For the following cooperation training, the problem load experienced by the parents seems to be more relevant than the intensity of the child’s problem behavior as assessed by them. This is to be examined in the future.DisclosureNo significant relationships.

Network analyses of Oppositional Defiant Disorder (ODD) symptoms in children

Based on parent and teacher ratings of their children, this study used regularized partial correlation network analysis (EBIC glasso) to examine the structure of DSM-5 Oppositional Defiant Disorder (ODD) symptoms. Parent and teachers (N = 934) from the general community in Malaysia completed questionnaires covering DSM-5 ODD symptoms. The most central ODD symptom for parent ratings was anger, followed by argue. For teacher ratings, it was anger, followed by defy. For both parent and teacher ratings, the networks revealed at least medium effect size connections for temper and argue, defy, and argue, blames others, and annoy, and spiteful and angry. Overall, the findings were highly comparable across parent and teacher ratings, and they showed a novel understanding of the structure of the ODD symptoms. The clinical implications of the findings for assessment and treatment of ODD are discussed.

‘Treatable and Changeable’: The Effect of Treatment and Malleability Information on Stigma Towards Children with Behavioural Problems and Their Parents

AbstractImproving knowledge about childhood mental health issues, reducing stigma, and encouraging appropriate treatment-seeking are important goals for public health. This study examined the effect of treatment and malleability information on stigmatisation towards children with Oppositional Defiant Disorder (ODD) and their parents, and on endorsements of causal beliefs. In an experimental study, university students (N = 234) were randomly allocated to receive/not receive treatment information (information on the existence and effectiveness of treatment for ODD) and to receive/not receive malleability information (information emphasising brain malleability and the potential to change). Participants then rated four measures of stigma towards a fictitious child with ODD and mother (blame, incompetence, dangerousness, and social distance), and rated their endorsements of causal explanations for ODD. Neither treatment nor malleability information had significant effects on stigmatisation towards either the child or mother. However, this information did impact upon causal beliefs about ODD as stemming from biological or mixed biological/environmental causes. Implications for the future development of public health initiatives and stigma research on childhood mental health are discussed.

Adding the Coping Power Programme to parent management training: the cost-effectiveness of stacking interventions for children with disruptive behaviour disorders

Parent management training (PMT) programmes and child cognitive behavioural therapy are recommended approaches for treatment of oppositional defiant disorder in children, and combining these may be effective. However, little is known regarding the economic efficiency of this additive effect. A within-trial cost-effectiveness analysis was carried out in Sweden including 120 children aged 8–12 who screened positive for disruptive behaviour disorders, within a psychiatric care setting, and their parents. They were randomly assigned to either the Swedish group-based PMT Comet, or to an enhanced version, where an additional child component was provided, the Coping Power Programme (CPP). Child behaviour problems as well as healthcare and educational resource use were measured at baseline, post-test and at two-year follow-up. A net benefit regression framework was used to estimate differences in costs and health outcomes between the two intervention arms during the two-year period. Comet with CPP cost on average 820 EURO more per family than Comet only. At the 2-year follow-up, there were 37% recovered cases of ODD in Comet with CPP, in comparison to 26% in the Comet only arm. At a willingness-to-pay of approximately 62,300 EURO per recovered case of ODD, Comet with CPP yielded positive net benefits, in comparison to Comet only. Offering children the CPP simultaneously as their parents receive PMT, in comparison to only providing PMT, yields clinically relevant gains. Despite the relatively small cost for CPP, investment in combining PMT and CPP should be guided by resource prioritisation. Trial registration number: ISRCTN10834473, date of registration: 23/12/2015

The Parent–Child Relationship and Posttreatment Child Outcomes Across Two Treatments for Oppositional Defiant Disorder

This study examined the degree to which the parent–child relationship uniquely predicted clinical outcomes in externalizing problems and adaptive skills in children meeting diagnostic criteria for oppositional defiant disorder and whether facets of this relationship moderated the effects of two unique psychosocial treatments. We recruited 134 children and their parents (38.06% female; M age = 9.52 years, range = 7–14; 83.58% White). Families were randomly assigned to 1 of 2 treatments: Parent Management Training (PMT) and Collaborative and Proactive Solutions (CPS). We formed principal components from pretreatment reports and behaviors of the parent–child relationship to predict within- and between-family outcomes in children’s externalizing problems and adaptive skills. Four principal components were supported (parental warmth, parental monitoring, family hostility, and family permissiveness). Parental monitoring predicted fewer externalizing problems, whereas family permissiveness predicted more externalizing problems. Parental warmth predicted greatest improvements in children’s adaptive skills among families receiving PMT. Family hostility predicted more externalizing problems and poorer adaptive skills for children; however, families receiving CPS were buffered from the negative effect of family hostility on adaptive skills. The parent–child relationship can uniquely inform posttreatment outcomes following treatment for oppositional defiant disorder. Certain treatment approaches may better fit unique relationships that emphasize warmth and/or hostility, allowing clinicians to anticipate and tailor treatments to families.

A Case Report of the Treatment of Oppositional Defiant Disorder (ODD) in a Non-specialist, Resource-Limited Environment Using the Co-care Approach

As the incidence of Oppositional Defiant Disorder (ODD) continues to grow, non-specialist mental health providers, particularly those in rural and remote areas, were access to mental health services are limited, will be increasingly called upon to treat this disorder. This will be particularly true for general practitioners, family physicians, paediatricians, mid-level providers and others, given the relative scarcity of clinical psychologists, psychiatrists, and mental health providers in such settings. It is important for non-mental health specialists to recognise and have a basic understanding of how ODD can be treated in such settings. As such, this case report presents a typical ODD patient in such a setting, and details the course of the successful treatment of the patient using a variety of approaches, including parent-child interaction training, family therapy, social skills training, problem solving training in a co-care arrangement with a specialist mental health provider.

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.

Oppositional Defiant Disorder and Its Clinical Management

Oppositional defiant disorder (ODD) is a psychiatric disorder classified in the DSM-5 among disruptive, impulse control, and conduct disorder. The core features of ODD include a pervasive and impairing pattern of anger, irritability, inflexibility, defiance, malevolence, and aggression. Symptoms of ODD typically present during preschool. ODD can be a harbinger of conduct disorder. Isolated, transient symptoms of ODD are normal during development. Mood disorders, attention-deficit/hyperactivity disorder, and neurodevelopmental disorders are important considerations in differential diagnosis. However, ODD frequently co-occurs with other psychiatric diagnoses. Complex interactions with temperamental emotional dysregulation, family stress, early life stress, inconsistent parenting, and genetic and physiologic factors likely underlie the risk, pathophysiology, and prognosis of ODD. Unfortunately, these interactions and the neurobiological underpinnings of ODD are still poorly characterized. Although first-line treatments for ODD involve behavioral and psychosocial interventions, a thoughtful consideration of pharmacotherapy for co-occurring disorders and severe symptoms is an important component of treatment planning. Herein we review the epidemiology, etiology, pathophysiology, diagnostic evaluation, and treatment planning of ODD. Recent applicable controversies such as dimensional conceptualization of psychiatric disorders and the potential intersection of ODD and disruptive mood dysregulation disorder are also summarized. This review contains 5 figures, 4 tables, and 44 references. Key words: aggression, attention-deficit/hyperactivity disorder, conduct disorder, defiance, disruptive behaviors, disruptive mood dysregulation disorder, DSM-5, irritability, oppositional defiant disorder, parent management training

The Cost of Oppositional Defiant Disorder and Disruptive Behavior: A Review of the Literature

This purpose of this paper is to review the literature on the treatment of Oppositional Defiant Disorder, with a specific focus on cost analyses. In general the literature shows that while there has been substantial research on Oppositional Defiant Disorder there has been little focus on the costs involved. A search of the major databases in psychology and the social sciences yielded only seven articles even marginally appropriate for a review of costs associated with Oppositional Defiant Disorder and related disruptive behavior. Interestingly, only two of these studies investigated treatment costs specifically associated with Oppositional Defiant Disorder. These studies showed that the treatment of Oppositional Defiant Disorder is much less expensive than the treatment of Conduct Disorder and family therapy is the most cost effective approach. Overall, the review showed that there is a dearth of literature related to treatment costs, which leads to the conclusion that much more research is needed on the cost of treating Oppositional Defiant Disorder.

Perceived Parent-Child Relations, Conduct Problems, and Clinical Improvement Following the Treatment of Oppositional Defiant Disorder.

Our objective in this study was to examine the moderating influence of parent-child relationship quality (as viewed by the child) on associations between conduct problems and treatment responses for children with oppositional defiant disorder (ODD). To date, few studies have considered children's perceptions of relationship quality with parents in clinical contexts even though extant studies show the importance of this factor in children's behavioral adjustment in non-clinical settings. In this study, 123 children (ages 7 - 14 years, 61.8% male, 83.7% white) who fulfilled DSM-IV criteria for ODD received one of two psychosocial treatments: Parent Management Training or Collaborative & Proactive Solutions. In an earlier study, both treatments were found to be effective and equivalent in treatment outcomes (Ollendick et al., in press). In the current study, pre-treatment maternal reports of conduct problems and pre-treatment child reports of relations with parents were used to predict outcomes in ODD symptoms and their severity following treatment. Elevated reports of children's conduct problems were associated with attenuated reductions in both ODD symptoms and their severity. Perceived relationship quality with parents moderated the ties between conduct problems and outcomes in ODD severity but not the number of symptoms. Mother reports of elevated conduct problems predicted attenuated treatment response only when children viewed relationship quality with their parents as poorer. When children viewed the relationship as higher quality, they did not show an attenuated treatment response, regardless of reported conduct problems. The current findings underscore the importance of children's perspectives in treatment response and reductions in externalizing child behaviors.

Treatment of Childhood Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is a common behavioral disorder of childhood which can be described as a learned pattern of behavior reinforced by caregivers’ responses. Behavioral modification for ODD, particularly in preschool and school-aged children, should primarily focus on teaching caregivers to reinforce positive behaviors, discourage negative behaviors, and ultimately interrupt the cycle of argumentativeness and deliberate attention-seeking behavior. Unfortunately, children who are referred for behavioral therapy for ODD often do not receive evidence-based treatments that target the root cause of the disorder. There is some role for the use of psychopharmacology in the treatment of ODD, though primarily in the treatment of underlying and comorbid disorders. The core symptoms of ODD are not amenable to pharmacotherapy, and behavioral modification is the mainstay of intervention. Attention-deficit hyperactivity disorder (ADHD) frequently occurs with ODD. Poor impulse control is a core feature of ADHD, and appropriate use of stimulant and/or non-stimulant ADHD medications can help children with ODD make better behavioral choices and be more successful with behavior modification programs. There is some evidence for the effectiveness of atypical antipsychotics in disruptive behavior disorders (DBDs), but the target symptoms of explosive and aggressive behaviors are seen only in children with more severe ODD who progress to conduct disorder (CD). Pediatric providers should understand the evidence-based behavioral interventions and targeted psychiatric medications that will achieve the best outcomes for children with ODD.

Parent–Child Interaction Therapy With Emotion Coaching for Preschoolers With Attention-Deficit/Hyperactivity Disorder

Preschoolers with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for the development of comorbid conduct disorder (CD) and depression. Early predictors of serious adverse outcomes within this population include parenting characterized by high levels of negativity and low levels of positivity, maternal depression, and child emotion regulation (ER) difficulties. Parent–child interaction therapy (PCIT) is an evidence-based treatment for oppositional defiant disorder and CD that has also been shown to improve comorbid child internalizing symptoms and maternal depression by enhancing parenting and improving the parent–child relationship. PCIT-emotion development (PCIT-ED) is an adaptation for depressed preschoolers, grounded in developmental literature, which teaches parents to become “emotion coaches” for their children, in an effort to build child ER skills. In this paper, we describe the iterative process by which we implemented and adapted PCIT-ED based on our experiences treating nine children with ADHD. We present three case examples that exemplify our process in adapting the PCIT-ED manual. This work suggests that PCIT with parent emotion coaching (PCIT-ECo) may be a promising treatment approach for young children with ADHD. Future research will need to examine this adaptation relative to standard PCIT to determine whether our integration of parent emotion coaching results in added improvement in child ER, internalizing and externalizing problems, and functional impairment.

Phenomenology of Clinic-Referred Children and Adolescents with Oppositional Defiant Disorder and Comorbid Anxiety

This study examined profiles of clinic-referred youth with co-morbid oppositional defiant disorder (ODD) and anxiety disorders (ADs) compared to youth with ODD without ADs. One hundred and twenty seven clinic-referred youth with ODD (ages 7–14, 85.6 % Caucasian) were assessed through a multi-method, multi-informant approach. Global functioning, ODD symptom impairment, child internalizing symptoms, caregiver distress, and parent-child relationship quality were explored to test group differences based on AD diagnosis. Youth with ODD and comorbid ADs generally had higher levels of global impairment, internalizing symptoms, caregiver distress, and parent-child relationship problems as compared to youth with ODD only. These findings, which generally suggest greater impairment in the group of youth with ODD/AD, offer support for the presence of distinct clinical features in youth with ODD/AD compared to youth with ODD alone. Such findings may have important implications for assessment and treatment of ODD in youth. For example, interventions to target broader child internalizing symptoms, caregiver distress, and parent-child relationships may be particularly important in youth with ODD/AD profiles.

Parental Emotion Coaching and Child Emotion Regulation as Protective Factors for Children with Oppositional Defiant Disorder.

We assessed linkages of mothers' emotion coaching and children's emotion regulation and emotion lability/negativity with children's adjustment in 72 mother-child dyads seeking treatment for Oppositional Defiant Disorder (ODD). Dyads completed questionnaires and discussed emotion-related family events. Maternal emotion coaching was associated with children's emotion regulation, which in turn was related to higher mother-reported adaptive skills, higher child-reported internalizing symptoms, and lower child-reported adjustment. When children were high in emotion lability/negativity, mothers' emotion coaching was associated with lower mother and child reports of externalizing behavior. Results suggest the role of emotion regulation and emotion lability in child awareness of socio-emotional problems and support the potential of maternal emotion coaching as a protective factor for children with ODD, especially for those high in emotion lability.

Relations Between Parenting Behavior and SES in a Clinical Sample: Validity of SES Measures

Two common methods of measuring socioeconomic status (SES) were examined in relation to observed parenting behaviors in a clinical sample of 89 mothers of 3- to 6-year-olds referred for treatment of oppositional defiant disorder. Families were 74% Caucasian, 9% African American, 5% Hispanic, 1% Asian, and 11% Biracial. Most children were male (75%). Parenting behaviors were measured with the Dyadic Parent–Child Interaction Coding System (DPICS) categories of prosocial talk and negative talk. Analyses were conducted with SES measured in two ways: (a) the Hollingshead Four-Factor Index of Social Status (HI) was correlated with parenting behaviors; and (b) family income, parent education (5 categories), and parent occupation (5 categories) were used to predict parent behavior. SES was significantly positively related to maternal prosocial talk. When SES was operationalized as income, occupation, and education, the model predicted three times more variance in maternal prosocial talk than the HI alone. SES was not related to maternal negative talk by either measure of SES.

Predictors and Correlates of Completing Behavioral Parent Training for the Treatment of Oppositional Defiant Disorder in Pediatric Primary Care

This study examined the role of pretreatment demographic and clinical predictors of attendance as well as barriers to treatment and consumer satisfaction on attendance at therapist-led parent training with 86 families of children ages 3 to 6 years conducted in pediatric primary care settings. Only socioeconomic status (SES) and minority group membership were significantly associated with not completing treatment. Using optimal data analysis procedures, high SES correctly predicted treatment completion 83.6% of the time. Being from a low SES, minority group family correctly predicted noncompletion of treatment 72.7% of the time, but being from a low SES, white family predicted treatment completion 80% of the time. Since barriers to treatment, such as stressors, obstacles to treatment, and treatment demands were unrelated to attendance in the present study, other factors related to social class and minority status that could contribute to better consumer satisfaction and treatment attendance must be investigated.

Study of temperament characteristic and family environment of children with oppositional defiant disorder

Objective To study the relation ship among child teporament,family environment factors and oppositional defiant disorder(ODD),so as to probe if there is between temperament and environment of ODD children,helping the diagnosis and theatment of ODD.Methods (1)In this stuay the information was collected from all enrolled subjects,including 60 children with ODD and 60 healthy.(2)by using the chinese school children Temperament scale(CSTS)and Family Environment scale(FES-CV),all chidren were assessed.cohesion,contradictoriness,expressiveness,independence,achievementorientation,intellect orientation,entertainment,sense of organization and control between children in ODD group and those in normal group(P＜0.01).Conclusion Children with ODD have obvious temperament variations and more disadvantage family environment factors than normal children.It is necessary to investing ate the interaction between temperament and environment during the diagnosis course and the treatment of ODD. Key words: Oppositional defiant disorder; Temperament; Family environment

Psychopharmacological Treatment of Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) consists of an enduring pattern of uncooperative, defiant and hostile behaviour toward authority figures that does not involve major antisocial violations and is not accounted for by the developmental stage of the child. The rate of ODD in children and adolescents in the general population has been reported to be between 2% and 16%. The International Classification of Diseases 10th Revision (ICD-10) classifies ODD as a mild form of conduct disorder (CD), and it has been estimated that up to 60% of patients with ODD will develop CD. Therefore, ODD should be identified and treated as early and effectively as possible.In more than one-half of patients with attention-deficit hyperactivity disorder (ADHD), ODD is also part of the clinical picture. There is strong evidence in the literature to suggest that ODD and ADHD overlap; many medications that are used to treat ADHD may also be efficacious in the treatment of ODD. A few studies have reported the positive effects of psychostimulants or atomoxetine in the treatment of ODD associated with ADHD. Patients with ODD and CD with severe aggression may respond well to risperidone, with or without psychostimulants. Mood regulators, alpha(2)-agonists and antidepressants may also have a role as second-line agents in the treatment of ODD and its co-morbidities.

Methylphenidate in Children With Oppositional Defiant Disorder and Both Comorbid Chronic Multiple Tic Disorder and ADHD

Our primary objective was to determine if immediate-release methylphenidate is an effective treatment for oppositional defiant disorder diagnosed from mother's report in children with both chronic multiple tic disorder and attention-deficit hyperactivity disorder (ADHD). Children (n = 31) aged 6 to 12 years received placebo and 3 doses of methylphenidate twice daily for 2 weeks each under double-blind conditions and were assessed with ratings scales and laboratory measures. Results indicated significant improvement in both oppositional and ADHD behaviors with medication; however, the magnitude of treatment effect varied considerably as a function of disorder (ADHD > Oppositional behaviors), informant (teacher > mother), assessment instrument, and specific oppositional behavior (rebellious > disobeys rules). Drug response was comparable with that in children (n = 26) who did not have diagnosed oppositional defiant disorder, but comorbidity appeared to alter the perceived benefits for ADHD according to mother's report. Methylphenidate is an effective short-term treatment for oppositional behavior in children with comorbid ADHD and chronic multiple tic disorder.