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 behavior 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 conduct 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 behavior 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 behavioral 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 behavior 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). …