Oppositional Defiant Disorder 

Treatments

Parent Management Training (Using the Webster-Stratton intervention).     

Treatment Summary: The parenting program (Webster-Stratton, 1997) provided instruction and videotaped modeling of key parenting activities including appropriate play, and use of parental attention, praise, consequences, and appropriate discipline techniques, including time out. Videotaped vignettes demonstrated the principles involved; therapists used a manual to guide discussion and gave homework. Treatment was provided either to individual parents or to small parent groups (two to three parents). All parents enrolled in the therapist-led interventions were given a copy of Webster-Stratton’s book, The Incredible Years (Webster- Stratton, 1992), which served as a companion work to the intervention. 

• Reference: Lavigne, J., LeBailly,S., Gouze,K., Cicchetti, C., et al (2008). Treating Oppositional Defiant Disorder in Primary Care: A Comparison of Three Models. Journal of Pediatric Psychology 33(5). 449-461 

• Submitter: Barry Crum 

Brief Behavioral Intervention (BBI) 

Treatment Summary: The focus of the treatment is on parent behavior management skills. The family’s daily routine is analyzed to identify problems in current interaction. Brief Behavioral Intervention utilizes child directed play and the practice of differential attention such as praise and planned ignoring, giving effective commands and the effective use of time out. Support is provided in weekly counseling sessions with behavior logs for use in discussions and to show progress. Successful completion of each skill determines progress through BBI. 

• Reference: Axelrod, M.E., Garland, B.H., & Love, K.B. (2009). Brief behavioral intervention for young children with disruptive behaviors. Journal of Clinical Psychology in Medical Settings. 16, 263-269. 

• Submitter: Cynthia Gumbert 

Treatment Algorithm for ODD 

Treatment Summary: Comprehensive assessment is compiled to indicate whether ODD is a singular diagnosis, or has a chance of co morbidity. The first step is psychosocial interventions and behavioral therapy. A second step may be needed to assist the individual after several months without positive results. This entails a medication regimen using a psychostimulant such as atomoxetine, methylphenidate or amphetamine. In cases where multiple diagnoses are indicated, behavioral therapy and medication will vary according to severity and type of diagnosis that coincides with ODD. Medication provided should be prescribed starting with the lowest dose compared to the individuals needs and may be increased over time as needed. 

• Reference: Turgay, A. (2009). Psychopharmacological treatment of oppositional defiant disorder. CNS Drugs, 23(1), 1 – 17. 

• Submitter: Kelli A. Friddle 

Parent-Child Interaction Therapy (PCIT) 

Summary of Treatment:  

Parent-Child Interaction Therapy, known as PCIT, is a type of parent training program that teaches parents appropriate ways to interact with their children while increasing positive behaviors in the child. It is a performance based treatment program in which the treatment is complete when the desired goal has been met. Because of its goal orientation, it is ideal in helping families achieve lower levels of stress and higher functioning among family members in a short amount of time (Fernandez, Butler, and Eyberg, 2011).  

The purpose of PCIT is to train parents to not only provide emotional support for their child, but also to be in control of their child’s behavior (Fernandez et al., 2011). PCIT is effective in reducing parent stress levels and undesirable behaviors in children because it teaches parents to use effective parenting styles (Fernandez et al., 2011). In the two studies referenced below, the effectiveness of PCIT was examined. In the studies, PCIT allowed the parents to examine the current effectiveness of their parenting styles and then learn more effective techniques to use with their children. As part of their therapy, parents were taught and given opportunities to focus on two types of interactions, child directed interaction (CDI) and parent directed interaction (PDI). The CDI component gave the parent direct interaction with their child through play time. With the experience of play time, this child directed interaction allowed the parent to use positive reinforcements that rewarded the child for exhibiting desirable behaviors. Parents were taught effective ways to use verbal praise, selective ignoring, and reflective listening (Nixon, Sweeney, Erickson, and Touyz, 2003). Parents also learned to use PDI, parent directed interaction. The parent directed interaction component expected the parent to be consistent in their discipline and allowed him or her to create a routine, structured environment for the child. With PDI, parents learned to use parenting strategies that help them with consistency, consequences, and other behavior management techniques.  Using CDI and PDI creates a positive environment for the child and allows the parent to focus on positive interactions and behaviors. According to these studies, consistently focusing on the positive behaviors and interactions of the child will result in a decrease in severe behavior problems.  

• References: Fernandez, M.A., Butler, A.M., & Eyberg, S.M. (2011). Treatment outcome for low socioeconomic status african american families in parent-child interaction therapy: A pilot study. Child and Family Behavior Therapy, 33, 32-48. doi: 10.1080/07317107.2011.545011 & Nixon, R.D.V., Sweeney, L, Erickson, D.B., & Touyz, S.W. (2003). Parent-Child Interaction Therapy: A comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Journal of Counseling and Clinical Psychology, 71(2), 251-260. doi: 10.1037/0022-006X.71.2.251 

• Submitted by: Kelly Bailey 

Parent Management Training (PMT) 

Summary of Treatment: In an article by Costin and Chambers, Parent management training (PMT) is assessed as a treatment method for oppositional defiant disorder (ODD). PMT focuses on the parent side of the parent-child relationship, emphasizing that which is within the parent’s area of control. This treatment method teaches the parents of a child with ODD to reward the child’s pro-social behaviors while systematically ignoring or penalizing their socially aversive behaviors (Costin & Chambers 2007). PMT also encourages parents to develop a stronger sensitivity to their child’s needs by educating them on the two-way interactional effects of the parent-child relationship (Costin & Chambers 2007). 

• Reference: Costin, J., & Chambers, S. M. (2007). Parent management training as a treatment for children with oppositional defiant disorder referred to a mental health clinic. Clinical Child Psychology And Psychiatry, 12(4), 511-524. doi:10.1177/1359104507080979 

• Submitted by: Greg Ruehlen