Oppositional defiant disorder (ODD) is a common clinical condition seen among children and adolescents in behavioral health settings. In this article, we review behavioral treatment programs and their clinical use in managing ODD.
Methods
We searched PubMed, PsycInfo, and Scopus from 2000 to 2020 using the terms “oppositional defiant disorder” and “treatment.” We found 1,665 articles, including clinical trials, review articles, and case control studies of evidence-based ODD treatments in patients age <18. Articles were screened to identify literature focusing on evidence-based behavioral treatment programs for ODD.
Results
The literature search revealed abundant evidence supporting the role of behavioral treatment programs for managing ODD and other disruptive behavior disorders. In this review, we discuss the most recent findings on established and effective strategies, including Parent Management Training, Parent-Child Interaction Therapy, Collaborative Problem Solving, Incredible Years program, Triple-P Positive Parenting Program, Start Now and Plan program, and Coping Power Program.
Conclusions
ODD can cause significant distress to patients and their caregivers. Familiarity with behavioral treatment programs provides clinicians with tools for managing this condition in clinical settings.
Get full access to this article
View all access options for this article.
References
1.
CarubiaBBeckerALevineBH. Child psychiatric emergencies: updates on trends, clinical care, and practice challenges. Curr Psychiatry Rep.2016; 18: 41. doi:10.1007/s11920-016-0670-9
2.
Diagnostic and statistical manual of mental disorders, 5th ed. American Psychiatric Association; 2013: 462-466.
3.
RileyMAhmedSLockeA.Common questions about oppositional defiant disorder. Am Fam Physician.2016; 93: 586-591.
4.
MikolajewskiAJTaylorJIaconoWG. Oppositional defiant disorder dimensions: genetic influences and risk for later psychopathology. J Child Psychol Psychiatry.2017; 58: 702-710. doi:10.1111/jcpp.12683
5.
NoordermeerSDLumanMOosterlaanJ.A systematic review and meta-analysis of neuroimaging in oppositional defiant disorder (ODD) and conduct disorder (CD) taking attention-deficit hyperactivity disorder (ADHD) into account. Neuropsychol Rev.2016; 26: 44-72. doi:10.1007/s11065-015-9315-8
6.
RoweR, CostelloEJ, AngoldA, . Developmental pathways in oppositional defiant disorder and conduct disorder. J Abnorm Psychol. 2010;119:726-738. doi: 10.1037/a0020798
7.
PerlmanSBJonesBMWakschlagLS. Neural substrates of child irritability in typically developing and psychiatric populations. Dev Cogn Neurosci.2015; 14: 71-80. doi:10.1016/j.dcn.2015.07.003
8.
TungILeeSS. Negative parenting behavior and childhood oppositional defiant disorder: differential moderation by positive and negative peer regard. Aggress Behav.2014; 40: 79-90. doi:10.1002/ab.21497
9.
DanielsonMLBitskoRHGhandourRM. Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. J Clin Child Adolesc Psychol.2018; 47: 199-212. doi:10.1080/15374416.2017.1417860
10.
SteinerHRemsing L; Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry.2007; 46: 126-141. doi:10.1097/01.chi.0000246060.62706.af
DrugliMBLarssonBFossumS. Five- to six-year outcome and its prediction for children with ODD/ CD treated with parent training: long-term outcome after parent training. J Child Psychol Psychiatry.2010; 51: 559-566. doi:10.1111/j.1469-7610.2009.02178.x
13.
KazdinAEWhitleyMK. Pretreatment social relations, therapeutic alliance, and improvements in parenting practices in parent management training. J Consult Clin Psychol.2006; 74: 346-355. doi:10.1037/0022-006X.74.2.346
14.
JohnstonOGBurkeJD. Parental problem recognition and help-seeking for disruptive behavior disorders. J Behav Health Serv Res.2020; 47: 146-163. doi:10.1007/s11414-018-09648-y
15.
JosephHMFarmerCKippH. Attendance and engagement in parent training predict child behavioral outcomes in children pharmacologically treated for attention-deficit/hyperactivity disorder and severe aggression. J Child Adolesc Psychopharmacol.2019; 29: 90-99. doi:10.1089/cap.2018.0119
16.
KaminskiJWValleLAFileneJH. A meta-analytic review of components associated with parent training program effectiveness. J Abnorm Child Psychol.2008; 36: 567-589. doi:10.1007/s10802-007-9201-9
17.
CostinJChambersSM. Parent management training as a treatment for children with oppositional defiant disorder referred to a mental health clinic. Clin Child Psychol Psychiatry.2007; 12: 511-524. doi:10.1177/1359104507080979
18.
NobelEHoekstraPJ Agnes Brunnekreef J, . Home-based parent training for school-aged children with attention-deficit/hyperactivity disorder and behavior problems with remaining impairing disruptive behaviors after routine treatment: a randomized controlled trial. Eur Child Adolesc Psychiatry.2020; 29: 395-408. doi:10.1007/s00787-019-01375-9
19.
DanforthJSHarveyEUlaszekWR. The outcome of group parent training for families of children with attention-deficit hyperactivity disorder and defiant/ aggressive behavior. J Behav Ther Exp Psychiatry.2006; 37: 188-205. doi:10.1016/j.jbtep.2005.05.009
20.
MalikTARooneyMChronis-TuscanoA. Preliminary efficacy of a behavioral parent training program for children with ADHD in Pakistan. J Atten Disord.2017; 21: 390-404. doi: 10.1177/1087054714524158
21.
OstbergMRydellA-M. An efficacy study of a combined parent and teacher management training programme for children with ADHD. Nord J Psychiatry.2012; 66: 123-130. doi:10.3109/08039488.2011.641587
22.
PfiffnerLJRooneyMHaackL. A randomized controlled trial of a school-implemented school-home intervention for attention-deficit/hyperactivity disorder symptoms and impairment. J Am Acad Child Adolesc Psychiatry.2016; 55: 762-770. doi:10.1016/j.jaac.2016.05.023
23.
PlueckJEichelbergerIHautmannC. Effectiveness of a teacher-based indicated prevention program for preschool children with externalizing problem behavior. Prev Sci.2015; 16: 233-241. doi:10.1007/s11121-014-0487-x
24.
VeenmanBLumanMOosterlaanJ.Efficacy of behavioral classroom programs in primary school. A meta-analysis focusing on randomized controlled trials. PLoS One.2018; 13: e0201779. doi:10.1371/journal.pone.0201779
25.
ChackoABedardAVMarksD. Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children. Child Neuropsychol.2018; 24: 427-450. doi:10.1080/09297049.2017.1282450
26.
vanden Hoofdakker BJ, NautaMH, vander Veen-Mulders L, . Behavioral parent training as an adjunct to routine care in children with attention-deficit/hyperactivity disorder: moderators of treatment response. J Pediatr Psychol.2010; 35: 317-326. doi: 10.1093/jpepsy/jsp060
27.
LecavalierLSmithTJohnsonC. Moderators of parent training for disruptive behaviors in young children with autism spectrum disorder. J Abnorm Child Psychol.2017; 45: 1235-1245. doi:10.1007/s10802-016-0233-x
28.
LindhiemOVaughn-CoaxumRAHigaJ. Development and validation of the Parenting Skill Use Diary (PSUD) in a nationally representative sample. J Clin Child Adolesc Psychol.2021; 50: 400-410. doi:10.1080/15374416.2020.1716366
29.
ForcinoSSNadlerCBRobertsMW. Parent training for middle childhood conduct problems: child opposition to timeout and token fines. Practice Innovations.2019; 4: 1-12. doi:10.1037/pri0000090
30.
Hughes-ScaliseAPrzeworskiA.All in the family: family-based behavioral treatment of child obsessive-compulsive disorder and oppositional defiant disorder within the context of marital and family discord. Clin Case Stud.2014; 13: 52-67. doi:10.1177/1534650113504490
31.
ForehandRParentJPeischVD. Do parental ADHD symptoms reduce the efficacy of parent training for preschool ADHD? A secondary analysis of a randomized controlled trial. Behav Res Ther.2017; 97: 163-169. doi:10.1016/j.brat.2017.08.002
32.
DawsonAEWymbsBTMarshallSA. The role of parental ADHD in sustaining the effects of a family-school intervention for ADHD. J Clin Child Adolesc Psychol.2016; 45: 305-319. doi:10.1080/15374416.2014.963858
33.
SawrikarVHawesDJMoulC. The role of parental attributions in predicting parenting intervention outcomes in the treatment of child conduct problems. Behav Res Ther.2018; 111: 64-71. doi:10.1016/j.brat.2018.10.00
34.
DunsmoreJCBookerJAOllendickTH. Parental emotion coaching and child emotion regulation as protective factors for children with oppositional defiant disorder: emotion coaching with children with ODD. Soc Dev.2013; 22: 10.1111/j.1467-9507.2011.00652.x. doi:10.1111/j.1467-9507.2011.00652.x
35.
MillsSLBabinskiDEWaschbuschDA. MaternalPTSDand behavioral parent training treatment for a girl with conduct disorder and callous-unemotional traits. Clin Case Stud. 2018; 17: 482-498. doi:10.1177/1534650118795276
36.
ThomasRAbellBWebbHJ. Parent-child interaction therapy: a meta-analysis. Pediatrics.2017; 140: e20170352. doi:10.1542/peds.2017-0352
AbrahamseMEJungerMChavannesEL. Parent-child interaction therapy for preschool children with disruptive behaviour problems in the Netherlands. Child Adolesc Psychiatry Ment Health.2012; 6: 24. doi:10.1186/1753-2000-6-24
39.
BagnerDMEybergSM. Parent-child interaction therapy for disruptive behavior in children with mental retardation: a randomized controlled trial. J Clin Child Adolesc Psychol.2007; 36: 418-429. doi:10.1080/15374410701448448
40.
BriegelW.Tailoring parent-child interaction therapy (PCIT) for older children: a case study. Z Kinder Jugendpsychiatr Psychother.2018; 46: 298-304. doi:10.1024/1422-4917/a000536
41.
GreeneRW. Collaborative problem solving can transform school discipline. Phi Delta Kappan.2011; 93: 25-29. doi: 10.1177/003172171109300206
42.
JohnsonMOstlundSFranssonG. Attention-deficit/hyperactivity disorder with oppositional defiant disorder in Swedish children—an open study of collaborative problem solving. Acta Paediatrica.2012; 101: 624-630. doi:10.1111/j.1651-2227.2012.02646.x
43.
EpsteinTSaltzman-BenaiahJ.Parenting children with disruptive behaviours: evaluation of a collaborative problem-solving pilot program. Journal of Clinical Psychology Practice.2010; 1: 27-40.
44.
OllendickTHGreeneRWAustinKE. Parent management training and collaborative & proactive solutions: a randomized control trial for oppositional youth. J Clin Child Adolesc Psychol.2016; 45: 591-604. doi:10.1080/15374416.2015.1004681
45.
KulkarniGDeshmukhPBarzmanD.Collaborative problem solving (CPS) as a primary method of addressing acute pediatric pathological aggression along with other modalities. Psychiatr Q.2010; 81: 167-175. doi:10.1007/s11126-010-9126-2
46.
GreeneRWAblonJSGoringJC. Effectiveness of collaborative problem solving in affectively dysregulated children with oppositional-defiant disorder: initial findings. J Consult Clin Psychol.2004; 72: 1157-1164. doi:10.1037/0022-006X.72.6.1157
47.
GreeneRWinklerJ.Collaborative & proactive solutions (CPS): a review of research findings in families, schools, and treatment facilities. Clin Child Fam Psychol Rev.2019; 22: 549-561. doi:10.1007/s10567-019-00295-z
48.
ReidMJWebster-StrattonC.The incredible years parent, teacher, and child intervention: targeting multiple areas of risk for a young child with pervasive conduct problems using a flexible, manualized treatment program. Cogn Behav Pract.2001; 8: 377-386. doi: 10.1016/S1077-7229(01)80011-0
49.
HobbelSDrugliMB. Symptom changes of oppositional defiant disorder after treatment with the Incredible Years Program. Nord J Psychiatry.2013; 67: 97-103. doi:10.3109/08039488.2012.685888
50.
AxbergUBrobergAG. Evaluation of “the incredible years” in Sweden: the transferability of an American parent-training program to Sweden. Scand J Psychol.2012; 53: 224-232. doi:10.1111/j.1467-9450.2012.00955.x
51.
HomemTCGasparMFSeabra-SantosMJ. A pilot study with the Incredible Years Parenting Training: does it work for fathers of preschoolers with oppositional behavior symptoms?Fathering.2014; 12: 262-282. doi:10.3149/fth.1203.262
52.
HomemTCGasparM FSantosMJS. Incredible Years parent training: does it improve positive relationships in Portuguese families of preschoolers with oppositional/defiant symptoms?J Child Fam Stud.2015; 24: 1861-1875.
53.
LeijtenPRaaijmakersMA Orobio de Castro B, . Effectiveness of the Incredible Years parenting program for families with socioeconomically disadvan-taged and ethnic minority backgrounds. J Clin Child Adolesc Psychol.2017; 46: 59-73. doi:10.1080/15374416.2015.1038823
54.
PerrinECSheldrickRCMcMenamyJM. Improving parenting skills for families of young children in pediatric settings: a randomized clinical trial. JAMA Pediatr.2014; 168: 16-24. doi:10.1001/jamapediatrics.2013.2919
55.
FossumS Mørch W-T, Handegård BH, . Parent training for young Norwegian children with ODD and CD problems: predictors and mediators of treatment outcome. Scand J Psychol.2009; 50: 173-181. doi:10.1111/j.1467-9450.2008.00700.x
56.
SandersMRKirbyJNTellegenCL. The Triple P-Positive Parenting Program: a systematic review and meta-analysis of a multi-level system of parenting support. Clin Psychol Rev.2014; 34: 337-357. doi:10.1016/j.cpr.2014.04.003
57.
WettachRAebiM.Pilot study on the effectiveness of a multimodal group treatment for children with oppositional defiant disorder in clinical primary care. Article in German. Z Kinder Jugendpsychiatr Psychother.2016; 44: 220-230. doi:10.1024/1422-4917/a000424
58.
SampaioFBarendregtJJFeldmanI. Population cost-effectiveness of the Triple P parenting programme for the treatment of conduct disorder: an economic modelling study. Eur Child Adolesc Psychiatry.2018; 27: 933-944. doi:10.1007/s00787-017-1100-1
59.
KarverMSCaporinoN.The use of empirically supported strategies for building a therapeutic relationship with an adolescent with oppositional-defiant disorder. Cogn Behav Pract.2010; 17: 222-232. doi:10.1016/j.cbpra.2009.09.004
60.
ParkerJZaboskiBJoyce-BeaulieuD.School-based cognitive-behavioral therapy for an adolescent presenting with ADHD and explosive anger: a case study. Contemp School Psychol.2016; 20: 356-369. doi: 10.1007/s40688-016-0093-y
61.
NitkowskiDPetermannFBüttnerP. Behavior modification of aggressive children in child welfare: evaluation of a combined intervention program. Behav Modif.2009; 33: 474-492. doi:10.1177/0145445509336700
62.
BurkeJDLoeberR.The effectiveness of the Stop Now and Plan (SNAP) program for boys at risk for violence and delinquency. Prev Sci.2015; 16: 242-253. doi:10.1007/s11121-014-0490-2
63.
DerellaOJJohnstonOGLoeberR. CBT-enhanced emotion regulation as a mechanism of improvement for childhood irritability. J Clin Child Adolesc Psychol.2019; 48: S146-S154. doi:10.1080/15374416.2016.1270832
64.
DerellaOJBurkeJDRomano-VerthelyiAM. Feasibility and acceptability of a brief cognitive-behavioral group intervention for chronic irritability in youth. Clin Child Psychol Psychiatry.2020; 25: 778-789. doi:10.1177/1359104520918331
65.
MuratoriPMiloneALevantiniV. Six-year outcome for children with ODD or CD treated with the coping power program. Psychiatry Res.2019; 271: 454-458. doi:10.1016/j.psychres.2018.12.018
66.
HelanderMLochmanJHögströmJ. The effect of adding Coping Power Program-Sweden to Parent Management Training—effects and moderators in a randomized controlled trial. Behav Res Ther.2018; 103: 43-52. doi:10.1016/j.brat.2018.02.001
67.
Nelson-GrayROKeaneSPHurstRM. A modified DBT skills training program for oppositional defiant adolescents: promising preliminary findings. Behav Res Ther.2006; 44: 1811-1820. doi:10.1016/j.brat.2006.01.004
68.
MarcoJHGarcí-a-PalaciosABotella C. Dialectical behavioural therapy for oppositional defiant disorder in adolescents: a case series. Psicothema.2013; 25: 158-163. doi:10.7334/psicothema2012.119
69.
KerstenLPrätzlichMMannstadtS. START NOW - a comprehensive skills training programme for female adolescents with oppositional defiant and conduct disorders: study protocol for a cluster-randomized controlled trial. Trials.2016; 17: 568. doi:10.1186/s13063-016-1705-6
