Parental and Teacher Interventions for ODD and Conduct Disorder

Overview of Oppositional Defiant Disorder and Treatment Approaches

Oppositional Defiant Disorder (ODD) is characterized by persistent irritability and anger among children. Children with ODD also tend to be argumentative, defiant, and vindictive toward anyone in a position of authority over them. Their conduct impedes the normal daily activities expected of them. The lifetime prevalence of ODD has been measured at approximately 11% of the general population. ODD symptoms are apparent as early as age 8. Research has established that about 70% of all children with ODD no longer show symptoms of the condition by age 18. It has also been observed that only a small number of that group goes on to develop antisocial conduct in adulthood. The disorder has a multifactorial basis. There is substantial documentation pointing to parenting styles, heredity, and other psychosocial factors in the development of ODD. Other studies have also highlighted the role that changes in neurological anatomy play in the incidence of ODD (Graham, 2018).

ODD responds to therapy, and treatment recommendations are based on the age of the patient. Younger patients are reported to respond best when placed under parent management training. Children in middle school have been found to respond best to Cognitive Behavioral Therapy (CBT). Adolescents at more advanced ages are placed in multimodal programs informed by social learning. Certain classes of medications have also proved helpful in mitigating ODD symptoms, although the FDA has yet to approve any specific drug for the treatment of the disorder (Graham, 2018).

ODD treatment entails the involvement of family members in its execution. It may incorporate a range of psychotherapy and training programs for both the child with the condition and the parents. Treatment of ODD could take several months or more. Treatment of co-occurring conditions must be prompt, as they may worsen ODD if left unaddressed (Mayo Clinic, 2018).

Parental Interventions for Children with ODD

A mental health professional experienced in handling ODD can help a parent develop parenting skills to manage and reduce ODD behaviors. In some instances, the child may be incorporated into the training program so as to empower as many family members as possible on how to handle the child — and to help such children learn how to interact with parents and other authority figures around them.

Parent-Child Interaction Therapy (PCIT) is applied by coaching parents in real time as they interact with their children. In one method, a therapist sits behind a one-way mirror and uses an audio earpiece device to guide parents in reinforcing positive child behaviors. As a result, parents learn many effective parenting strategies. The relationship between parent and child is strengthened while problematic behaviors decrease.

When a child receives individual therapy, they can more easily learn how to cope with outbursts of anger and express their feelings in a respectful way. Family therapy is known to improve communication among family members and encourages unity within the family unit.

Through this approach, the child learns to identify and modify thought patterns that create behavioral problems. The collaborative problem-solving approach can improve both the parent's and the ODD child's ability to manage conflict constructively.

CPS has been identified as a promising approach for children with ODD. It seeks to help children learn how to cope with disappointment and frustration and to develop greater flexibility. Both parents and children practice brainstorming solutions to problems, negotiate, and choose outcomes that work for both parties — learning to resolve issues without escalating into conflict.

A child may benefit from therapy that helps them integrate more effectively into their social environment. Although some parenting techniques may seem straightforward, consistently applying them — especially under challenging circumstances — is not easy. Routine and practice help parents internalize these skills over time (Mayo Clinic, 2018).

Parental Interventions for Children with Conduct Disorder

Some children display persistent emotional and behavioral difficulties. Such children are said to have Conduct Disorder (CD). Children with conduct disorder have serious difficulty following rules, demonstrating empathy, and respecting other people's personal boundaries. Society commonly regards these children as delinquent. Conduct disorder arises because of several factors, including neglect, genetic vulnerability, trauma, academic failure, and child abuse (American Academy of Child and Adolescent Psychiatry, 2017).

It is important that children with conduct disorder be treated by experienced mental health professionals. It is common for children with conduct disorder to exhibit co-existing conditions such as PTSD, anxiety, ADHD, learning difficulties, substance abuse, and thought disorders. Available research indicates that children with conduct disorder will continue experiencing problems if they and their families do not receive proper treatment. Many children with conduct disorder struggle to meet the demands of adulthood, finding it difficult to maintain employment or sustain relationships (American Academy of Child and Adolescent Psychiatry, 2017).

Many evidence-based, family-centered therapy models for conduct disorder have been developed and are now practiced across more than 800 communities. These models include:

This model is designed to help families experiencing similar problems cooperate in resolving those problems. It provides an avenue for acquiring new skills and knowledge in handling children with conduct disorder. The model uses structured educational content while also allowing time for participants to socialize — through activities such as attending a concert, sharing a communal meal, or going to the movies. A group should typically consist of between 10 and 12 parents from diverse socioeconomic backgrounds, and sessions are designed to run for one to two hours (Henggeler & Sheidow, 2012).

This program is designed to address dysfunctional dynamics in families with children or adolescents experiencing behavioral difficulties. The model has been used across a wide range of settings and with diverse populations. Target groups span pre-adolescents to young people with moderate or severe issues such as conduct disorder, violent behavior, and drug abuse. Treatment sessions typically total between 12 and 14 hours. Each session has specified goals, assessment foci, designated intervention techniques, and the therapeutic competencies needed for success (Henggeler & Sheidow, 2012).

This model was created in the early 1980s and was aimed at offering community-based foster care as an alternative to state detention in cases that had proven difficult for standard foster care settings. The model is informed by social learning theory principles concerning behavior and the influence of the social environment on learning. Interventions are implemented within a socioecological framework that emphasizes the critical role of parental supervision and promotes school performance (Henggeler & Sheidow, 2012).

This model is informed by family systems and strategic theories. It applies family therapy techniques to positively alter how family members interact. The modification aims to eliminate the interactive patterns that encourage the occurrence of conduct disorder and problem behavior in children. A therapeutic alliance is established by engaging all family members. The approach focuses on strengths, which guides both assessment and the treatment plan. Maladaptive interactive patterns are addressed through restructuring. The process includes practical problem-solving in a prescribed format. Services are individualized based on each family's needs and are provided through weekly clinic or home sessions. Treatment typically spans four months, with between 8 and 24 sessions depending on family needs (Henggeler & Sheidow, 2012).