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

Abstract

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.

Parental and Familial Predictors and Moderators of Parent Management Treatment Programs for Conduct Problems in Youth

“…It follows that a more positive parent-child relationship, with fewer incompatibilities before commencing treatment, would lead to better outcomes. This was found in the studies examined in this review Lavigne et al, 2008;Miller-Slough et al, 2016), as well as being well documented in the wider literature (e.g., Booker, Ollendick, Dunsmore & Greene, 2016). Despite this, further replication is needed before definitive conclusions can be reached.…”

Change in Maternal Stress for Families in Treatment for their Children with Oppositional Defiant Disorder

“…Using a secondary analysis of a recently completed RCT (Ollendick et al, 2016), the current study examined change in maternal stress across the course of treatment for children with ODD. As with our previous findings (Booker et al, 2016), we expected children with more positive views toward parents to show greater improvements in severity of ODD symptoms over time. However, we expanded upon previous findings by testing whether children’s positive views toward parents would predict improvements in maternal stress over time, and whether such an effect would be explained by reductions in children’s ODD symptom severity over time.…”

“…Booker and colleagues (2016) have previously shown that children’s positive views toward the relationship with their parents predict greater improvement in ODD symptoms following treatment (measured as ODD severity on a semi-structured diagnostic interview). The current study expanded efforts to test the implications of children’s positive relations with parents.…”

Impairment’s Role in the Pathway From Externalizing Psychopathology to Depressive Symptoms in Adolescents With ADHD

“…Youth with externalizing psychopathology have high levels of social, academic, and family impairment alone and in association with ADHD (Booker et al, 2016; Wehmeier et al, 2010). Researchers theorize that aggression and conduct problems confer enhanced risk for depression at least partly due to functional impairments (i.e., Dual Failure model; Patterson & Capaldi, 1990; Patterson & Stoolmiller, 1991).…”

“…The enhanced risk that externalizing psychopathology confers for depression among youth with ADHD may be due to the nature of the functional impairments they experience (see McCarty et al, 2008; Patterson & Stoolmiller, 1991), including impairment in academic, social, and family domains (Barkley et al, 2006; Gathje et al, 2008). Externalizing psychopathology leads to (Biederman et al, 2008; Burke et al, 2010), and often exacerbates, functional impairment in youth with ADHD (Booker et al, 2016; Wehmeier et al, 2010), which may lead to the development of depression (e.g., Patterson & Capaldi, 1990; Patterson & Stoolmiller, 1991). Depression commonly onsets during adolescence (Merikangas et al, 2010) and portends the continuity of depressive symptoms into adulthood (Weissman et al, 1999).…”