Available Intervention and Treatment for Oppositional Defiant Disorder in Young Children - Term Paper Example

?Available Intervention and Treatment for Oppositional Defiant Disorder in Young Children Available Intervention and Treatment for Oppositional Defiant Disorder in Young Children Introduction Defiance is perceived as a negative behavior that may pose more social problems while one individual continues to exhibit it. It is usually seen on persons from childhood to late adulthood and this attitude may have apparent or unknown reasons. For the more usual defiant attitude, apparent reasons may include personal problems that a person may be going through during the time of defiance, or that a person may perceive negative impact for defying a request, instruction, or a duty. Defiance is described as non-compliance, argumentative, angry, and hostile behavior that usually destroy relationships between people interacting with one another (American Psychiatric Association, 2000). It may be characterized by verbal and physical aggression but it was suggested that high levels of physical aggression may not be required for diagnosis for the Oppositional Defiant Disorder or ODD (Loeber, Burke, Lahey, Winters, & Zerba, 2000). This paper will try to determine the available treatment and intervention options for oppositional defiance disorder among children in order to highlight the options available and for parents to determine which will fit best their children. Purpose It is important to know treatment options and their impact of treatment for ODD among children to prevent impairment of relationships that usually helps shape the stage of growth among children. Defiance damages the social connectivity of one individual towards others that may include his or her parents, teachers, siblings, immediate family members, playmates, schoolmates and others who may have anything to do with the child. Identification of possible treatments and interventions will provide options for parents or the family to reduce or eradicate the negative behavior. overview Defiance among children starts at age 3 years old. However, average onset is at age 6 and disorder is usually detected prior to adolescence (Hinshaw & Anderson, 1996). Prevalence of ODD between genders has been found to have mixed results: while ODD in boys and girls are almost equal before the age of six, there is higher among males at middle childhood (Loeber et al, 2000). There have also been suggestions about the issues of ODD as either a developmental precursor to Conduct Disorder, or a categorical diagnosis (Loeber et al, 2000). Treatment and Interventions - choose the first 2 studies you would like to discuss under this subheading There are several options for parents and families about the treatment and intervention methods they may avail or apply for their children diagnosed with ODD. Some of these include Behavioral Parent Training or BPT which also includes parent training and child treatment or PT+CT, Therapeutic Assessment or TA, , and Webster-Stratton Incredible Years Program. All these address ODD for children. This paper will focus on the BPT approach called PT+CT (Drugli, Larsson, Fossum, and Morch, 2010) and TA (Smith, Handler, and Nash, 2010). - compare and contrast the first 2 studies Both studies determine the efficacy of intervention or treatment among children. BPT is a family-based intervention and claimed to be scientifically validated treatment for ODD (Chambless et al, 1998). There have been several identified BPT programs which slightly differ in format such as group vs. individually administered, treatment setting within clinic or the community, and instructional techniques such as emphasis on role play, coaching, modeling or didactic (MacKenzie, year). Other BPT practices include “parent management training” (Kazdin, 1997), “behavioral family therapy” (McMahon and Forehand, 2003), “parent training” (McMahon and Forehand, 1984) and “parent-child interaction therapy” (Eyberg and Boggs, 1998) and the PT+ CD approach (Drugli et al, 2010). TA on the other hand is considered a new treatment approach using assessment and psychotherapy. It is a focused intervention for adults, adolescents, children, and couples fusing psychological assessment and short psychotherapy and usually starts at the first contact with patient (Smith et al, 2010). TA conducted with children and their families ran for about nine weeks with one to two hour sessions. First was the initial meeting and then three or four test-administration session, then, a family intervention session, a summary or discussion session, a child feedback session, and a follow-up session after 60 days from the child feedback session. i) purpose: (1-3 sentences) The purpose of Drugli et al’s study (2010) was to determine the long-term outcome for children with severe conduct problems 5-6 years after treatment with the Incredible Years Parent Training (PT) with or without Child Treatment or a comparison of the PT+CT approach against PT alone. Meanwhile, Smith et al (2010) examined the efficacy of the TA model with preadolescent boys with oppositional defiant disorder and their families. The only difference with the usual TA model was that the study used only one clinician instead of two. The purpose was to make TA model become more accessible to practitioners in real clinical settings and highlight the collaborative relationship among the clinician, the child, and his or her family. ii) sample / participants: (who? how many?, etc.) The sample for Drugli et al’s (2010) study consisted of 127 children aged 4-8 who were referred for treatment of ODD by their parents. 99 of the children were randomized for treatment and 28 children were relegated to a waiting-list control group. The families of the waiting-list control group were also given treatment after 6 months although they were no longer included in the follow-up assessment for ethical reasons. In the PT+CD model, “Mean child age at study entry was 6.6 years (SD = 1.3). All children had either a full or sub-threshold (see below) diagnosis of ODD. In addition, 19% (n = 24) were diagnosed with CD/sub-threshold CD, 35% (n = 45) with ADHD, and 10% (n = 13) with anxiety or depression,” (Drugli et al, 2010, 560). Meanwhile, the TA study screened boys assessed at a university outpatient clinic within the 9-12 age range after completion of a demographic questionnaire. Most important consideration was the ODD diagnosis confirmed with the supervising psychologist (Smith et al, 2010). Three families – two Caucasian and one mixed race Caucasian-African were chosen in the case study. The session involves providing feedback to the parents in the form of collaborative dialogue using various levels described as “Level 1 information is readily accepted, raises little anxiety, and validates clients’ external reality. Level 2 information is not wholly in disagreement with the parents’ existing story, but it may require reformulation of the current view and, thus, might cause some anxiety. Information that is entirely dystonic to the parents’ story is termed Level 3. This kind of feedback has the potential to raise the parents’ anxiety substantially and, without the proper preparation, might be rejected,” (Smith et al, 2010, 596). iii) methodology: a) instruments/measures The inclusion criteria in Drugli et al’s study (2010) used Larson et al’s (2009) randomized controlled replication trial. The children were first screened with the Eyberg Child Behavior Inventory (Boggs, Eyberg, and Reynolds, 1990) using the 90th percentile as a cut-off score based on Norwegian norms. Children who met the requirements were interviewed by trained interviewers using the Kiddie-SADS, a semi-structured diagnostic interview assessing the psychopathology in children and adolescents according to DSM-IV criteria (Drugli et al, 2010). The TA model used a live video that allowed parents to observe the assessment of their child in real time as they observe the child and clinician in an adjacent room. They were given test materials to follow along as these were administered to the child and were encouraged to take down notes (Smith et al, 2010). b) procedures: how did they collect the data? what did they do? iv) data analysis: qualitative or quantitative? The PT+CD model used qualitative data by collecting questionnaire measures at pre and post-treatment, and after 1 year follow-up. K-SADS interviews were also undertaken at pre-treatment and at 1, and 5-6 year follow-up (Smith et al, 2010). The Eyberg Child Behavior Inventory or ECBI uses a 36-item inventory for parents in conduct report for their children 2-16 years on 1-7 scale. Total intensity scores were used from 36 to 252 using an internal consistency of .86 (Smith et al, 2010). The TA model used both qualitative and quantitative data analysis with standard procedures in enlisting parents as collaborators, using a set of assessment questions that guide the treatment, and follow-up inquiry in regards to the family’s questions. A response was asked from the children on the Milton Pre-Adolescent Clinical Inventory of Personality with regards to losing temper and association to questions or objects asked by the doctor (Drugli et al, 2010). v) main findings: what did the study reveal? The Drugli et al study (2010) found that children with ODD and their families benefited from participating in the treatment specifically the TA model. On the other hand, the study on PT+CD found a correlation between improved behavior and treatment. In addition, the treatment model also worked best with two-parent families than single parent families for children with severe ODD or CD problems. Parental stress was also linked to more problematic ODD girls (Smith et al, 2010) vi) relate it back to your overall topic: how does this particular journal relate to what you are discussing? The studies indicate the relevance of treatment and family or parent participation as well as family structure in the outcome of the intervention/treatment. While both models worked, various observations should also be considered that influenced study results including pre-treatment and post-treatment factors that may adversely or beneficially affect the treatment results. As Smith et al (2010) observed, “. All 3 families benefitted from participation in TA across multiple domains of functioning, but the way in which change unfolded was unique for each family… The TA model is shown to be an effective treatment for preadolescent boys with oppositional defiant disorder and their families. Further, the time-series design of this study illustrated how this empirically grounded case-based methodology reveals when and how change unfolds during treatment in a way that is usually not possible with other research designs,” (593). On the other hand, it has been established by Drugli et al (2010) “the study support the maintenance of positive long-term results for young children treated with parent training because of serious conduct problems, and identify characteristics of children and families in need of added support to parent training programs,” (559). Other Studies on ODD Another study by Emond, Ormel, Veenstra, and Oldehinkel (2007) observed the preschool social understanding and difficult behaviors that are considered predictors for ODD. These are hot temperedness, disobedience, bossiness, and even bullying. The purpose of the study was to find out up to what extent do difficult preschool behaviors and social cognition predicted ODD and aggressive conduct disorder among preadolescents. The sample population is pre-adolescents aged 10-12 and 13-15 who were members of the TRacking Adolescents’ Individual Lives Survey (TRAILS), an ongoing cohort study based on a sample representative of the Dutch population that investigated the development of mental health from preadolescence into adulthood. The study used data from the ?rst (T1) and second (T2) assessment wave of TRAILS, which ran from March 2001 to July 2002, and September 2003 to December 2004. They used the Child Behavior Checklist and the Youth Self-Report, with the preschool behavior evaluated by the parental questionnaire ‘How was your child as a preschooler?’. The mentioned preschool behaviors except bullying were found to be linked with adolescent ODD and that there was no preschool behaviors to predict later ACD but not ODD. The associations did not differ between boys and girls with roughly similar preadolescent (age 10–12) and early adolescent (age 13–15) outcomes. The authors suggested that, “poor social understanding was implicated in the development of ACD but not in the development of ODD may help to demarcate the individuality of each disorder and offer leads for (differential) treatment strategies,” (Emond et al, 200, 221). The fourth study by Lavigne et al (2008) determined the success of nurse-led or psychologist-led parent-training program against a minimal intervention in treating early childhood ODD. The sample population were enrolled in 24 Chicago-area pediatric practices and grouped according to demographic characteristics. The 117 children participants were aged 3- 6 year olds and their parents who met specified criteria for ODD based on clinical consensus diagnoses and other requirements by the authors. The study found that there was significant improvement across post-treatment and 12-month follow-up for all groups with a reliable dose effect gained after seven sessions on the Eyberg intensity scale and none sessions on the Child Behavior Checklist externalizing scale. The researchers concluded that “There is little advantage to the therapist-led treatment over bibliotherapy unless parents attend a significant number of sessions,” (Lavigne et al, 2008, 449). Critical Analysis Intervention and treatment usually involves professionals but much of the efforts are expected from parents and teachers. Determination of options and programs, however, indicate the importance of the clinician / professional in the treatment process. However, the most important challenge for families with suspected ODD is access. As also mentioned in the studies, various methods require resources from the families with ODD children. Not all families with children having ODD may afford therapies of any model. As indicated, many of those which treatment and intervention worked least were of ODD children from single-parent set-up. This may indirectly mean less privileged families. Access in this manner is doubly challenged as aside from lack of it, intervention is also almost unfelt. There is also the consideration for parent and therapist relationship. As already noted, parents and the therapist behavior may also interfere in the treatment process where completion may not be met or drop-out becoming inevitable. Implications for Teaching / Link to Education The study of ODD and treatment options provide teachers and educators an overview of possible approaches in dealing with suspected ODD children in the classroom or education setting. While educators may not have formal treatment formulas at hand unlike psychologists and their counterparts, educators may not be left behind in providing a more inclusive and understanding learning environment where children with ODD may actually experience embracing methods that will help them improve their behavior. The role of the parent in this setting, however, should not be overlooked. It should always be noted that the home, family, and the parents play crucial overall development of the child with ODD. Their supportive engagement will foster a more positive outcome. Conclusion ODD among children is a challenge not only in the family and clinical setting, but in a bigger community setting where these children will have to mingle with as they grow. Addressing ODD at an early stage will decrease bigger societal challenges that result from ignored symptoms and lack of diagnoses and treatment. However, the problem with ODD, as much as other health and social issues that plagued modern societies now is not the absence of treatment or intervention, but the lack of access by families as well as resources. Government and non-government organization programs may help eradicate or reduce instances of ODD when resources are properly pooled and services are provided for those who need it. However, there should also be emphasis on the role of family set-up where studies already indicated the positive effect of two-parent set-up against single-parent homes in the positive outcome treatment of children with ODD. Reference Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits-Christoph, et al. (1998). Update on empirically validated therapies II. The Clinical Psychologist, 51, 3-21. Drugli, M.B., B. Larsson, S. Fossum, and W.T. Morch (2010). Five- to six-year outcome and its prediction for children with ODD/CD treated. 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