Oppositional Defiant Disorder (ODD) is defined by the Diagnostic & Statistical Manual of Mental Disorders (DSM), the book clinicians use to diagnose ODD, as:
There are five research-based therapeutic strategies for treating ODD in children/adolescents. These strategies are referred to as psycho-social therapies, and are described in further detail below:
Five Therapeutic Strategies for ODD
1. Parental Management Training (PMT)
PMT includes quality time with the child and differential reinforcement strategies (reinforcing only the behaviors you wish to increase) to give proper direction to the child’s motivation. It focuses on parenting skills. Though more effective with smaller children, components of positive parenting practices can be effective with adolescents as well.
Classic evidenced-based PMT programs such as those by psychologists Dr. Alan Kazdin or Dr. Russell Barkley, or the GenerationPMTO program are proven effective. Other effective methods of PMT include parent-child interaction therapy, in which video-based monitoring and feedback are utilized to make parent training easier. These parenting programs can be effective across economic classes and ethnic variation.
Some PMT programs also include school-based interventions that help lead to improvements in a child’s behavior in the school setting. Some examples include the Pax: Good Behavior Game or Incredible Years.
FFT is a short-term, high quality/research-based intervention program with an average of 12 to 14 sessions over a three to five month period. FFT works primarily with 11 to 18-year-olds who have been referred for behavioral or emotional problems by the juvenile justice, mental health, school or child welfare system. Services are conducted in both clinic and home settings, and can also be provided in schools, child welfare facilities, probation and parole offices/aftercare systems and mental health facilities.
FFT is a strength-based model that is built on a foundation of acceptance and respect. There is a primary focus on assessment and intervention to address risk and protective factors within and outside of the family that impact the adolescent or their development.
BSFT believes in a strategic approach that uses pragmatic, problem-focused, and planned interventions. This strategic approach emerged from an explicit focus on developing an intervention that was quick and effective in eliminating symptoms. In BSFT, this strategic approach is evident in the following assumptions:
- Interventions are tailored to the unique characteristics of families and are implemented to achieve attainable treatment goals.
- Interventions are problem focused. A problem-focused approach first targets patterns of interactions that most directly influence the child’s psychosocial adjustment and antisocial behaviors. BSFT targets one problem at a time.
- Interventions are well planned, meaning that the therapist determines the maladaptive interactions (i.e.,
interactions that are directly related to the youth’s behavior problems), determines which of these might be targeted, and establishes a plan to help the family develop more effective patterns of interaction
- BSFT can be implemented in a variety of settings, including community social services agencies, mental health clinics, health agencies, and family clinics.
- BSFT is delivered in 8 to 12 weekly 1- to 1.5-hour sessions.
- The family and BSFT counselor meet either in the program office or the family’s home.
- Sessions may occur more frequently around crises because these are opportunities for change.
4. Cognitive Behavior Therapy (CBT)
According to the American Psychological Association, “Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems. CBT aims to change one’s negative thinking patterns and behavioral patterns. Numerous research studies suggest that CBT leads to significant improvement in functioning and quality of life. In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.”
When a child is slightly older (pre-adolescent/adolescent), CBT in different formats is a very useful component of the treatment of ODD, including aggression. Problem-solving skills training and perspective-taking are components of an effective CBT model for children with ODD. Two particular CBT programs that have shown effective results, made for late elementary/early middle school students, are the Anger Coping Program, and the Coping Power Program, both discussed below.
The Anger Coping Program is a cognitive-behavioral group intervention, designed to decrease aggressive and disruptive behaviors by teaching children coping skills to handle difficult situations and feelings. The program consists of 18 sessions, approximately one hour in length. Each session incorporates clear explanations, group discussions, and in-session activities such as role-plays and games. Many opportunities for practice and fine tuning of skills are incorporated into the sessions. A daily goal sheet is used for monitoring challenging behaviors between sessions, which also aims to help the children generalize skills learned in group to other settings such as the home and classroom.
The Coping Power Program, another cognitive-behavioral group intervention, is designed for use with aggressive children and their parents and is often implemented near the time of children’s transition to middle school.
There is a parent component of the program which consists of 16 group meetings held during the 5th and 6th grade school years. Parents are taught ways of reinforcing their children’s positive behaviors, as well as effective discipline techniques for eliminating negative behaviors. Skills for providing academic support in the home, improving family communication, and building family cohesion are also a focus of the program. The program also teachers parents how to give effective instructions and establish age-appropriate rules and expectations for their children. In addition to these basic parenting skills, the program describes relaxation techniques that parents can use to deal with their own stress. Tips for taking care of personal needs and effective time management strategies are also provided.
5. Multisystemic Therapy
Multisystemic Therapy incorporates peer interventions (e.g., developing communication and social skills in peer or play group therapy); social interventions; and family, school, and individual interventions to simultaneously address challenging behaviors that permeate many sectors of a child’s life (family relationships, friendships, school success, individual coping skills).
Multidimensional treatment within foster care ensures that multiple protective factors are in place, such as a reinforcing environment, structured day, adequate supervision, and positive peers.
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