Academic journal article The International Journal of Behavioral Consultation and Therapy

Parent Training for Families of Children with Comorbid ADHD and ODD

Academic journal article The International Journal of Behavioral Consultation and Therapy

Parent Training for Families of Children with Comorbid ADHD and ODD

Article excerpt


Paper presents the details of a parent training program for families of children with comorbid ADHD/ODD. The goal of the training is to develop specific parenting skills that promote pro-social compliance and decrease disruptive child behavior. There are two parts to the parent training program. First, a theoretical framework of interactions between parents and their hyperactive children is presented. Second, a task analysis of the skills learned by parents is presented in the form of The Behavior Management Flow Chart. This flow chart synthesizes the research on child management into a visual unit that allows a clear portrayal of child behavior management steps.

Keywords: parent training, hyperactivity, defiance, Behavior Management Flow Chart


Children with Attention-deficit Hyperactivity Disorder (ADHD) demonstrate developmentally inappropriate degrees of overactivity, impulsiveness, and inattention (American Psychiatric Association, 1987). Approximately 55% of children with ADHD also have behavior characteristic of Oppositional Defiant Disorder (ODD; Barkley, 2006). This is important because children with co-occurring ADHD/ODD behavior have a distinctive pattern of dysfunction dissimilar to ADHD alone and ODD alone children. The etiology of familial transmission is different with an overall outcome that is generally worse than seen in children with just ADHD or ODD alone (Barkley; Hinshaw, 1994; Lynam, 1996). For such children, there is a trend toward combined psychostimulant/behavior therapy treatments. Nonetheless, the controversy surrounding the overuse of psychostimulant medication (LeFever, Arcona, & Antonuccio, 2003), as well as the potential for negative side effects to medication, the failure of research to demonstrate enduring change after the cessation of medication, and the fact that 20-30% of children with ADHD do not have a positive response to stimulant medication (Connor, 2006) demonstrates the need for improved parent training programs. The effects of a typical regimen of stimulant medication wear off by evening (Garland, 1998), so even parents whose children are on an effective dose of medication may benefit from parent training. However, it has not been demonstrated that parent training programs for families of children with ADHD and ODD are a sufficient to modify parent and child behavior (see Graziano & Diament, 1992, Pelham & Hinshaw, 1992, for reviews).

Previous Outcome Research

In response to limited improvements in such child noncompliance, Danforth (1998a) designed a child behavior management system called the Behavior Management Flow Chart (BMFC). The primary target behavior of the BMFC is noncompliance along with aggression and disruption. The effects of parent training, using parameters established in the Behavior Management Flow Chart, on parent behavior and on the disruptive behavior of children, were evaluated in four outcome studies (Danforth, 1998b; 1999; 2001; Danforth, Harvey, Ulaszek, & McKee, in press). Children's' ages ranged from 4-12 and each child met the DSM IV criteria for ODD and ADHD (American Psychiatric Association, 1987). Each child also met diagnostic research criteria for ADHD (Barkley, 1988) with average intelligence scores. T-scores on standardized rating scales assessing ADHD and oppositional defiant/aggressive behavior were typically more than two standard deviations above the mean. Almost every baseline direct observation session revealed clinically significant noncompliance, below 60% (Forehand, 1977). Thus, child problem behavior measured at pre-screening and baseline was strong. Outcome measures included standardized child behavior and parent self-report rating scales, home telephone interviews, direct observations of mother/child interaction, and home-based audio recordings. Parent training sessions were conducted with individual families or in a group format with ten families per group. …

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