Counseling Outcomes for Youth with Oppositional Behavior: A Meta-Analysis

Article excerpt

Oppositional defiant disorder (ODD) involves patterns of negativistic, defiant, disobedient, and hostile behavior toward authority figures that last for at least 6 months (American Psychiatric Association [APA], 2013). ODD is among the most prevalent and resource-demanding mental health problems for children and adolescents (Loeber, Burke, Lahey, Winters, & Zera, 2000), with 5% to 10% of children ages 8 to 16 years having notable ODD behavior problems (Fraser & Wray, 2008). Characteristics of ODD include persistent stubbornness and refusal to comply with instructions, unwillingness to compromise with adults or peers, persistently and deliberately testing limits, failing to accept responsibility for one's own actions and blaming others for one's own mistakes, deliberately annoying others, and frequently losing one's temper (APA, 2013). ODD has also been associated with excessive arguing, cognitive and social deficits, and significantly problematic adult-child and child-peer interactions (Greene et al., 2002). According to Finger et al. (2011), youth with ODD demonstrate high rates of aggressive and antisocial behaviors, with a subset displaying callousness and psychopathic traits, including a lack of guilt, empathy, and remorse.

It is sometimes difficult to determine whether a child truly meets the criteria for having an ODD diagnosis because many of the behavioral qualifications are commonly seen among youth in early childhood and adolescence (Fraser & Wray, 2008). If a child's behaviors consistently cause distress to the family system and have an effect on his or her social and educational functioning, further evaluation is warranted. ODD has been linked to many other comorbid disorders, such as anxiety; depression; and, most commonly, attention-deficit/ hyperactivity disorder (ADHD; Biederman, Newcorn, & Feldman, 2007). Jensen et al. (2001) found that ODD occurred in 30% to 60% of children diagnosed with ADHD.

ODD has historically been considered a male problem (Loeberet al., 2000), and the developmental factors that accounted for symptoms in girls were only partly understood (Hipwell et al., 2002; Messer, Goodman, Rowe, Meltzer, & Maughan, 2006). One study (Munkvold, Lundervold, & Manger, 2011) found that the impact of symptoms and the prevalence of ODD were higher in boys than in girls. Fraser and Wray (2008) found that girls were more likely to demonstrate symptoms after the onset of puberty, during the adolescent years, whereas boys more frequently showed symptoms in early childhood. The manifestation of ODD in boys also differed from the manifestation of ODD in girls in that boys were more likely to demonstrate physical aggression or threaten others (overt aggression), whereas girls were more likely to harm or disrupt relationships with others (Crick & Grotpeter, 1995), better known today as relational aggression. Individuals diagnosed with early-onset ODD were more likely to have been abused by their parents, drop out of school, engage in serious crimes, and have greater long-term involvement with the mental health system.

Because ODD is such a serious and common disorder and is comorbid with other disorders, it is important to determine whether counseling and psychotherapy reduce symptoms in individuals diagnosed with ODD. Primary counseling strategies discussed in the literature include family interventions and individual and group counseling approaches with children and adolescents. Family interventions, especially parent training programs, have been empirically supported as efficacious (Lonigan, Elbert, & Johnson, 1998). Brestan and Eyberg's (1998) research indicated that families completing a parent training program achieved both short- and long-term treatment goals. In addition to their known effect on child conduct problems, parenting group interventions promoted both child and family competencies (Borden, Schultz, Herman, & Brooks, 2010). Participants in a study of self-administered videotape parent training reported significantly fewer child behavior problems, reduced levels of stress, and less use of physical punishment (Webster-Stratton, 1990). …