Oppositionality

In practice, oppositional young people are treated with a variety of psychological and behavioral interventions targeting the child and the family. The broad aim of treatment is to increase compliance and reduce conflict. Working with one or both parents (or a parental figure) is desirable. The therapist usually tries to help parents understand the way they perceive and respond to the child; teach them more effective, nonviolent discipline strategies; find ways to reduce the frequency and intensity of arguments; and encourage parents to increase cooperative and leisure activities. The most promising way of achieving most of these goals appears to be parent management training (Kazdin 1998).

Parent management training refers to a set of procedures in which parents are taught to alter their child's behavior. It is based on the view that defiance and noncompliance are inadvertently developed or maintained by maladaptive patterns of parent-child interaction. These include harsh discipline, inconsistency, lack of satisfactory resolution of conflict, directly reinforcing deviant behavior, and not reinforcing appropriate behaviors. The treatment has been evaluated in controlled trials with prepubertal children and adolescents with oppositional problems of varying severity. Parent management training results in marked improvement in oppositional behavior, treatment gains are maintained up to three years, and there may also be improvements in areas not directly targeted by treatment, such as sibling adjustment and maternal depression (Scott et al. 2001; Kazdin 1998).

This therapy teaches parents to identify problem behaviors, to introduce prompts, instructions, and modeling to facilitate desirable behavior, and to use positive reinforcement. On average, programs run for six to eight weeks. Only one parent is required to attend in many of them. Traditionally, parent management training has been administered to individual families in a clinical setting. However, group delivery, often using videotaped material, and self-administration by manuals have made these treatments more accessible while remaining effective (Sanders and Markie-Dadds 1996).

An extensive range of medications has been tried for children with behavior problems, if not specifically for oppositionality. There are limited data about the response of oppositional defiant behaviors to psychotropic drugs. Therefore, medication should usually be reserved for cases with a concurrent (comorbid) disorder that is amenable to drug treatment (such as depression or attention deficit/hyperactivity disorder), and to children where oppositionality is the manifestation of another condition, such as depression (Rey and Walter 1999).